Staff time required
The department estimates that it will take approximately 80 hours to develop the proposed rules. The Department will use the assistance of the Emergency Medical Services Advisory Board to develop the continuing education requirements in ch.
HFS 110.
Entities affected by the rule
The citizens of Wisconsin, counties, emergency medical technicians, and ambulance service providers
Comparison with federal regulations
There are no federal regulations that are governing or applicable to these rules.
Health and Family Services
Subject
The Department of Health and Family Services proposes to modify ch.
HFS 129, relating to the certification of programs and requirements for training and testing of nurse aides, home health aides, and hospice aides.
Policy analysis
Chapter
HFS 129 establishes conditions of certification of instructional programs, including standards for instructors, curriculum and criteria for the competency evaluation programs for persons who work as nurse aides in hospitals, nursing homes, facilities for the developmentally disabled, home health agencies or hospices. HFS 129 also establishes standards for the development of a registry of persons who have satisfactorily completed the training program, competency program or who otherwise are eligible for listing in the registry.
This Statement of Scope replaces the Statement of Scope published in May 2003 to include notice of additional changes that the department proposes to make due to recent modifications to the program including the requirements for the training and testing of feeding assistants as set forth under
42 CFR 483.35 and
483.160, medication aides as set for the under
42 CFR 60, and the process to waive the two-year prohibition of a nurse aide training program under Public Law 105-15 (H.R. 968).
The Department proposes to revise ch.
HFS 129 for several reasons:
1. To include requirements for the training and testing of feeding assistants and medication aides.
Feeding assistants differ from nurse aides in that a feeding assistant may only assist residents who have no feeding complications with the activities of eating and drinking. A medication aide is a nurse aide who is also approved to administer medications under the supervision of a licensed nurse.
2. To reflect the Department's decision to standardize the administration and operation of nurse aide competency evaluation statewide by contracting for this service.
Federal regulations set forth under CFR 483.152 and 483.154 authorize states to choose to offer a nurse aide training and competency evaluation program, or to review, and approve or disapprove program applications upon request. The Department has been reviewing, and approving or disapproving nurse aide training and competency evaluation programs based on standards in ch.
HFS 129.08. Anyone who meets those standards may conduct a testing program.
However, the Department believes that specifying standards for competency evaluation programs cannot assure the maintenance of neutral and objective facility-sponsored instructional and competency evaluation tests that are free from possible conflicts of interest posed by the need to meet facility staffing requirements. Therefore, the Department proposes to modify ch.
HFS 129 to reflect the Department's contracting out the implementation of such competency testing.
3. To improve the accuracy and integrity of the nurse aide registry.
Under
42 CFR 483.152 (2), s.
146.40 (4g), Wis Stats., and ch.
HFS 129.10 of the Wisconsin Administrative Code, the Department is required to maintain a list, known as a “registry," of all persons deemed qualified to work in Wisconsin as a nurse aide. Aside from committing an offense that would bar a person from remaining on the list, the Department intends to add state provisions for removing a person's name from the list. The Department believes that the list of qualified nurse aides, currently numbering over 183,000, contains many persons who no longer are available to or interested in working as a nurse aide. Therefore, the Department intends to modify ch.
HFS 129 to require nurse aides to periodically update their registration information and, in the process, allow the Department to maintain a more accurate list of nurse aides. Periodic updating will also provide the Department the opportunity to verify the information provided by nurse aides.
4. To clarify who may be included on the registry and who is eligible to work as a nurse aide and, specifically, as a medication aide. The Department will also clarify the circumstances under which a person not currently included on the registry may work in a health care facility, such as an RN, LPN, etc.
5. To make ch.
HFS 129 more consistent with current federal regulations governing nurse aides.
The Department proposes to update aspects of ch.
HFS 129 to reflect federal requirements established since ch.
HFS 129 was originally promulgated April 1992. Specifically, the Department will propose to incorporate federal requirements relating to:
Withdrawal of Department approval of a nurse aide training and competency evaluation program or a nurse aide competency evaluation program if the entity providing the program refuses to permit unannounced visits by the Department.
Nurse aide training needing to be performed by or under the general supervision of a RN who possesses a minimum of 2 years of nursing experience, at least 1 year of which must be in the provision of long term care facility services.
The inability of a facility to charge fees for training and competency testing to a person who is employed by or has received an offer of employment from a health care facility. In addition, in the case of a person becoming employed by federally certified nursing home within 12 months after completing a training and testing program, the requirement for the Department to reimburse the person for the costs of such training and testing.
Requiring that the skills demonstration part of the evaluation be performed in a facility or laboratory setting comparable to the setting in which the person will function as a nurse aide and be administered and evaluated by a RN with at least 1 year's experience in providing care for the elderly or the chronically ill of any age.
Requiring a competency testing program to use a system that prevents disclosure of both the pool of questions and the individual competency evaluations.
Requiring that the skills demonstrated must consist of a demonstration of randomly selected items drawn from a pool consisting of the tasks generally performed by nurse aides.
Establishing what happens if a person does not complete the evaluation satisfactorily, and impose a maximum number of three times that person may attempt to complete the evaluation successfully.
6. To expand the mechanisms available to the Department for enforcing compliance of training and testing programs.
Existing enforcement options in ch.
HFS 129.05 (2) (c) are limited to suspension or revocation of certification or imposing a plan of correction. Although these are valuable enforcement tools, they do not give the Department the flexibility it needs to tailor its response to the severity of non-compliance with this chapter. The Department will propose to revise ch.
HFS 129 to include additional enforcement options such as requiring a training or competency program whose approval has been revoked to remain ineligible to submit a new nurse aide training or testing program application for a period of up to one year, issuing a statement of deficiency and placing conditions on certification. The Department also will propose additional enforcement penalties for instructors and examiners who fail to follow program requirements.
7. To include the feeding assistant training and testing program requirements.
The Department proposes updating ch.
HFS 129 to include reference to federal regulations set forth under CFR 483.35 and 483.160 which authorize states to choose to offer a paid feeding assistant training and competency evaluation program, or to review, and approve or disapprove program applications upon request. This training and testing is conducted in nursing homes or intermediate care facility for persons with mental retardation (ICFs/MR), to assist residents who have no feeding complications with the activities of eating and drinking. The feeding assistant is not permitted to provide any other nursing or nursing related service.
8. To include the medication aide training and testing program requirements.
Federal regulations set forth under
42 CFR 483.60 permit the use of unlicensed personnel, if State law permits, to administer drugs under the general supervision of a licensed nurse. This training and testing is conducted in nursing homes, technical colleges and private enterprises. The Department proposes to update ch.
HFS 129 to include these medication aide requirements.
9. To include the process for requesting, reviewing and approving or disapproving waivers to Federal sanctions to training programs.
]The Department proposes to include reference to Public Law 105-15 (H.R. 968), revised specific provisions of the Social Security Act, which permits a State to waive the two-year prohibition of Nurse Aide Training offered in (not by) certain nursing homes if the State:
Determines there is no other such program offered within a reasonable distance of the facility,
Assures, through an oversight effort, that an adequate environment exists for operating the program in the facility, and
Provides notice of such determination and assurances to the State long term care ombudsman.
Statutory authority
Staff time required
The Department estimates that it will take approximately 50 hours to draft the rulemaking order. The Department will also seek the participation of the Bureau on Aging and Long Term Care, the Department of Workforce Development, the Department of Public Education, the Wisconsin Association of Homes and Services for the Aging, the Wisconsin Health and Hospital Association, the Wisconsin Health Care Association, the Wisconsin Technical College System, the Wisconsin Long Term Care Workforce Alliance and private industry.
Entities affected by the rule
Facilities for the Developmentally Disabled, Home Health Agencies, High Schools, Hospice Agencies, Hospitals, Nursing Homes, Private Programs, Technical Colleges, State Agencies, and Universities.
Comparison with federal regulations
Federal conditions of participation for the Registry of nurse aides, nurse aide training and testing programs, and training of paid feeding assistants are in the Code of Federal Regulations,
42 CFR 483. These regulations establish conditions and standards for maintenance and operation of a nurse aide registry, and for conducting training and testing programs for nurse aides and paid feeding assistants. State and federal regulations for registry services and the training and testing of nurse aide and paid feeding assistants are comparable; however, the state requirements augment more general federal regulations by providing specificity in certain areas
. The intent of these regulations is to foster safe and adequate care and treatment of clients by these caregivers.
Insurance
Subject
Objective of the rule. By motion on March 1, 2006 the Joint Committee for Review of Administrative Rules (JCRAR) voted to suspend specific subsections of ch.
Ins 9, Wis. Adm. Code. At the hearing, JCRAR asked the Office to modify those same provisions by rule. The Office will consider modifying ch.
Ins 9, Wis. Adm. Code, with respect to the matters governed by the suspended provisions. Modifications under consideration include: deleting the term “limited scope plan" and replacing it with the appropriate plan or plans including defined network, preferred provider and limited service health organization; modify the emergency medical care provisions, modify language for insurers related to use of utilization management, and modify language related to providers hours of operation.
Policy analysis
A description of existing policies relevant to the rule and of new policies proposed to be included in the rule and an analysis of policy alternatives: Revisions to ch.
Ins 9, Wis. Adm. Code, became effective March 1, 2006. New policies proposed for consideration in this notice of scope include elimination of application of the revised rule to limited scope plans, consider whether the revised rule provides the appropriate standard for coverage of emergency care treatment, and adjusting the language of the revised rule as it relates to utilization management and provider hours of operation. In accordance with the Office's agreement to address the JCRAR's motions, the Office intends to modify specific portions of the revised ch.
Ins 9, Wis. Adm. Code.
There is no viable alternative to establishing by rule the requirements for these health insurance products. The statutory framework contained within ch.
609 and s.
632.85, Wis. Stats., raise the issues that the proposed rule will address.
Statutory authority
Staff time required
200 hours.
Entities affected by the rule
The proposed rule will affect insurers which offer defined network plans, health maintenance organizations, limited scope plans, preferred provider plans and limited service health organization plans. Insurers will be required to revise their relationships, including provider and insurance contracts, with health care providers, health care provider networks, employers and individuals.
Comparison with federal regulations
The Office is unaware of any proposed or existing federal regulation that is intended to address the activities to be regulated by this proposed rule.
Insurance
Subject
Objective of the rule. By motion on March 1, 2006 the Joint Committee for Review of Administrative Rules (JCRAR) voted to suspend s.
Ins 9.32 (2) (c) and
(e) 1., Wis. Adm. Code, and the phrase “(c) and “ in s.
Ins 9.33, Wis. Adm. Code. At the hearing, JCRAR requested the Office to modify these provisions by rule. The Office, after consulting with interested parties, including consumer representatives, insurers, and representatives of Wisconsin health care providers, will consider appropriate modifications to ch.
Ins 9, Wis. Adm. Code, to address the topic of the JCRAR suspended provisions.
Policy analysis
Chapter
Ins 9, Wis. Adm. Code, became effective March 1, 2006. Chapter
Ins 9 includes the provisions cited above which address the circumstances where an operation or procedure is performed by an in-panel provider but some ancillary services, such as anesthesiology, radiology or lab tests, are performed by non-participating providers. OCI will, after consulting with interested parties, consider whether there are alternative standards, or alternative implementation, that may more appropriately address this matter than the standards included in the suspended provisions of revised ch.
Ins 9, Wis. Adm. Code.
There is no viable alternative to establishing by rule the requirements for these health insurance products. The statutory framework contained within ch.
609 and s.
632.85, Wis. Stats., raise the issues that the proposed rule will address.
Statutory authority
Staff time required
200 hours.
Entities affected by the rule
The proposed rule will affect insurers which offer defined network plans, health maintenance organizations, preferred provider plans and limited service health organization plans. Insurers will be required to revise their relationships, including provider and insurance contracts, with health care providers, health care provider networks, employers and individuals.
Comparison with federal regulations
The Office is unaware of any proposed or existing federal regulation that is intended to address the activities to be regulated by this proposed rule.
Natural Resources
Subject
Objective of the rule. Modifications to portions of ch.
NR 22, pertaining to Wisconsin-Iowa boundary waters. The proposed changes would implement harvest restrictions for commercially-caught shovelnose sturgeon in Wisconsin-Iowa waters of the Mississippi River.
Policy analysis
The Department is beginning the process of recommending changes to Wisconsin administrative code relating to commercial fishing for shovelnose sturgeon. The Department anticipates requesting hearings on these changes in June, 2006, and holding hearings, if approved, in August 2006.
Statutory authority
Staff time required
The Department anticipates spending approximately 160 hours in the rule development process.
Entities affected by the rule
Fewer than five commercial fishermen licensed by Wisconsin will be affected by the proposed rule changes.
Comparison with federal regulations
