Illinois:
Wisconsin offers personal care as an optional Medicaid state plan service, but Illinois does not. Illinois does offer some types of personal care services under waivers.
Minnesota:
Both Minnesota and Wisconsin offer personal care as an optional Medicaid state plan service. Wisconsin is in the middle of the 3 states in terms of the settings where the personal care services benefit may be provided. In Wisconsin, the services may be provided in the home or in community-based residential setting in facilities of 20 beds or less. Minnesota provides the service in the home, in community-based residential settings, in schools, and in the workplace.
Iowa:
Wisconsin offers personal care as an optional Medicaid state plan service, but Iowa does not. Iowa does offer some types of personal care services under waivers.
Michigan:
Both Michigan and Wisconsin offer personal care as an optional Medicaid state plan service. Michigan is one of only 2 states nationwide (the other is New Jersey) that covers assistive devices or equipment under the PCS benefit. Nationwide, 17 of the 25 states that offer personal care services (71%) allow some kind of consumer direction for the PCS benefit. Michigan allows it to some extent (as does Minnesota). Wisconsin very recently began offering a self-directed personal care option on a very limited basis to participants in the self-directed program known as IRIS (Include, Respect, I Self-Direct).
Wisconsin is in the middle of the 3 states in the region terms of the settings where the personal care services benefit may be provided. Michigan is more restrictive than Wisconsin, as the service may only be provided in the home. In Wisconsin, the services may be provided in the home or in community-based residential setting in facilities of 20 beds or less.
Minnesota is the most stringent of the 3 states in terms of who may authorize the use of personal care services. Minnesota requires a statement of medical need from a physician and an assessment as to need by a public health nurse. In Michigan, physicians, social workers, case managers, physician assistants, and nurse practitioners may all authorize personal care services. Wisconsin only allows personal care services when authorized by a physician.
Summary of factual data and analytical methodologies
The department relied on all of the following sources to determine the impact on small businesses, specifically personal care agencies to draft the rules:
1. The Department met with the Home Care Advisory Committee (HCAC) and reviewed the initial draft of the rule. This committee is composed of representatives of the Wisconsin Personal Services Association (WPSA), Wisconsin Homecare Organization (WHO), Professional Homecare Providers (PHP), subcontracted personal care agencies, ILCs, home health agencies.
2. The 2002 Economic Census – Wisconsin Geographic Series, compiled by the U.S. census bureau every 5 years for each year ending in “2" and “7" and contains the latest available economic data (2007 data is not yet published-October 2009) compiled on businesses located in Wisconsin.
3. Criteria adopted by the Department and approved by the Wisconsin Small Business Regulatory Review Board to determine whether the Department's rules have a significant economic impact on a substantial number of small businesses. Pursuant to the Department's criteria, a rule will have a significant economic impact on a substantial number of small businesses if at least 10% of the businesses affected by the rules are small businesses and if operating expenditures, including annualized capital expenditures, increase by more than the prior year's consumer price index or reduces revenues by more than the prior year's consumer price index. For the purposes of this rulemaking, 2008 is the index year. The consumer price index is compiled by the U.S. Department of Labor, Bureau of Labor Statistics; the preliminary rate for the Midwest in 2008 is currently estimated at 3.9 percent.
4. Section
227.114 (1) (a), Wisconsin Stats. defines “small business" as a business entity, including its affiliates, which is independently owned and operated and not dominant in its field, and which employees 25 or fewer full-time employees or which has gross annual sales of less than $5,000,000.
Analysis and supporting documents used to determine effect on small business
The North American Industry Classification System (NAICS) includes personal care agencies in the Health Care and Social Assistance sector, (sector 62) and further defined in sub-sector 6216 home health agencies (home based services). This industry sector comprises establishments primarily engaged in providing skilled nursing services in the home, along with a range of the following: personal care services; homemaker and companion services; physical therapy; medical social services; medications; medical equipment and supplies; counseling; 24-hour home care; occupation and vocational therapy; dietary and nutritional services; speech therapy; audiology; and high-tech care, such as intravenous therapy. Employment statistics and revenue data are not readily available for the personal care agency share of these major health care providers. The DQA has no data on personal care agencies, as these are not currently regulated by the agency. Based on the limited data available, it is estimated that 70 personal care agencies will initially seek certification from the department. The number of small business entities is unknown. Certification is required for these agencies to qualify for reimbursement from the Medicaid program. Currently, personal care agencies are reimbursed for services through counties or other third-party Medicaid providers.
This emergency order makes it possible for personal care agencies to bill the Wisconsin Medicaid program directly by complying with certification requirements in the Medicaid regulations. The overall outcome for the small businesses affected by the rules should be positive.
2009 Act 28, the 2009-11 biennial budget bill, expands the types of entities that can be certified by the department as Medicaid personal care providers. In particular, personal care agencies other than counties, Tribes, home health agencies, and Independent Living Centers can be certified directly as Medicaid providers. This emergency rule amends the existing Medicaid personal care certification rule, DHS 105, to implement the biennial budget provisions.
Counties, Tribes, home health agencies, and Independent Living Centers that are already Medicaid certified personal care providers under the prior statutory provisions, can remain personal care providers, without initiating or going through an application process.
In addition to specifying the certification procedures for independently certified personal care agencies, the emergency rule also updates requirements and includes new requirements for personal care providers to strengthen the protection of clients' health, safety, and rights. These changes apply both to existing certified personal care providers and to personal care agencies that seek certification under the Act 28 provisions. Based on consultations with personal care providers, these new requirements are best practices that have generally already been adopted by providers. For this reason they are not expected to impose new workload on providers.
The fiscal impact on small business as defined in s.
227.114 (1), Stats., should be minimal. The items listed below have been identified as potentially increasing revenues or costs to personal care providers.
Independent personal care agency certification
The provisions of the emergency rule will allow personal care agencies that provide services under contract with a county, Tribe, home health agency, or independent living center to become independently certified and bill the Medicaid program directly for personal care services. In addition, other agencies that do not currently serve Medical Assistance recipients will be able to be certified as Medical Assistance providers, begin serving Medical Assistance recipients, and be reimbursed for their services. The rule provisions would increase revenues for agencies that seek to be certified.
Application and annual fee
Personal care agencies that seek Medicaid certification under the provisions of Act 28 will be required to pay an initial application fee and an annual fee. Fees will be established by the Department's Division of Quality Assurance and may be periodically revised. The amount of the annual fee will be based on a number of factors including revenues from operations. The Division of Quality Assurance anticipates that initially the application fee will be $300. It is anticipated the annual fee will range from a minimum of $500, not to exceed $2,500 and will be based on the annual revenue of the freestanding personal care agency.
If an agency is required by the Department to separately certify a branch office, the agency will be required to pay an initial application fee and an annual fee for the separately certified entity. The amount of the annual fee for branch office certification will be based on a number of factors including revenues from operations. The Division of Quality Assurance anticipates that initially the application fee and the annual fee will be the same as for the parent agency and will be based on the annual revenue of the freestanding personal care agency.
Provision of Information
Counties, ILCs and federally recognized American Indian tribes or bands will be required to provide, in a format approved by the Department, identifying information about the personal care provider and those agencies and individuals that provide Medicaid personal care services through a contract with the personal care provider. This information will enable the Department to develop and maintain a data base of certified personal care providers to organize, store and retrieve information about personal care services provided in Wisconsin for various reporting and planning activities. The proposed rule does not include home health agencies because the Department already collects this information from home health agencies through the license application process and the annual report. It is estimated that the average time to complete this information will be 30 minutes at an estimated cost of $14.
Minimize Risk of Infection
The first substantive revision requires agencies to provide staff training and proper supplies to minimize the risk of infection and to monitor for compliance. This requirement is expected to result in minimal costs to providers because many personal care providers in Wisconsin already provide staff training and monitoring to meet current standards of practice and Centers for Disease Control (CDC) guidelines. Any provider that does not meet this standard is able to access information from CDC's web site to train their staff and start their monitoring program. Additional costs for sundry supplies (e.g., gloves, masks, etc.) are expected to be minimal.
Communicable disease screening
Personal care providers will be required to ensure that employees are screened for the presence of clinically apparent communicable diseases, including tuberculosis, within 90 days before the employee has direct client contact. This standard is similar to employee health screening requirements for nursing homes, home health agencies, hospices, hospitals, facilities for the developmentally disabled and restaurants. The Journal of American Medical Association (April 19, 2000) identifies health care workers as a group at risk for acquiring tuberculosis. Pulmonary tuberculosis is a contagious disease that is usually spread through the coughing and sneezing of an infected person. Transmission of the infection usually occurs only after prolonged exposure. It is important for persons in high risk groups to be tested to ensure they are free from infectious disease to prevent exposure and spread of the disease to clients and to identify the need for treatment.
The average time to complete the pre-employment screening is estimated to be 30 minutes, at an estimated cost of $14 per employee. Although not required by rule, this may encourage providers to complete a tuberculosis skin test, at an average cost of $50 each.
Training and Orientation
The rules will require an estimated additional 4 hours of training and orientation for personal care workers (PCWs) and registered nurses. It is estimated that the average hourly rate is $28.00 salary and fringe. Estimated per staff costs are $116 per affected employee.
Discharge summary
The proposed rules require the completion of a discharge summary for all clients. It is estimated that a registered nurse will need 10 minutes to complete this requirement. The per-client cost is estimated at $7 ($40 per hour salary and fringe x 10 minutes).
Small Business Impact
The proposed rule will affect at least 10% of the small businesses affected by the rule, but the rules will not have a significant negative economic impact on those businesses.
Small business regulatory coordinator
Rosie Greer
Phone: 608-266-1279
Fiscal Estimate
A copy of the full fiscal estimate may be obtained from the department's contact person listed below upon request.
Agency Contact Person
Pat Benesh, Quality Assurance Program Spec-Senior
Division of Quality Assurance
1 West Wilson St., Room 534
Madison, WI 53701
Phone: 608-264-9896
Fax: 608-267-0352
Notice of Hearings
Natural Resources
Fish, Game, etc., Chs.
NR 1—
NOTICE IS HEREBY GIVEN That pursuant to ss.
23.091,
23.09 (2) (intro),
23.11 (1),
23.28 (3),
23.293,
27.01 (2) (j),
27.01 (10) (b) and
(f),
227.11 (2) (a) and
23.33 (4) (b), Stats., the Department of Natural Resources, hereinafter the Department, will hold a public hearing on a rule revising Chapter
NR 45, relating to the use of department properties.
Chapter
NR 45, Wis. Adm. Code, which is the principle rule governing the conduct of visitors to the properties and facilities owned, acquired by easement, or leased by the department. The rule revision contains a number of fee changes relative to camping, and an increase in commercial use permit fees to address the continued costs of providing quality services. The proposed rule will also clarify the term “edible fruits" for collection, removing invasive plants without a permit, collection of dead and down wood below the ordinary high water mark, evictions from state properties, allowing designated roads in northern state forest properties as ATV route when authorized by the property master plan, allowing uncased bows and firearms when crossing the Glacial Drumlin state trail adjacent to the Lake Mills wildlife area when engaged in legal hunting. The rule also addresses launching of motor boats on portions of a water body when there are restrictions on the property's master plan, fee waivers for state park admission for holders of National park service pass program, requirement of vehicle admission fee at Parfey's Glen state natural area and creates a ban on glass containers at Straight Lake state park and prohibits the launching of motorboat and gasoline powered ice augers on Straight and Rainbow lakes and establishes the creation of a slow-no-wake area in the “narrows" of the Dells of the Wisconsin river. This also includes housekeeping changes regarding the Department's property management rules.
Hearing Information
Date and Time
|
Location
|
May 17, 2010 - Monday
at 5:00 p.m., with the record held open until at least 6:00 p.m.
|
DNR Executive Offices
101 S. Webster Street
Room G09
Madison, WI 53707
|
May 18, 2010 - Tuesday
at 5:00 p.m., with the record held open until at least 6:00 p.m.
|
Woodruff Town Hall
1418 1st Avenue
Woodruff, WI 54568
|
Reasonable accommodations, including the provision of informational material in an alternative format, will be provided for qualified individuals with disabilities upon request. Contact Andy Janicki in writing at the Department of Natural Resources, P. O. Box 7921, 101 S. Webster St., LF/6, Madison, WI 53707; by E-mail to Andrew.Janicki@ wisconsin.gov or by calling (608) 267-7490. A request must include specific information and be received at least 10 days before the date of the scheduled hearing.
Copies of proposed rules and
fiscal estimate
The proposed rule and supporting documents, including the fiscal estimate, may be viewed and downloaded from the
Administrative Rules System Web site at http://adminruleswisconsin.gov. If you do not have Internet access, a printed copy of the proposed rule and supporting documents, including the fiscal estimate, may be obtained free of charge by contacting: Kathryn Fitzgerald, Department of Natural Resources, LF/6, PO Box 7921, 101 S. Webster Street, Madison, WI 53707 or by calling (608) 267-2764.
Submittal of Written Comments
Comments on the proposed rule must be received on or before May 21, 2010. Written comments may be submitted by U.S. mail, fax, E-mail, or through the Internet and will have the same weight and effect as oral statements presented at the public hearing. Written comments and any questions on the proposed rules should be submitted to: Kathryn Fitzgerald, Department of Natural Resources, LF/6, 101 S. Webster Street, Madison, WI 53707 or by calling (608) 267-2764.
Analysis Prepared by Department of Natural Resources
Statutes interpreted
Sections
23.091,
23.09 (2) (intro),
23.11 (4),
23.17,
23.175,
23.28 (3),
23.293,
23.33 (4) (b),
27.01 (2) (i) and
(j),
27.01 (10) (f) and
28.04 (2), Stats.
Statutory authority
Explanation of agency authority
In addition to the general authority granted by s.
227.11 (2) (a), Stats., to implement and interpret its statutory authority, the Department of Natural Resources has specific grants of rule making authority in chs.
23 and
27, Stats., to manage its properties.
Related statute or rule
All Wisconsin DNR property management regulations are found in this chapter.
Plain language analysis
Chapter
NR 45 is the principal rule governing the conduct of visitors to the properties and facilities owned, acquired by easement, or leased by the Department of Natural Resources (DNR). This chapter is reviewed and revisions proposed by staff on a regular basis. This rule revision contains a number of fee and policy changes relative to camping and other uses of DNR land. The increased fees address the continued costs of providing quality services.
An amended rule clarifies that collection of edible plants without a permit is for personal consumption, clarify the term “edible fruits," and remove the prohibition on collecting edible fruit on state natural areas.
The definitions include the Coulee Experimental state forest as a “northern state forests" so that the code provisions governing the northern state forests cover this property. An amended rule prohibits fires on the Coulee Experimental state forest.
A created rule makes it permissible to remove invasive plants without a permit.
A created rule prohibits the collection of dead and down wood located below the ordinary high water mark of the northern flowage properties for ecological and aesthetic purposes.
An amended rule governs evictions from DNR lands to prevent an evicted individual from entering a different state park, forest, or recreation area for a specified period after being evicted in order to alleviate law enforcement problems.
An amended rule clarifies that contractual agreements permit concessions or special events rather than commercial use permits.
An amended rule allows DNR to designate roads within northern state forest properties as ATV routes when the property master plan authorizes this use.
An amended rule clarifies that the exception to the requirement that firearms must be unloaded and enclosed in a case only applies on the portions of a property that are open to hunting.
A created rule allows uncased bows and firearms when crossing the Glacial Drumlin State Trail adjacent to lands that are part of the Lake Mills Wildlife Area.
An amended rule permits camping on state-owned sandbars on the Lower Chippewa River and limits the number of campers at the Turtle Flambeau Scenic Waters Area group campsites.
A created rule prohibits the launching or removal of motorboats on those portions of waterbodies located within DNR properties when the property's master plan restricts the use of motorboats.
