Rule-Making Notices (Hearing Notices)

Section 10. Effective Date. The rules adopted in this order shall take effect on the first day of the month following publication in the Wisconsin Administrative Register, pursuant to s. 227.22 (2) (intro.), Stats.

STATE OF WISCONSIN DEPARTMENT OF ADMINISTRATION DOA-2049 (R03/2012)	Division of Executive Budget and Finance 101 East Wilson Street, 10th Floor P.O. Box 7864 Madison, WI 53707-7864 FAX: [phone]
ADMINISTRATIVE RULES Fiscal Estimate & Economic Impact Analysis

1. Type of Estimate and Analysis
X Original   ⍽ Updated   ⍽ Corrected
2. Administrative Rule Chapter, Title and Number
Chir 2, 3
3. Subject
Practical exams for chiropractors
4. Fund Sources Affected			5. Chapter 20, Stats. Appropriations Affected
⍽ GPR   ⍽ FED   X PRO   ⍽ PRS   ⍽ SEG   ⍽ SEG-S			20.165(1)(g)
6. Fiscal Effect of Implementing the Rule
⍽ No Fiscal Effect ⍽ Indeterminate	⍽ Increase Existing Revenues ⍽ Decrease Existing Revenues		X Increase Costs X Could Absorb Within Agency's Budget ⍽ Decrease Cost
7. The Rule Will Impact the Following (Check All That Apply)
⍽ State's Economy ⍽ Local Government Units		⍽ Specific Businesses/Sectors ⍽ Public Utility Rate Payers ⍽ Small Businesses (if checked, complete Attachment A)
8. Would Implementation and Compliance Costs Be Greater Than $20 million? ⍽ Yes   X No
9. Policy Problem Addressed by the Rule
2013 Wisconsin Act 20 repealed the practical exam requirement for persons seeking licensure as a chiropractor in Wisconsin. The proposed rule seeks to amend current administrative code to reflect that change. Prior to the passage of Act 20, applicants for licensure to practice as a chiropractor in Wisconsin were required to successfully complete a practical exam testing clinical skills offered by the Chiropractic Examining Board. Now applicants must successfully complete parts I, II, III, IV of the examination administered by the National Board of Chiropractic Examiners (NBCE). Act 20 set the passing score of 438 for Part III and at least 475 on Part IV. The proposed rule will amend pertinent provisions of Chir 2 and 3 to reflect the changes made by Act 20.
10. Summary of the businesses, business sectors, associations representing business, local governmental units, and individuals that may be affected by the proposed rule that were contacted for comments.
The rule was posted on the Department of Safety and Professional Service's website for 14 days in order to solicit comments from businesses, associations representing businesses, local governmental units and individuals that may be affected by the rule. No comments were received.
11. Identify the local governmental units that participated in the development of this EIA.
No local governmental units participated in the development of this EIA.
12. Summary of Rule's Economic and Fiscal Impact on Specific Businesses, Business Sectors, Public Utility Rate Payers, Local Governmental Units and the State's Economy as a Whole (Include Implementation and Compliance Costs Expected to be Incurred)
This proposed rule will have minimal or no impact on specific businesses, business sectors, public utility rate payers, local governmental units or the state's economy as a whole.
13. Benefits of Implementing the Rule and Alternative(s) to Implementing the Rule
By replacing the practical exam with the nationally administered NBCE Exam, the Chiropractic Examining Board will be able to objectively identify individuals who have the knowledge and skills to be safe and effective practitioners. There is no alternative to implementing the rule due to the change in standard was brought about by the passage of 2013 Wisconsin Act 20.
14. Long Range Implications of Implementing the Rule
Consistent administration of the NBCE exam will result in identifying highly skilled and qualified persons becoming licensed chiropractors in Wisconsin.
15. Compare With Approaches Being Used by Federal Government
None.
16. Compare With Approaches Being Used by Neighboring States (Illinois, Iowa, Michigan and Minnesota)
Illinois: Illinois requires applicants to pass Parts I, II, and III of the National Board of Chiropractic Examination test with a score of at least 375 on all 3 parts of the exam. 68 ILL. Admin. Code 1285.60 b). Iowa: Licensure in Iowa requires passing Parts I, II, III and IV of the National Board of Chiropractic Examination exam. 645 IAC 41.2. Michigan: Michigan requires applicants to pass Parts I, II, III, and IV of the National Board of Chiropractic Examination test and adopts the test's recommended passing score. Mich. Admin. Code R. 338.12003 and 338.12005. Minnesota: The prerequisites for licensure in Minnesota include passing the National Board of Chiropractic Examiner's test: Parts I and II, the Written Clinical Competency Examination, and the Physiotherapy Examination. Applicants must also pass the NBCE Part IV and an exam on jurisprudence/ethics. Minn. R. 2500.0720.
17. Contact Name				18. Contact Phone Number
Shawn Leatherwood				608-261-4438

This document can be made available in alternate formats to individuals with disabilities upon request.

Safety and Professional Services —
Chiropractic Examining Board

rulemaking_notices CR 14-069 CR 14-069

NOTICE IS HEREBY GIVEN that pursuant to authority vested in the Chiropractic Examining Board in ss. 15.08 (5) (b), 227.11 (2) (a), and 446.02 (11), Wis. Stats., and interpreting s. 446.08, Wis. Stats., the Chiropractic Examining Board will hold a public hearing at the time and place indicated below to consider an order to create Chapter Chir 13, relating to the duty to inform patients of treatment options.

Hearing Information

Date:   Thursday, January 15, 2015
Time:   8:35 a.m.
Location:   1400 East Washington Avenue
  Room 121A
  (Enter at 55 North Dickinson St.)
  Madison, Wisconsin

Appearances at the Hearing

Interested persons are invited to present information at the hearing. Persons appearing may make an oral presentation but are urged to submit facts, opinions, and argument in writing as well. Facts, opinions, and argument may also be submitted in writing without a personal appearance by mail addressed to the Department of Safety and Professional Services, Division of Policy Development, P.O. Box 8366, Madison, Wisconsin 53708. Written comments must be received at or before the public hearing to be included in the record of rule-making proceedings.

Place Where Comments are to be Submitted and Deadline for Submission

Comments may be submitted to Shawn Leatherwood, Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Policy Development, 1400 East Washington Avenue, Room 151, P.O. Box 8366, Madison, WI 53708-8935, or by email to [e-mail]. Comments must be received at or before the public hearing to be held on January 15, 2015, to be included in the record of rule-making proceedings.

Copies of Rule

Copies of this proposed rule are available upon request to Shawn Leatherwood, Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Policy Development, 1400 East Washington Avenue, P.O. Box 8366, Madison, Wisconsin 53708, by email at [e-mail] or on our website at http://dsps.wi.gov/Default.aspx?Page=44e541e8-abdd- 49da-8fde-046713617e9e.

Analysis Prepared by the Department of Safety and Professional Services

Statutes interpreted

Section 446.08, Stats.

Statutory authority

Sections 15.08 (5) (b), 227.11 (2) (a), and 446.02 (11), Stats., and 2013 Wisconsin Act 345

Explanation of agency authority

Pursuant to ss. 15.08 (5) (b) and 227.11 (2) (a), Stats., the Chiropractic Examining Board is generally empowered by the legislature to promulgate rules that will provide guidance within the profession and that interpret the statutes it enforces or administers. Section 446.02 (11), Stats., gives express authority to the Chiropractic Examining Board to promulgate rules implementing s. 446.08, Stats., concerning informed consent. The legislature granted this express rule-making provision with the passage of 2013 Wisconsin Act 345. The proposed rule seeks to carry out this legislative mandate by incorporating the new standard regarding informed consent into the current chiropractic rules.

Related statute or rule

None.

Plain language analysis

On April 23, 2014, the Legislature enacted 2013 Wisconsin Act 345, which granted express rule-making authority to the Chiropractic Examining Board to promulgate rules concerning chiropractors and informed consent. This proposed rule codifies what was previously a common law duty under Hannemann v. Boyson, 2005 WI 94. Under the common law standard, chiropractors where to advise their patients of all alternate viable medical modes of treatment. Chiropractors were held to the reasonable person standard which required chiropractors to inform their patients of information necessary for a reasonable person to make an intelligent decision with regard to treatment. 2013 Wisconsin Act 345 changed the standard for chiropractors from the reasonable person standard to the reasonable chiropractor standard which requires disclosure only of the information that a reasonable chiropractor would know and disclose under the circumstances. The proposed rule creates a new chapter codifying the new standards into the current Chiropractic rules.

Summary of, and comparison with, existing or proposed federal regulation

None.

Comparison with rules in adjacent states

Illinois: Illinois does not have comparable statutory requirement for chiropractors to obtain informed consent from their patients.

Iowa: Iowa does not have comparable statutory requirement for chiropractors to obtain informed consent from their patients.

Michigan: Michigan does not have comparable statutory requirement for chiropractors to obtain informed consent from their patients.

Minnesota: Minnesota does not have comparable statutory requirement for chiropractors to obtain informed consent from their patients.

Summary of factual data and analytical methodologies

No factual data or analytical methodologies were used in drafting the proposed rule due to the proposed rule being prompted by the passage of 2013 Wisconsin Act 345.

Analysis and supporting documents used to determine effect on small business or in preparation of economic impact analysis

These proposed rules do not have an economic impact on small businesses, as defined in s. 227.114 (1), Stats. The Department's Regulatory Review Coordinator may be contacted by email at [e-mail], or by calling [phone].

Fiscal Estimate and Economic Impact Analysis

The Fiscal Estimate and Economic Impact Analysis are below.

Agency Contact Person

Shawn Leatherwood, Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Policy Development, 1400 East Washington Avenue, Room 151, P.O. Box 8366, Madison, Wisconsin 53708; telephone [phone]; email at [e-mail].

Text of Rule

SECTION 1. Chapter Chir 13 is created to read:

CHAPTER CHIR 13

INFORMED CONSENT

Chir 13.01 Authority and purpose. (1) Authority. The rules in this chapter are adopted pursuant to the authority delegated by ss. 15.08 (5) (b), 227.11 (2) (a), and 446.08, Stats.

(2) Purpose. The purpose of the rules is to define the obligation of a chiropractor to communicate alternate modes of treatment to a patient.

Chir 13.02 Informed Consent. Any chiropractor who treats a patient shall inform the patient about the availability of reasonable alternate modes of treatment and about the benefits and risks of these treatments. The reasonable chiropractor standard is the standard for informing a patient. The reasonable chiropractor standard requires disclosure only of information that a reasonable chiropractor would know and disclose under the circumstances.

Chir 13.03 Exceptions to communication of alternate modes of treatment. (1) The chiropractor's duty to inform patients of alternate modes of treatment does not require disclosure of any of the following:

(a) Detailed technical information that in all probability a patient would not understand.

(b) Risks apparent or known to the patient.

(c) Extremely remote possibilities that might falsely or detrimentally alarm the patient.

(d) Information in emergencies where failure to provide treatment would be more harmful to the patient than treatment.

(e) Information in cases where the patient is incapable of consenting.

(f) Information about alternate modes of treatment for any condition the chiropractor has not included in their diagnosis at the time the chiropractor informs the patient.

Chir 13.04 Recordkeeping. A chiropractor's patient record shall include documentation that he or she has communicated alternate modes of treatment to their patient and has obtained informed consent from their patient in keeping with Chir 11.02 (5).

Section 2. EFFECTIVE DATE. The rules adopted in this order shall take effect on the first day of the month following publication in the Wisconsin Administrative Register, pursuant to s. 227.22 (2) (intro.), Stats.

STATE OF WISCONSIN DEPARTMENT OF ADMINISTRATION DOA-2049 (R03/2012)	Division of Executive Budget and Finance 101 East Wilson Street, 10th Floor P.O. Box 7864 Madison, WI 53707-7864 FAX: [phone]
ADMINISTRATIVE RULES Fiscal Estimate & Economic Impact Analysis

1. Type of Estimate and Analysis
X Original   ⍽ Updated   ⍽ Corrected
2. Administrative Rule Chapter, Title and Number
Chir 11
3. Subject
Duty to inform patients of treatment options
4. Fund Sources Affected			5. Chapter 20, Stats. Appropriations Affected
⍽ GPR   ⍽ FED   X PRO   ⍽ PRS   ⍽ SEG   ⍽ SEG-S			20.165(1)(g)
6. Fiscal Effect of Implementing the Rule
X No Fiscal Effect ⍽ Indeterminate	⍽ Increase Existing Revenues ⍽ Decrease Existing Revenues		⍽ Increase Costs ⍽ Could Absorb Within Agency's Budget ⍽ Decrease Cost
7. The Rule Will Impact the Following (Check All That Apply)
⍽ State's Economy ⍽ Local Government Units		⍽ Specific Businesses/Sectors ⍽ Public Utility Rate Payers ⍽ Small Businesses (if checked, complete Attachment A)
8. Would Implementation and Compliance Costs Be Greater Than $20 million? ⍽ Yes   X No
9. Policy Problem Addressed by the Rule
This proposed rule is a result of recent legislation. 2013 Wisconsin Act 345 instituted a new standard regarding how chiropractors are to obtain informed consent from their patients. Before Act 345, chiropractors were held to the reasonable person standard which required chiropractors to inform their patients of information necessary for a reasonable person to make an intelligent decision with regard to treatment. As a result of Act 345, chiropractors must obtain informed consent from their patients by advising them of reasonable alternate medical modes of treatment and the benefits and risks of those treatments in a manner consistent with the reasonable chiropractor standard. The reasonable chiropractor standard requires disclosure only of information that a reasonable chiropractor would know and disclose under the circumstances. The proposed rule will incorporate this new standard into the current chiropractic rules.
10. Summary of the businesses, business sectors, associations representing business, local governmental units, and individuals that may be affected by the proposed rule that were contacted for comments.
The proposed rule was posted on the Department and Professional Services website for 14 days in order to solicit comments from businesses, associations representing of Safety businesses, local governmental units and individuals that may be affected by the rule. No comments were received
11. Identify the local governmental units that participated in the development of this EIA.
No local governmental units participated in the development of this EIA.
12. Summary of Rule's Economic and Fiscal Impact on Specific Businesses, Business Sectors, Public Utility Rate Payers, Local Governmental Units and the State's Economy as a Whole (Include Implementation and Compliance Costs Expected to be Incurred)
This proposed rule will not have a significant impact on specific businesses, business sectors, public utility rate payers, local governmental units or the state's economy as a whole.
13. Benefits of Implementing the Rule and Alternative(s) to Implementing the Rule
Chiropractors will advise their patients in a manner that is consistent with current law. There is no alternative to implementing the proposed rule due to the changes being necessitated by passage of legislation.
14. Long Range Implications of Implementing the Rule
Chiropractors consistently advising patients of reasonable alternate medical modes of treatment options will result in chiropractors upholding their duty to inform patients in accordance with s. 446.08, Stats.
15. Compare With Approaches Being Used by Federal Government
None.
16. Compare With Approaches Being Used by Neighboring States (Illinois, Iowa, Michigan and Minnesota)
Illinois: Illinois does not have comparable statutory requirement for chiropractors to obtain informed consent from their patients. Iowa: Iowa does not have comparable statutory requirement for chiropractors to obtain informed consent from their patients Michigan: Michigan does not have comparable statutory requirement for chiropractors to obtain informed consent from their patients Minnesota: Minnesota does not have comparable statutory requirement for chiropractors to obtain informed consent from their patients
17. Contact Name				18. Contact Phone Number
Shawn Leatherwood				608-261-4438

This document can be made available in alternate formats to individuals with disabilities upon request.

Notice of Hearing

Transportation

rulemaking_notices EmR1426 EmR1426

NOTICE IS HEREBY GIVEN that, pursuant to ss. 227.17 and 227.24 (4), Stats., the State of Wisconsin Department of Transportation (“WisDOT") will hold a public hearing on Tuesday, January 13, 2015, on an emergency rule that will amend Wis. Admin. Code Chapter Trans 327, relating to motor carrier safety.

Hearing Information

Date:   Tuesday, January 13, 2015
Time:   2:00 p.m. to 4:00 p.m.
Location:   Wisconsin Department of Transportation
  4802 Sheboygan Ave., Room 144B
  Madison, Wisconsin 53707

If you have special needs or circumstances regarding communication or accessibility at a hearing, please call Jennifer Peters, Administrative Rulemaking Coordinator, at [phone] prior to the hearing date. Accommodations such as ASL interpreters, English translators, or materials in audio format will be made available on request to the fullest extent possible.

Appearances at the Hearing, Submission of Written Comments, and Deadline for Submission

Interested persons are invited to appear at the hearing and will be afforded the opportunity to make an oral presentation of their positions. Persons making oral presentations are requested to submit their written comments. WisDOT will accept written comments until January 16, 2015, at 4:30 p.m. Written comments may be sent to: Alison Lebwohl, Bureau of Driver Services Section, Division of Motor Vehicles, WisDOT, 4802 Sheboygan Avenue, Room 809, Madison, Wisconsin 53705, or sent by email to: [e-mail].

Copies of the Rule

You may receive a paper copy of the rules or fiscal estimate by contacting Jennifer Peters, Administrative Rulemaking Coordinator at WisDOT Office of General Counsel, 4802 Sheboygan Avenue, Room 115B, Madison, Wisconsin 53705, or [e-mail]. A copy of the rule is available at http://adminrules.wisconsin.gov. This site allows you to view documents associated with this emergency rule promulgation.

Analysis Prepared by the Department of Transportation

Statutes interpreted

Sections 343.06 (3), 343.065 (3), 343.14 (2) (i) 1., 343.23 (2) (a), 343.265 (1r), and 343.27, Stats.

Statutory authority

Section 343.065 (3), Stats.

Explanation of agency authority

Current law requires the Department of Transportation to administer the driver license law for commercial motor vehicles contained in ch. 343, Wis. Stats. The state has declared its purpose and intent to implement and enforce the federal driver license laws so as to ensure receipt by this state of any federal highway aids. Federal law requires states to conform to federal regulations affecting commercial motor vehicles and their drivers, or face withholding of federal highway funds. See 49 CFR 384.401. The amounts to be withheld from a state that fails to conform to federal regulations affecting commercial motor vehicles or their drivers are 5% of federal highway aid for the first year of substantial nonconformity, and 10% per year of nonconformity thereafter. Current Wisconsin law also requires department rules affecting driver licenses not to conflict with, and be at least as stringent as, standards set by the federal commercial motor vehicle safety act, 49 USC 31301 to 31317 and the regulations adopted under that act.

On December 1, 2008, the federal motor carrier and safety administration (“FMCSA") issued its final rule concerning “Medical Certification Requirements as Part of the CDL [Commercial Driver License]" at 73 Federal Register 73096. Among other changes, the federal regulation requires commercial motor vehicle drivers to declare whether they intend to engage in driving operations that require the driver to maintain proof of medical examination showing the driver meets fitness qualifications, and requires the state driver licensing agency to “downgrade" the CDL of any driver that fails to timely make such certification or to maintain such proof on file. In response, Wisconsin enacted conforming statutory requirements as part of 2011 Wisconsin Act 32 (the 2011-13 biennial budget act), and required the Department of Transportation to: promulgate rules to define “downgrade" in accordance with federal law and regulations or guidance from the applicable federal agency; establish the process for downgrading a CDL, and whether or not a new CDL document will be issued after a CDL is downgraded; and to establish the process for reinstating a downgraded CDL after the department receives a valid medical certification or other appropriate certification of physical qualifications from the licensee. See s. 343.065 (3), Stats.

This rulemaking implements s. 343.065 (3), Stats. The objective of this rule is to: implement federal requirements for commercial drivers to declare their intended driving type; obtain from drivers federally required medical examiner's certificates to the department; electronically enter the driver's self-certification of driving type and the status of their federal medical examiner's certification online for access by the driver, employers and other state; and for the department to timely make those certificates available for inspection by other states in which the driver may drive.

Related statute or rule

See the “Statutes interpreted": section; chs. Trans 112 and 327, Wis. Adm. Code.

Plain language analysis

This proposed rule-making would bring Wisconsin into conformity with federal regulations requiring that commercial drivers certify where they drive in commerce (“Tier of Operation"), and require drivers engaged in non-excepted interstate commerce to keep a valid federal medical certificate on file with the licensing state. The federal medical examiner's certificate (“FedMed Card") is proof of a qualified medical examination that determined the driver meets federal medical qualifications for operating a commercial motor vehicle. This rule does not change the requirements for when commercial drivers must hold a valid FedMed Card. Specifically, under this rule-making:

•   All commercial drivers must certify their Tier of Operation to the Department. This may be: 1) interstate non-excepted (Tier 1); 2) interstate excepted (Tier 2); 3) intrastate non-excepted (Tier 3); or 4) intrastate excepted (Tier 4). Drivers can make the certification by mail, fax, online or by email, using a computer or a Smartphone, or at a DMV service center.

•   All commercial drivers certifying their tier of operations as Tier 1 must file a FedMed Card with the department, and keep it up-to-date. Drivers can file FedMed Cards by mail, fax, online or by email, using a computer or a Smartphone, or at a DMV service center.

•   The department will update that commercial driver's record shown on the Commercial Driver License Information System (CDLIS) within 10 days, showing the self-certified tier of operation and whether the driver has filed any required FedMed Card or medical variance.

•   The department will “downgrade" the CDL of any commercial driver who: 1) Does not certify his or her tier of operation by January 30, 2014; 2) Self-certifies himself or herself as a Tier 1 driver and does not provide a valid FedMed Card; or 3) Is a Tier 1 driver whose FedMed Card expires, or is removed or rescinded by FMCSA. Federal regulations require downgrading for these reasons. The department will “downgrade" the CDL by removing the CDL privilege from the holder's driver's license, and the driver cannot drive commercial motor vehicles again until he or she certifies a tier of driving other than Tier 1, or submits a valid FedMed Card or medical variance. The driver may reinstate the CDL privilege without additional testing by correcting the cause for the downgrade.

•   The department will notify commercial drivers by mail or another method, and notify enrolled employers through Employer Notify, no more than 55 days before a FedMed Card filed with the department expires, upon expiration of that FedMed Card, and immediately upon downgrade.

•   Drivers will be able to use the online application – and employers who have signed up to use Employer Notify will be able to use Employer Notify – to verify: downgrade or reinstatement of commercial privileges; tier of operation; and, for Tier 1 drivers, the expiration date of FedMed Cards.

•   Fraudulent FedMed Cards – whether presented online, in a DMV field station, or at a safety and weight enforcement facility operated by the Division of State Patrol scale – will be considered a false application and treated accordingly.

•   If future federal rule-making provides FedMed information directly to states, then commercial drivers are required to certify only their tier of operation, but not necessarily provide a copy of a current FedMed Card to the department.

Summary of, and preliminary comparison with, existing or proposed federal regulation