Scope statements
Dentistry Examining Board
Subject
Training requirements for dental hygienists applying local anesthesia by applicator.
Objective of the rule. This proposed rule would exempt subginival, local anesthetics administered by applicator from the educational program requirements of Ch. DE 7, which currently apply to dental hygienists who administer local anesthesia by injection. With the exception, the 10 hours of didactic and 11 hours of clinical education would not be required if the dental hygienist limits administration of local anesthetics to applicators.
Policy analysis
A new type of subginival, local anesthesia applied by applicator, not by injection, is available and is being marketed in Wisconsin. The current rule concerning certification of dental hygienists to administer local anesthesia does not explicitly contemplate local anesthetics administered in this manner, so a revision is sought to clarify educational requirements for dental hygienists who apply local, subginival anesthesia by applicator.
In terms of its application, some states consider local anesthetics applied by applicator as they do medicaments applied in periodontal pockets, similar to certain antibiotics. Dental hygienists may apply such medicaments under supervision. Others consider it a topical anesthetic. In these instances, no rule-making may be required.
Comparison with federal requirements
There is no existing or proposed federal regulation for summary and comparison.
Statutory authority
Sections 15.08 (5) (b), 227.11 (2) and 447.02 (2) (e), Stats.
Staff time required
200 hours.
Financial Institutions - Banking
Subject
Sections DFI—Bkg 80.85 (1), (2) and (5) relating to prohibited bases for discriminating in the extension of consumer credit.
Policy analysis
The objective of the rule is to amend ss. DFI—Bkg 80.85 (1) and (2), and create DFI—Bkg 80.85 (5). The purpose of this rule is to expand the prohibited bases for discriminating in the extension of consumer credit. Currently the Wisconsin Consumer Act makes discrimination on the basis of sex or marital status in the granting or extension of credit an unconscionable credit practice. The rule makes discrimination on the basis of a prohibited basis in the granting or extension of credit an unconscionable credit practice. The rule defines prohibited basis to include the already existing bases as well as additional bases.
Statutory authority
Sections 426.108 and 227.11 (2), Stats.
Staff time required
100 hours.
Entities affected by the rule
Credit providers.
Federal regulation addressing the activities
Health and Family Services
Subject
The Department proposes to repeal sections HFS 61.91 to 61.98 and create ch. HFS 35, rules relating to outpatient mental health clinics, and to revise sections HFS 105.13 (2) and 107.22 rules relating to outpatient mental health services and certification of psychotherapy providers under Medical Assistance (MA).
Policy analysis
Sections HFS 61.91 to 61.98 address procedures for certification; required personnel; service requirements; and denial, involuntary termination or suspension of certification for outpatient mental health clinics; clinical supervision, collaboration, and consultation; written authorization of psychotherapy by a physician; initial assessments of clients and development of treatment plans; progress notes; discharge summaries; and record keeping. In addition to these requirements, these rules require clinics to ensure continuity of care for persons with mental disorders or alcohol and drug abuse problems by rendering or arranging for the provision of specified services, including but not limited to, residential facility placement; aftercare for continuing treatment in the community to help the patient maintain and improve adjustment following a period of treatment in a facility; and emergency care. Section HFS 105.22 provides the requirements for MA certification of psychotherapy providers, staffing of outpatient facilities, and MA reimbursement for outpatient psychotherapy services. Section HFS 107.13 (2) details the Medicaid requirements for covered services for outpatient psychotherapy services, prior authorization and other limits and procedures, and non-covered services under MA.
Sections HFS 61.91 to 61.98 have been revised several times over the years, but have not been comprehensively reviewed and rewritten since May 1981. Section HFS 105.22, was last revised in 1991, and s. HFS 107.13 (2), which was last revised in 2004, but not comprehensively reviewed and rewritten since March 1986. Several changes affecting the needs of persons who seek outpatient mental health services and the operation of the outpatient mental health clinics have occurred since the referenced rules were last revised. These changes include the passage of 2001 Wisconsin Act 80 dealing with licensure of social workers and other professionals; 1993 Act 138 and N8 dealing with advanced practice nurse prescribers; a shortage of psychiatrists in parts of the state; and research regarding recovery-oriented treatment. In addition, many professionals and representatives of outpatient mental health clinics indicate that the current rules are burdensome, costly, and do not help to lead to the desired outcomes of persons receiving treatment.
The Department believes that ss. HFS 61.91 to 61.98 need a comprehensive rewrite to address these issues and to incorporate functional changes to the rules made through several statewide variances based on input from providers and professional organizations. In repealing ss. HFS 61.91 to 61.98 and creating ch. HFS 35 to replace these sections, the Department intends to address several areas including, allowing clinics to alternatively meet, the standards of one of several national accrediting bodies, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO); establishing a detailed certification process similar in both organization and content to the certification process set out in rules for other community mental health certified programs, which includes actions taken against certified programs and permits provisional certification pending correction of minor deficiencies; adding a requirement for a criminal records check on prospective new employees; modifying the requirements for professional staffing of a clinic; changing requirements of staff supervision to a quality improvement process; adding training requirements for clinic staff; adding or expanding rule language on admission, assessment, consent for treatment, treatment planning and medications administration; and adding sections on client rights and obtaining information about client satisfaction with treatment.
Proposed changes to ss. HFS 105.22 and 107.13 (2), will ensure that the language in these rules is consistent with the language in the proposed ch. HFS 35 and will reflect current practices and needs, such as, indexing the number of visits and dollar amounts before a prior authorization is required.
The Department believes that the proposed changes will result in rules that are less burdensome to mental health providers and improved services to mental health consumers.
Statutory authority
The Department's authority to repeal and create these rules is found in ss. 49.45 (10), 51.42 (7) (b) and 227.11 (2), Stats.
Staff time required
Estimated hours of staff time to draft the rules – 200 staff hours. An advisory committee will provide opportunities for input from mental health consumers, mental health advocates, professional organizations, accreditation organizations (e.g., Joint Commission on Accreditation of Healthcare Organizations, Council on Accreditation), and providers to the drafting process.
Entities affected by the rule
Entities that may be affected by the proposed rules are public and private outpatient mental health clinics certified by the Department of Health and Family Services.
Comparison with federal requirements
42 CFR pt. 440.130 permits use of Medicaid funds to provide diagnostic, screening, preventive, and rehabilitative services, including any medical or remedial services recommended by a physician or other licensed practitioner of the healing arts, within the scope of his practice under state law, for maximum reduction of physical or mental disability and restoration of a recipient to his best possible functional level. There are no other known proposed or existing federal regulations pertinent to outpatient mental health clinics.
Marriage and Family Therapy, Professional Counseling and Social Work Examining Board - Social Worker Section
Subject
Internship requirements.
Objective of the rule. To create and clarify a specific term of hours for the internship requirement for the social work training certificate, and to more clearly define what constitutes a human services internship.
Policy analysis
Currently, the Social Worker Section rules specify no hourly requirements for the required human services internship. Under the current rules, the board may reject a social worker training certificate applicant based on what they deem as an insufficient length of internship. Therefore, the Social Worker Section is modifying its rules to specify that social worker training certificate applicants who are pursuing their required human services experience through internship must engage in at least 400 hours of supervised practice. The section also intends to better clarify what constitutes a human services internship.
Statutory authority
Sections 15.08 (5) (b), 227.11 (2), 457.03 and 457.22, Wis. Stats.
Comparison with federal requirements
There is no existing or pending federal regulation relating to internship requirements for social worker training certificate applicants.
Staff time required
200 hours.
Marriage and Family Therapy, Professional Counseling and Social Work Examining Board - Marriage and Family Therapist Section
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