Reporting, bookkeeping and other procedures required for compliance with the rules.
An application form prescribed by the Department must be completed and submitted to the Department by any authority or local governmental unit, as defined in section
66.1104 (1) (a) and
(b) of the Statutes, that desires to receive a reallocation of the bonding authority.
Types of professional skills necessary for compliance with the rules.
No new professional skills are necessary for compliance with the rules.
Rules have a significant economic impact on small businesses?
No.
Environmental Impact
The Department has considered the environmental impact of the proposed rules. In accordance with chapter Comm 1, the proposed rules are a Type III action. A Type III action normally does not have the potential to cause significant environmental effects and normally does not involve unresolved conflicts in the use of available resources. The Department has reviewed these rules and finds no reason to believe that any unusual conditions exist. At this time, the Department has issued this notice to serve as a finding of no significant impact.
Fiscal Estimate
Assumptions used in arriving at fiscal estimate
Although the rules will result in review of documentation relating to reallocations for recovery zone facility bonds, the time needed for these reviews is expected to be spent by current employees. Therefore, the proposed rules are not expected to have any significant fiscal effect on the department.
The proposed rules are not expected to impose any significant costs on the private sector because the rules address submittal of documentation, and other activities, only by governmental units that choose to pursue obtaining recovery zone facility bonding authority which is reallocated by the Department.
State fiscal effect
None.
Local government fiscal effect
None.
Long-range fiscal implications
None known.
Agency Contact Person
Steven Sabatke
Wisconsin Department of Commerce
Bureau of Business Finance and Compliance
P.O. Box 7970
Madison, WI, 53707-7970
Phone: (608) 267-0762
Notice of Hearing
(2nd Hearing)
Health Services
NOTICE IS HEREBY GIVEN that pursuant to ss.
49.45 (2) (a) 11.,
(10) and
(42) and
227.11 (2), Stats., the Department of Health Services will hold a
second public hearing on emergency and proposed permanent rules to consider revisions to Chapters
DHS 105,
106 and
133 (no additional changes are being proposed for chs.
DHS 106 and
133), relating to Medical Assistance certification for personal care agencies and providers, and affecting small businesses.
The Department of Health Services is conducting a second public hearing on chs. DHS 105, 106 and 133 to give the public an opportunity to comment on additional proposed revisions to s. DHS 105.17 (1f) and (5) (ar). The proposed provisions would, under certain circumstances, require separate approval of a branch office from the parent agency and would require counties, Independent Living Centers (ILC) and federally recognized American Indian tribes or bands to provide identifying information about the personal care provider and contract agencies. For further explanation, see the analysis prepared by the Department of Health Services, listed in the “Plain language analysis" and the “Analysis and supporting documents used to determine effect on small business" sections in this public hearing notice.
No additional changes or amendments have been made to the initial proposed rule. The Department will respond to comments received from the February 3, 2010, hearing and the second public hearing scheduled for May 12, 2010, at one time, in one document. Comments received from both public hearings will be given equal consideration. Changes made to the proposed rule by the Department in response to public comments will be published on the Wisconsin Administrative Rules website.
Hearing Information
Date and Time:
|
Location:
|
May 12, 2010
10:00 a.m. – 12:00 p.m.
|
Dept. of Health Services
Wilson State Office Building
1 West Wilson Street
Room 950B
Madison, Wisconsin
|
Accessibility
English
DHS is an equal opportunity employer and service provider. If you need accommodations because of a disability or need an interpreter or translator, or if you need this material in another language or in an alternate format, you may request assistance to participate by contacting Pat Benesh at (608) 264-9896. You must make your request at least 7 days before the activity.
Spanish
DHS es una agencia que ofrece igualdad en las oportunidades de empleo y servicios. Si necesita algún tipo de acomodaciones debido a incapacidad o si necesita un interprete, traductor o esta información en su propio idioma o en un formato alterno, usted puede pedir asistencia para participar en los programas comunicándose con Pat Benesh al número (608) 264-9896. Debe someter su petición por lo menos 7 días de antes de la actividad.
Hmong
DHS yog ib tus tswv hauj lwm thiab yog ib qhov chaw pab cuam uas muab vaj huam sib luag rau sawv daws. Yog koj xav tau kev pab vim muaj mob xiam oob qhab los yog xav tau ib tus neeg pab txhais lus los yog txhais ntaub ntawv, los yog koj xav tau cov ntaub ntawv no ua lwm hom lus los yog lwm hom ntawv, koj yuav tau thov kev pab uas yog hu rau Pat Benesh ntawm (608) 264-9896. Koj yuav tsum thov qhov kev pab yam tsawg kawg 7 hnub ua ntej qhov hauj lwm ntawd.
Copies of the Proposed Rules
A copy of the rules may be obtained from the department at no charge by downloading the documents from
www.adminrules.wisconsin.gov or by contacting:
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
Submittal of Written Comments
Comments may be submitted to the agency contact person listed above or to the Wisconsin Administrative Rules Website at
www.adminrules.wisconsin.gov until
May 13, 2010, 4:30 p.m.
Analysis Prepared by the Department of Health Services
Statute interpreted
Statutory authority
Explanation of agency authority
Section
49.45 (2) (a) 11., Stats., authorizes the department to establish criteria for certification of providers of Medical Assistance, certify providers who meet certification criteria and promulgate rules to implement the statute.
Section
49.45 (10), Stats., authorizes the department to promulgate rules consistent with its duties in administering Medical Assistance, including its duties relating to reimbursement for personal care services by certified providers.
Section
49.45 (42) (c), Stats., allows the department to charge a fee to certify a provider of personal care services that is not an independent living center (ILC), county department, a federally recognized American Indian tribe or band in Wisconsin or a licensed home health agency.
Section
227.11 (2) (a), Stats., allows agencies to promulgate rules interpreting the provision of any statute enforced or administered by the agency if the agency considers it necessary to effectuate the purpose of the statute.
Related statute or rule
Plain language analysis
The department proposes standards by which to certify freestanding personal care agencies, county departments, home health agencies, federally recognized American Indian tribe or band in Wisconsin, and ILCs as personal care providers. The proposed rules includes certification requirements for persons that want to directly bill and be reimbursed by the Medical Assistance program for the personal care services provided to recipients of Medical Assistance. The rules include new provisions that all personal care providers must follow. The new provisions are:
•
Provide employee orientation, evaluation and health screening, including tuberculosis.
•
Train staff regarding infection control and prevention.
•
Provide client rights, including determination of client appropriateness for service, provisions of rights and notice of how to file a complaint with the department.
•
Require a service agreement and a notice and criteria for discharge.
•
Promptly notify the physician of a significant change in condition.
Since the first public hearing that was held on February 3, 2010, the Department made additional proposed revisions to s.
DHS 105.17.
Based on experience with other programs that provide services to clients statewide, the Department proposes under s.
DHS 105.17 (5) (ar) to require separate approval of branch offices if the Department determines that the branch office, because the volume of services provided or the distance between the branch office and the parent agency, cannot adequately share supervision and administration with the parent agency.
Additionally, the Department proposes under s.
DHS 105.17 (1f) to require counties, ILCs and tribes or bands to provide identifying information about the personal care provider and those agencies and individuals that provide Medicaid personal care services through a contract with the provider.
This data base will allow the Department to organize, store and retrieve information about personal care services provided in Wisconsin for various reporting and planning activities. The proposal does not affect home health agencies because the Department already collects this information from home health agencies through the license process and annual report process.
Comparison with federal regulations
Section
440.167 of 42 CFR contains the requirements for providing personal care services to Medicaid recipients. Section
440.167 does not provide detail on the types of agencies which are allowed to provide personal care services or to directly bill the Medicaid program for reimbursement.
Comparison with rules in adjacent states
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:
