Rule-Making Notices (Hearing Notices)

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 Shancethea.Leatherwood@ wisconsin.gov.

Text of Rule

SECTION 1. Chir 2.025 is amended to read:

Chir 2.025 Time for completing applications and taking examination. An application is incomplete until all materials described in s. Chir 2.02 are filed with the board. All application materials described in s. Chir 2.02 shall be filed with the board within one year from the date the first item is filed. If an application is incomplete for more than one year, or if an applicant fails to take an examination within one year from the date the application is complete first item was filed, the applicant shall begin the application process anew in order to take the practical examination demonstrating clinical competence for a license as a chiropractor.

SECTION 2. Chir 2.03 (1) is amended to read:

Chir 2.03 (1) State law examination. An applicant shall pass an examination on state laws including but not limited to ch. 446, Stats. and chs. Chir 1 to 11 12.

SECTION 3. Chir 2.03 (2) is repealed.

SECTION 4. Chir 2.07(1) is amended to read:

Chir 2.07 (1) National examination. To pass the examination of the national board of chiropractic examiners, each applicant for licensure by exam shall receive a grade determined by the board legislature to represent minimum competence to practice. The board may adopt the passing grade recommended by the national board of chiropractic examiners.

SECTION 5. Chir 2.07 (3) and 2.11 (2) and (3) are repealed.

SECTION 6. Chir 2.12 is created to read:

Chir 2.12 Practical examination demonstrating clinical competence. An applicant who applied for licensure as a chiropractor between January 1, 2012 and June 30, 2013, and who took the practical exam shall not be required to have successfully completed the practical exam and shall be considered to have satisfied all examination requirements to obtain a license to practice as a chiropractor in this state if the person has completed all of the following:

(a) Achieved a score of 375 or higher on Part III of the examination administered by the National Board of Chiropractic Examiners.

(b) Achieved a score of 375 or higher on Part IV of the examination administered by the National Board of Chiropractic Examiners.

(c) Successfully completed the exam on Wisconsin laws related to the practice of chiropractic.

SECTION 7. Chir 3.03 (1) (e) is amended to read:

Chir 3.03 (1) (e) Has successfully completed a practical examination demonstrating clinical competence which, in the board's judgment, is substantially equivalent to the practical examination demonstrating clinical competence is accepted acceptable by to the board. The board will find acceptable any one of the following as an equivalent to a practical examination: Part IV of the examination administered by the National Board of Chiropractic Examiners, the state practical exam from the endorsement candidate's jurisdiction or the special purpose examination in chiropractic.

SECTION 8. Chir 3.03 (1) (f) is repealed and recreated to read:

Chir 3.03 (1) (f) Has successfully completed the special purpose examination in chiropractic, if the applicant has not completed one of the following:

1. Passed Parts I and II of the examination administered by the National Board of Chiropractic Examiners and a state practical exam from the endorsement candidate's jurisdiction.

2. Passed Parts I, II, III and IV of the examination administered by the National Board of Chiropractic Examiners.

SECTION 9. Chir 3.03 (2) (f) and (g) are amended to read:

Chir 3.03 (2) (f) Verification of successful completion of a practical examination, or its equivalent, demonstrating clinical competence which, in the board's judgment, is substantially equivalent to the practical examination demonstrating clinical competence is accepted by the board. The verification shall be forwarded directly to the board from the state that administered the examination or from the national board.

Chir 3.03 (2) (g) Proof of successful completion of the special purpose examination in chiropractic or the initial licensure Parts I, II, III, and IV of the examination of the national board of chiropractic examiners. The proof of completion shall be forwarded directly to the board from the institution that administered the examination.

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.