Med 8.07 (1) SCOPE AND LIMITATIONS. In providing patient services medical care, the entire practice of any physician assistant shall be under the supervision of a licensed physician. The scope of practice is limited to providing patient services
medical care specified in sub. (2). A physician assistant's practice may not exceed the scope of practice of the supervising physician. A
medical care task assigned by the supervising physician to a physician assistant may not be delegated by the physician assistant to another person.
(2) (title) PATIENT SERVICES MEDICAL CARE. (intro.) Patient services Medical care a physician assistant may provide include includes:
(c) Performing routine therapeutic procedures, including, but not limited to, injections, immunizations, and the suturing and care of wounds.
(e) Assisting the supervising physician in a hospital or facility, as defined in s. 50.01 (1m), Stats., by assisting in surgery, making patient rounds, recording patient progress notes, compiling and recording detailed narrative case summaries and accurately writing or executing standing orders or other specific orders following consultation with and at the direction of the supervising
under the supervision of a licensed physician.
(f) Assisting in the delivery of services
medical care to a patient by reviewing and monitoring treatment and therapy plans.
(i) Preparing Issuing written prescription orders for drugs if specifically directed to do so by the supervising under the supervision of a licensed physician and in accordance with procedures specified in s. Med 8.08 (2).
SECTION 13. Med 8.08 (title), (1), (2) (intro.), (a), (b), (c), (d), (e) 2. and 3. are amended to read:
Med 8.08 (title) Prohibitions and
Prescribing limitations. (1) ACUPUNCTURE AND INDEPENDENT PRESCRIBING PROHIBITED. A physician assistant may not practice acupuncture in any form and may not prescribe or dispense any drug independently. A supervising physician may direct a physician assistant to prepare a prescription order according to procedures specified in sub. (2).
(2) PRESCRIBING LIMITATIONS. (intro.) A physician assistant may prepare issue a prescription order only if all of the following conditions apply:
(a) The physician assistant prepares issues the prescription order only in patient situations specified and described established written protocols guidelines. The
protocol guidelines shall be reviewed at least annually by the physician assistant and his or her supervising physician.
(b) The supervising physician and physician assistant determine by mutual agreement that the physician assistant is qualified through training and experience to prepare issue a prescription order as specified in the established written protocols
guidelines.
(c) When practicable, the physician assistant consults directly with the supervising physician prior to preparing a prescription order. In any case the The supervising physician shall be is available for consultation as specified in s. Med 8.10 (2)
(3).
(d) The prescription orders prepared under procedures in this section contain, in addition to other information required by law, the name, address and telephone number of the supervising physician
, the DEA registration number of the supervising physician if the prescription is prepared for a controlled substance, the name and address of the physician assistant, legibly printed, the DEA registration number of the physician assistant if the prescription is prepared for a controlled substance and if the physician assistant is registered with DEA, and the signature of the physician assistant.
(e) 2. Reviews and countersigns within one day
72 hours the patient record prepared by the physician assistant practicing in the office of the supervising physician or at a facility or a hospital in which the supervising physician has staff privileges; or
3. Reviews by telephone or other means, as soon as practicable but within a 48-hour 72-hour period, and countersigns within one week, the patient record prepared by the physician assistant who practices in an office facility other than the supervising physician's main office of a facility or hospital in which the supervising physician has staff privileges.
SECTION 14. Med 8.10 (1) is amended to read:
Med 8.10 (1) No physician may concurrently supervise more than 2 physician assistants unless the physician submits a written plan for the supervision of more than 2 physician assistants and the board approves the plan. A physician assistant may be supervised by more than one physician.
Fiscal Estimate
1. The anticipated fiscal effect on the fiscal liability and revenues of any local unit of government of the proposed rule is: $0.00.
2. The projected anticipated state fiscal effect during the current biennium of the proposed rule is: $0.00.
3. The projected net annualized fiscal impact on state funds of the proposed rule is: $0.00.
Initial Regulatory Flexibility Analysis
These proposed rules will be reviewed by the department through its Small Business Review Advisory Committee to determine whether there will be an economic impact on a substantial number of small businesses, as defined in s. 227.114 (1) (a), Stats.
Copies of Rule and Contact Person
Copies of this proposed rule are available without cost upon request to: Pamela Haack, Department of Regulation and Licensing, Office of Administrative Rules, 1400 East Washington Avenue, Room 171, P.O. Box 8935, Madison, Wisconsin 53708 (608) 266-0495.
Notice of Hearing
Revenue
Notice is hereby given that pursuant to s. 227.11 (2) (a), Stats., and interpreting s. 77.54 (9a), Stats., s. 77.51 (18) and (22) (a), Stats., as amended by 1997 Wis. Act 27 and s. 77.54 (43), Stats., as created by 1997 Wis. Act 27, the Department of Revenue will hold a public hearing at the time and place indicated below, to consider the amendment of rules relating to printed material exemptions and the sales and use tax treatment of advertising agencies.
Hearing Information
February 26, 1999 Room #207, GEF 3
Friday 125 South Webster St.
10:00 a.m. MADISON, WI
Handicap access is available at the Butler Street entrance of the building.
Written Comments
Interested persons are invited to appear at the hearing and may make an oral presentation. It is requested that written comments reflecting the oral presentation be given to the Department at the hearing. Written comments may also be submitted to the contact person shown below no later than March 5, 1999, and will be given the same consideration as testimony presented at the hearing.
Contact Information
Mark Wipperfurth, (608) 266-8253
Department of Revenue
125 South Webster St.
P.O. Box 8933
Madison, WI 53708-8933
Analysis by the Dept. of Revenue
Statutory authority: s. 227.11 (2) (a), Stats.
Statutes interpreted: s. 77.54 (9a), Stats., s. 77.51 (18)
and (22) (a), Stats., as amended
by 1997 Wis. Act 27, and
s. 77.54 (43), Stats., as created
by 1997 Wis. Act 27
SECTION 1. Tax 11.19 (2) (d) and (f) and (5) (intro.) and (b) are amended to reflect the amendment of s. 77.51(18) and (22) (a), Stats., and the creation of s. 77.54 (43), Stats., by 1997 Wis. Act 27. These changes provide a sales tax exemption for raw materials of printed materials transported and used solely outside of Wisconsin. Previously, these materials were only exempt from use tax.
Section Tax 11.19 (6) is amended, to clarify that the exemption for governmental units applies only to Wisconsin governmental units, and to reflect that certificate of exempt status numbers are being given to governmental units.
SECTION 2. Tax 11.70 (3) (m) is created, to reflect the amendment of s. 77.51 (18) and (22) (a), Stats., and the creation of s. 77.54 (43), Stats., by 1997 Wis. Act 27.
Text of Rule
SECTION 1. Tax 11.19 (2) (d) and (f), (5) (intro.) and (b) and (6) are amended to read:
Tax 11.19 (2) (d) Section 77.54 (2m), Stats., provides an exemption for the “gross receipts from the sales of and
the storage, use or other consumption of tangible personal property or services that become an ingredient or component of shoppers guides, newspapers or periodicals or that are consumed or lose their identity in the manufacture of shoppers guides, newspapers or periodicals, whether or not the shoppers guides, newspapers or periodicals are transferred with charge to the recipient." This exemption applies to newspapers, shoppers guides and periodicals which are issued at average intervals not exceeding 3 months. It does not apply to advertising supplements that are not newspapers as defined in s. 77.51 (8), Stats.
(f) Section 77.51 (18) and (22) 77.54 (43), Stats., provides that storage and use for purposes of imposing Wisconsin use tax does not include the keeping, retaining or exercising any right or power over a sales and use tax exemption for raw materials
for used for the processing, fabricating or manufacturing into, attachment of, attaching to or incorporation into incorporating into, printed materials to be that are transported outside Wisconsin and thereafter used solely outside Wisconsin.
(5) Wisconsin sales and use tax is not imposed on raw materials that would otherwise be subject to use tax under s. 77.53 (1), Stats., purchased by a publisher or printer of printed materials if both of the following conditions are met:
(b) The resulting printed materials will be shipped outside Wisconsin for use transported and used solely outside Wisconsin.
(6) EXEMPT PURCHASERS. Sales of printed material to federal and Wisconsin governmental units, and Wisconsin public schools, and certain nonprofit religious, charitable, educational or scientific organizations holding a certificate of exempt status are exempt under s. 77.54 (9a) or 77.55 (1), Stats. Sales to federal and Wisconsin governmental units and public schools need not be supported by exemption certificates, if a copy of the purchase order from the organization is retained or the governmental unit's certificate of exempt status number is recorded on the bill of sale. Sales to persons nonprofit organizations holding a certificate of exempt status can be shown to be exempt by recording the certificate of exempt status number on the bill of sale.
Note to Revisor: 1) In sub. (3), all quoted statutory material should be in italics.
2) Replace the first note at the end of s. Tax 11.19 with the following:
Note: Section Tax 11.19 interprets ss. 77.51 (8) and (13h), 77.52 (2) (a) 11., 77.54 (2m), (9a), (15), (25) and (43) and 77.55 (1), Stats.
3) In the second note at the end of s. Tax 11.19, remove the word “and" before part (i) and add the following at the end of the note:
; and (j) The sales and use tax exemption for raw materials becoming printed materials transported and used solely outside Wisconsin became effective December 1, 1997, pursuant to 1997 Wis. Act 27.
SECTION 2. Tax 11.70 (3) (m) is created to read:
Tax 11.70 (3) (m) Raw materials processed, fabricated or manufactured into, attached to or incorporated into printed materials that are transported and used solely outside Wisconsin.
Example: Company A, located in Wisconsin, publishes catalogs it gives away to potential customers. Company A purchases paper from a company who delivers it to a Wisconsin printer that prints the catalogs for Company A. The catalogs are transported and used solely outside Wisconsin.
The paper purchased by Company A for the catalogs is exempt from Wisconsin sales or use tax.
Note to Revisor: 1) At the end of sub. (2) (b), change the word “Example" to “Examples."
2) In the second example at the end of sub. (2)(c), add the words “by the advertising agency" at the end of the fourth sentence, after “are produced"; also renumber the example from 2 to 3 and add the following new examples:
2) Assume the same facts as Example 1, except that Company C mails 90% of the flyers to customers outside Wisconsin and 10% to customers in Wisconsin.
Ten percent of the total charge to Company C by the advertising agency for the flyers, including the preliminary art, finished art and flyers, is subject to tax.
4) Assume the same facts as Example 3, except that 5 dubs are mailed by the advertising agency to radio stations outside Wisconsin.
Fifty percent of the entire charge by the advertising agency for the production of the master tape and dubs is subject to tax. The remaining 50% is not subject to tax because that portion of the sale took place outside Wisconsin.
3) In the example at the end of sub. (3)(j), change “an advertising agency" to “a Wisconsin advertising agency"; also, change the word “Example" to “
Examples," number the example 1, and add the following new example:
2) Assume the same facts as Example 1, except that Company I provides the paper to the printer, in addition to the finished art.
The charge to Company I by the Wisconsin advertising agency for the preliminary art and finished art is subject to Wisconsin sales tax. The printer is selling a printing service, and not tangible personal property, to Company I. The destined for sale requirement is not met and exemption from tax does not apply.
4) In the first note at the end of s. Tax 11.70, change the zip code from “53708" to “53708-8902."
5) Replace the second note at the end of s. Tax 11.70 with the following:
Note: Section Tax 11.70 interprets ss. 77.51 (14) (intro.) and (h) and (14r), 77.52 (1) and (2) and 77.54 (2), (2m), (6) (b), (25) and (43), Stats.
6) In the third note at the end of s. Tax 11.70, remove the word “and" before part (c) and add the following at the end of the note:
; and (d) The sales and use tax exemption for raw materials for printed materials transported and used solely outside Wisconsin became effective December 1, 1997, pursuant to 1997 Wis. Act 27.
Initial Regulatory Flexibility Analysis
This proposed rule order does not have a significant economic impact on a substantial number of small businesses.
Fiscal Estimate
This rule reflects the creation of a sales tax exemption for printed materials by 1997 Wis. Act 27. It also clarifies the exemption for sales to governmental units. It has no fiscal effect.
