Chs. HFS 13 & HSS 129 - Reporting and investigation of allegations of caregiver misconduct and the operation of the caregiver misconduct registry.
Summary of Final Regulatory Flexibility Analysis:
These rules apply to the following licensed, certified, registered or approved “entities:”
-certified community mental health programs;
-certified community alcohol and other drug abuse (AODA) prevention and treatment programs;
-ambulance service providers;
-adult family homes certified or licensed by the Department;
-residential care apartment complexes (formerly called assisted living facilities);
-community-based residential facilities (CBRFs);
-nursing homes and facilities for the developmentally disabled;
-hospice programs;
-home health agencies;
-rural medical centers; and
-hospitals.
Many of the entities are small businesses as “small business” is defined in s. 227.114 (1) (a), Stats. This includes about 1/3 of the community mental health and AODA programs; 25 of 450 ambulance service providers; 7 of 45 residential care apartment complexes; 600 of 1120 CBRFs; 96 of 472 nursing homes; most of the hospice programs; and 115 of 191 home health agencies.
The rules require an entity to report to the Department allegations of caregiver misconduct toward residents or patients. Misconduct is abuse or neglect of a client or misappropriation of the client's property. The Department has current rules in ch. HFS 129 that require this reporting by nursing homes and facilities for the developmentally disabled, hospitals, home health agencies and hospice programs. Section 146.40 (4g) and (4r), Stats., was amended by 1997 Wisconsin Act 27 to expand the reporting responsibility to the other types of care and treatment providers listed above. This order consolidates under ch. HFS 13 the required reporting of misconduct, follow-up investigation by the Department and maintenance by the Department of a registry of caregivers for whom allegations of misconduct have been substantiated.
Chapter HFS 13 will not itself have a significant economic impact on a substantial number of small businesses. Expansion of the scope of the caregiver misconduct reporting requirement from 5 service provider types to 11 service provider types is a statutory requirement.
Comments of Legislative Standing Committees
The Assembly Committee on Health held a public hearing on the proposed rules on April 13, 1999, and the Senate Committee on Health, Utilities and Veterans and Military Affairs held a public hearing on the proposed rules on April 28, 1999. Both committees, following their hearings, requested the Department to make modifications in
CR 98-188.
The Department on May 12, 1999, informed the committee chairpersons that it was making one germane modification in
CR 98-188. That was to have separate definitions for “abuse” and “neglect,” rather than include “neglect” in the definition for “abuse,” with the abuse definition amended so that it is focused on actions taken purposely with intent to harm and the neglect definition focused on actions done purposely without intent to harm.
No further comments were received from the standing committees.
S. Ins 2.80 - Valuation of life insurance policies model regulation.
Summary of Final Regulatory Flexibility Analysis:
The Office of the Commissioner of Insurance has determined that this rule will not have a significant economic impact on a substantial number of small businesses and therefore a final regulatory flexibility analysis is not required.
Summary of Comments of Legislative Standing Committees:
The legislative standing committee had no comments on this rule.
Ch. NR 10 - Deer management units 73C (Iowa and Grant counties) and 75 (Iowa and Lafayette counties).
Summary of Final Regulatory Flexibility Analysis:
The proposed rules are applicable to individual hunters and landowners; therefore, a final regulatory flexibility analysis is not required.
Summary of Comments by Legislative Review Committees:
The proposed rules were reviewed by the Assembly committee on natural Resources and the Senate Committee on Agriculture, Environmental Resources and Campaign Finance Reform. On February 17, 1999, the Assembly Committee on Natural Resources extended the review period for 30 days. No public hearing was scheduled during that time.
Chs. Psy 1 through 5 - Requirements for examination and licensure of psychologists, renewal and conduct.
Summary of Final Regulatory Flexibility Analysis:
These proposed rules will have no significant economic impact on small businesses, as defined in s. 227.114 (1)(a), Stats.
Summary of Comments:
No comments were reported.
S. PD 6.04 (5) - Multiple appointments on the same case.
Summary of Final Regulatory Flexibility Analysis:
These proposed rules will have no significant economic impact on small businesses, as defined in s. 227.114 (1)(a), Stats.
Summary of Comments:
No comments were reported.
S. PI 3.03 - Alternative teacher permits.
Summary of Final Regulatory Flexibility Analysis:
These proposed rules will have no significant economic impact on small businesses, as defined in s. 227.114 (1)(a), Stats.
Summary of Comments:
No comments were reported.
S. Tax 11.68 - Construction contractors.
Summary of Final Regulatory Flexibility Analysis:
The proposed rule order does not have a significant economic impact on a substantial number of small businesses.
Summary of Comments:
No comments were reported.
S. Tax 11.70 - Printed material exemptions and the sales and use tax treatment of advertising agencies.
Summary of Final Regulatory Flexibility Analysis:
This proposed rule order does not have a significant economic impact on a a substantial number of small businesses.
Summary of Comments:
No comments were reported.
E x e c u t i v e O r d e r s
The following is a listing of recent Executive Orders issued by the Governor.
Executive Order 370. Relating to the Appointment of a Hearing Officer.
Executive Order 371. Relating to a Proclamation that the Flag of the United States and the Flag of the State of Wisconsin be Flown at Half-Staff on Memorial Day.
Public Notices
Public Notice
Health and Family Services
(Medical Assistance Reimbursement of Hospitals)
The State of Wisconsin reimburses hospitals for medical services provided to low-income persons under the authority of Title XIX of the Federal Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. The State's Department of Health and Family Services administers this program which is called Medicaid or Medical Assistance (MA). Federal statutes and regulations require state plans, one for outpatient services and one for inpatient services, which provide the methods and standards for paying for hospital outpatient and inpatient services.
Summary
State plans are now in effect for the reimbursement of outpatient hospital services and inpatient hospital services. The Department is proposing to make several changes in these plans effective July 1, 1999. Many of these changes are included in the proposed 1999-2001 state budget. Upon enactment of the 1999-2001 state budget, certain of these proposed changes will be modified if necessary to effectuate the mandates included in the budget act.
Outpatient Hospital Services
Proposed changes in the state plan for reimbursement for outpatient hospital services may include:
1. Adjustment of the percentages by which base year outpatient costs are increased for the July 1999 through June 2001 biennium to implement the payment adjustments included in the 1999-2001 budget act.
2. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds. The amount paid for this adjustment would not change. However, this modification would cause a redistribution of the funds among qualifying hospitals.
3. Modification of supplemental payments to essential access city hospitals (EACH) to maintain compliance with federal payment limits. This modification would not change the total amount paid. It would, however, adjust the amount paid through outpatient payments versus inpatient payments.
4. For the indigent care allowance, adjustment of the maximum available funding, modification of the criteria for a hospital to qualify for an allowance, and modification of the methodology for distributing the available funds to qualifying hospitals in order to carry out provisions of 1999-2001 budget act and to maintain compliance with federal payment limits.
5. Criteria for funding of critical access hospitals to implement a provision the 1999-2001 budget act. Qualifying criteria include designation by Medicare and Wisconsin Medicaid as a critical access hospital. Establish a methodology to allow qualifying hospitals to receive reasonable cost reimbursement. Payments for this adjustment would maintain compliance with federal payment limits.
6. Establishment of qualifying criteria and a distribution methodology for a supplemental payment to certain hospitals to implement a provision of the 1999-2001 budget act.
Inpatient Hospital Services
Proposed changes in the state plan for reimbursement for inpatient hospital services may include:
1. For the payment system which is based on diagnosis-related groups (DRG's), adjustment of DRG weighting factors, standard DRG base rates, area wage indices, and capital and medical education payments to implement the overall rate adjustment provided by the 1999-2001 budget act.
2. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds. The total amount paid for this adjustment would not change. However, this modification would cause a redistribution of the funds among qualifying hospitals.
3. Updating of the disproportionate share adjustment parameters to recognize a more current proportion of services provided by hospitals to Medicaid recipients.
4. Revision of the indirect medical education adjustment percentage to meet the requirements of the 1999-2001 budget act relating to hospitals located in Wisconsin. The formula used to calculate the indirect medical education percentage includes a multiplier factor that when revised affects the amount of funds distributed to qualifying hospitals.
5. Modification of the direct medical education payment and the indirect medical education adjustment in order to meet the requirements of the 1999-2001 budget act relating to hospitals not located in Wisconsin.
6. Modification of supplemental payments to essential access city hospitals (EACH) to maintain compliance with federal payment limits. This modification would not change the total amount paid. It would, however, adjust the amount paid through inpatient versus outpatient.
7. For the indigent care allowance, adjustment of the maximum available funding, modification of the criteria for a hospital to qualify for an allowance, and modification of the methodology for distributing the available funds to qualifying hospitals in order to carry out provisions of the 1999-2001 budget act and to maintain compliance with federal payment limits.
