To find out more about the hearing or to request a copy of the rules, write or phone:
Judith Nugent
Bureau of Health Information
Division of Health Care Financing
P.O. Box 7984
Madison, Wisconsin 53707-7984
(608)266-2863 or,
if you are hearing impaired,
(608) 261-7798 (TDD)
If you are hearing or visually impaired, do not speak English, or have circumstances which might make communication at a hearing difficult and if you, therefore, require an interpreter or a non-English, large print or taped version of the hearing document, contact the person at the address or phone number shown above. A person requesting a non-English or sign language interpreter should contact the person at the address or phone number given above at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.
Written comments on the proposed rules received at the above address no later than June 29, 2001 will be given the same consideration as testimony presented at the hearing.
Fiscal Estimate
The rules are being modified to implement the statutory changes included in
1997 Wis. Act 231, which authorizes DHFS to begin collecting data from Wisconsin hospitals on each emergency department (ED) patient. Responsibility for that data collection has been assigned to the Division of Health Care Financing, Bureau of Health Information (BHI). Wisconsin Act 231 also grants the Department the authority to assess hospitals for the associated costs involved. The authorizing statute created and funded a 1.0 FTE research technician position to log, edit and process the emergency department data as submitted. These changes detail the requirements for collecting emergency department information from hospitals with emergency departments. The rules provide for assessing hospitals from which data are collected for the costs of collection, database development and maintenance, generation of data files and standard reports, orientation and training and the expenses of the Board of Health Care Information.
Under the revised rules, BHI increases operating costs by $40,200 for 1.0 FTE PR position. The additional costs include other BHI staff support, office space, systems development costs and support and the maintenance of data files along with the generation of data files and standard reports. The costs of orientation and training and the expenses of the Board of Health Care Information also contribute toward the remaining $34,800.
Assessments would be added to the annual hospital assessment. Seventy-five thousand dollars would only be collected from hospitals with emergency departments based on an approved formula. Future assessments will vary as revenues increase from the sale of data.
There are no local government costs. A copy of the full fiscal estimate may be obtained from Sandy Breitborde who may be contacted via the contact information provided in this notice.
Initial Regulatory Flexibility Analysis
The proposed rules affect hospitals, freestanding ambulatory surgery centers and physicians. Six hospitals meet the s.
227.114 (1), Stats., definition of a “small business." In addition, the Department estimates that approximately 2,400 to 2,800 physician practices that would be required to submit data under these proposed rules have fewer than 25 employees. The Department does not have data from ambulatory surgery centers that allow an estimate of which centers may be characterized as “small businesses." Many centers are located at a medical clinic or hospital.
The proposed rules add a category of data associated with emergency departments to the data already periodically submitted by hospitals. Therefore, no new reporting or bookkeeping procedures or new professional skills are required for compliance with the proposed rule.
To accommodate entities that can meet the s.
227.114 (1), Stats., definition of a “small business," the rules propose applying a
less stringent standard for a physician who does not currently submit electronic claims. In addition, the rule proposes that the Department may grant an exception to the data submission requirements for a physician who submits an affidavit of financial hardship and supporting evidence demonstrating financial inability to comply with the requirements of the rules.
Section
227.114, Stats., requires agencies to consider whether any of the following methods can be employed for reducing the effect of rulemaking orders on small businesses:
•
Establishing less stringent compliance or reporting requirements;
•
Establishing less stringent schedules or deadlines for compliance or reporting requirements;
•
Consolidating or simplifying compliance or reporting requirements;
•
Establishing performance standards to replace design or operational standards required in the rule; and
•
Exempting small businesses from any or all requirements of the rule.
With respect to hospitals meeting the definition of “small business," the Department cannot do any of the preceding because doing so would be impractical insofar as it would negate the Department's ability to create a timely and complete set of emergency department data.
Notice of Proposed Rules
Health & Family Services
Notice is hereby given that pursuant to ss.
146.50 (5) (b) and
(d) 1.,
(6) (b) 2. and
(c) (intro.),
(6n),
(8m) and
(13) (a) and
(c) and
250.04 (7), Stats., and according to the procedures set forth in s.
227.16 (2) (e), Stats., the Department of Health and Family Services will amend ss. HFS 110 (title), 110.02, 110.03 (25) and (54), 110.05 (4) (b) 3., 110.06 (title), (1) (title) and (2) (title), 110.06 (3) to (5) and Note, 110.07 (3) (b) (intro.), 110.09 (1) (intro.), 110.09 (2) (a) and 110.09 (6), and create ss.
HFS 110.03 (42m),
110.07 (1) (c) 6m. and
6r. and
110.06 (2m), relating to licensing of ambulance service providers and licensing of emergency medical technicians-basic and emergency medical technicians-basic IV, as herein proposed, without public hearing, unless a petition for a hearing is received by the Department within 30 days after the publication of this notice on
June 1, 2001. A petition for a hearing will be accepted if signed by any of the following who will be affected by the proposed rule: 25 persons; the representative of an association that represents a farm, labor, business or professional group; or a municipality.
Contact Person
If you have any questions about this rule or about filing a written petition for a hearing, contact Jon Morgan, Bureau of Emergency Medical Services, P.O. Box 2659, Room 118, Madison, WI 53701-2659, 608-266-9781.
Analysis Prepared by the Department of Health & Family Services
Chapter
HFS 110 concerns the licensing of ambulance service providers, the certification of training centers, and the licensing and training of emergency medical technicians at the EMT-basic and EMT-basic IV levels of ability. Although the current rules recognize an EMT-basic IV licensure level, the current rules omit provisions providing for the Department's ability to issue EMT-basic IV training permits. The principal purpose of this proposed rulemaking order is to correct this oversight. The rulemaking order also proposes deleting the requirement to administer specific concentrations of epinephrine for anaphylactic shock.
Text of Proposed Rules
SECTION 1. Chapter
HFS 110 (title) is amended to read:
HFS 110 Licensing of Ambulance Service Providers and Emergency Medical Technicians-Basic and Basic IV
SECTION 2. HFS 110.02 is amended to read:
HFS 110.02 Applicability. This chapter applies to all applicants for and holders of an ambulance service provider license, an EMT-basic or EMT-basic IV license or an EMT-basic or EMT-basic IV training permit.
SECTION 3. HFS 110.03 (25) is amended to read:
HFS 110.03 (25) “Epinephrine" means the administration of epinephrine in a concentration of 1:1000 for signs and symptoms of anaphylactic shock using an auto-injector or other approved administration device.
SECTION 4. HFS 110.03 (42m) is created to read:
HFS 110.03 (42m) “Preceptor" means an individual licensed as an EMT-basic IV, EMT-intermediate, EMT-paramedic, a physician, a registered nurse or a physician assistant who meets the requirements listed in s.
HFS 110.07 (1) (c) 8. and who provides supervision of clinical or field experiences for individuals with an EMT-basic IV training permit.
SECTION 5. HFS 110.03 (54) is amended to read:
HFS 110.03 (54) "Wisconsin standard curriculum for training EMT-basic IV personnel" means the curriculum developed and approved by the department as essential for training EMT-basic IV personnel. This training is based on the 1985 national standard curriculum for training EMTs-Intermediate with adaptations developed and approved by the department.
SECTION 6. HFS 110.05 (4) (b) 3. is amended to read:
HFS 110.05 (4) (b) 3. Administration of epinephrine in a concentration of 1:1000 for adults or 1:2000 for pediatric patients, for anaphylactic shock.
SECTION 7. HFS 110.06 (title), (1) (title) and (2) (title) are amended to read:
HFS 110.06 EMT-basic and EMT-basic IV training permit. (1) EMT-BASIC APPLICATION.
(2) EMT-BASIC REQUIRED TRAINING.
SECTION 8. HFS 110.06 (2m) is created to read:
HFS 110.06 (2m) EMT-BASIC IV APPLICATION. An individual requesting an EMT-basic IV training permit shall comply with all of the following:
(a) Apply on a form provided by the department.
(b) Hold a valid EMT license issued by the department or document equivalent training that, at a minimum, meets the national standard curriculum for training EMTs-basic as defined in s.
HFS 110.03 (34).
(c) Be at least 18 years of age.
(d) Subject to ss.
111.321,
111.322,
111.335 and
146.50 (6), Stats., not have an arrest or conviction record that substantially relates to performance of the duties as an EMT as determined by the department.
(e) Present documentation of enrollment in department-approved EMT-basic IV training as evidenced by the course registration list.
(f) Provide any additional information requested by the department during its review of the application.
SECTION 9. HFS 110.06 (3) to (5) and Note are amended to read:
HFS 110.06 (3) ACTION BY THE DEPARTMENT. Within 40 business days after receiving a complete application for an EMT-basic
or EMT-basic IV training permit, the department shall either approve the application and issue the permit or deny the application. If the application for a permit is denied, the department shall give the applicant reasons, in writing, for the denial and shall inform the applicant of the right to appeal that decision under s.
HFS 110.09 (5). In this subsection, "complete application" means a completed application form and documentation that
, for an EMT-basic, the requirements of sub. (1) (b) to (f) are met
or, for an EMT-basic IV, the requirements of sub. (2m) (a) to (f) are met.
(4) RESTRICTIONS. (a) EMT-basic. 1. An individual holding an EMT-basic training permit may function as an EMT only under the direction of an EMT-basic, a registered nurse, a physician assistant or a physician.
(b)
2. An individual holding an EMT-basic training permit is not considered a licensed individual under s.
HFS 110.04 (1) (b) 2.
(c)3. An individual holding an EMT-basic training permit may perform any of the actions authorized for an EMT-basic for which he or she has been trained, except advanced skills requiring medical director approval, but only if directly supervised by a licensed EMT-basic, a registered nurse, a physician assistant or a physician.
(b)
EMT-basic IV. 1. An individual holding an EMT-basic IV training permit is not considered a licensed individual under s.
HFS 110.04 (1) (b) 3.
2. An individual holding an EMT-basic IV training permit may perform the actions authorized for an EMT-basic IV only if the medical director or a preceptor designated by the medical director or training center medical director is present and giving direction.
(5) DURATION OF PERMIT. An EMT-basic or EMT-basic IV training permit shall be issued for 2 years and may not be extended or renewed. A new EMT-basic training permit can be granted if the applicant enrolls in an EMT-basic course and successfully completes the first 46 hours of that course. A new EMT-basic IV training permit can be granted if the applicant enrolls in an EMT-basic IV course and successfully completes the classroom portion of the course.
Note: Copies of the form required to apply for issuance of an EMT-basic
or EMT-basic IV training permit are available without charge from the EMS Systems and Licensing Section, Division of Public Health, P.O. Box 2659, Madison, WI 53701-2659 or download the form from the DHFS website at
www.dhfs.state.wi.us/DPH_EMSIP/index.htm.
SECTION 10. HFS 110.07 (1) (c) 6m. and 6r. are created to read:
HFS 110.07 (1) (c) 6m. Identification and a listing of the qualifications of each person who will function as preceptor of EMT-basic IV field training, with specifications of that person's responsibilities. A copy of the preceptor's resume shall be kept on file at the training center and made available to the department upon request. The preceptor shall comply with all of the following:
a. Be licensed to at least the EMT-basic IV level. Physicians, registered nurses and physician assistants, with training and experience in the pre-hospital emergency care of patients, shall be considered to be trained to at least the EMT-intermediate level.
b. Have a minimum of 2 years experience as a licensed practicing EMT-basic IV or equivalent as determined by the department and be designated by the service medical director.
c. Have responsibility for completing records of the field training of EMT-basic IV students and forwarding them to the training center.
6r. Documentation that field training for EMTs-basic IV will be provided by a Wisconsin licensed EMT-basic IV ambulance provider or providers as evidenced by the signatures of the training center representative, training center medical director and the medical director and operator for all ambulance service providers agreeing to provide supervised field training. A copy of the signed agreement shall be kept on file at the training center and made available to the department upon request.
SECTION 11. HFS 110.07 (3) (b) (intro.) is amended to read:
HFS 110.07 (3) (b) Application for initial course approval at the EMT-basic or EMT-basic IV level shall be made by submitting to the department a statement that all sections of the national standard curriculum and department standards for training EMTs-basic in advanced skillsor EMTs-basic IV will be used and which identifies the number of hours devoted to classroom training and supervised clinical or field experience. Applications for approval of an initial course from a Wisconsin technical college system district shall be jointly reviewed by the department and the Wisconsin technical college system board. An application for initial course approval shall include all of the following:
SECTION 12. HFS 110.09 (1) (intro.), (2) (a) and (6) are amended to read:
HFS 110.09 Enforcement. (1) DENIAL OF LICENSE, AUTHORIZATION, PERMIT OR CERTIFICATION; NONRENEWAL; SUSPENSION; REVOCATION; OR REPRIMAND OF LICENSEE, PERMIT HOLDER, CERTIFIED TRAINING CENTER OR CERTIFIED EMT-BASIC OR EMT-BASIC IV INSTRUCTOR-COORDINATOR. The department may deny, refuse to renew, suspend or revoke an ambulance service provider license, an EMT-basic or EMT-basic IV license, an authorization for an EMT-basic or EMT-basic IV to use advanced skills, an EMT-basic or EMT-basic IV training permit, a training center certification or an EMT-basic or EMT-basic IV instructor-coordinator certification or reprimand a licensee, permit holder, certified training center or certified EMT-basic or EMT-basic IV instructor-coordinator after providing the applicant, ambulance service provider, EMT-basic or EMT-basic IV licensee, EMT training permit holder, certified training center or certified EMT-basic or EMT-basic IV instructor-coordinator with written notice of the proposed action and written notice of opportunity for a hearing under sub. (5) if the department makes a finding of any of the following:
(2) EMERGENCY SUSPENSION OF LICENSE, PERMIT OR CERTIFICATION. (a) The department may summarily suspend an ambulance service provider license, EMT-basic or EMT-basic IV license, authorization for an EMT-basic or EMT-basic IV to use advanced skills, EMT-basic
or EMT-basic IV training permit, training center certification or EMT-basic or EMT-basic IV instructor-coordinator certification when the department has probable cause to believe that the licensee, permit holder, certified training center or certified EMT-basic or EMT-basic IV instructor-coordinator has violated the provisions of s.
146.50, Stats., or this chapter, and that it is necessary to suspend the license or permit immediately, without advance written notice, to protect the public health, safety or welfare.
(6) REPRIMANDS. The department may reprimand a licensee, permit holder, certified training center or certified EMT-basic or EMT-basic IV instructor-coordinator if the department finds that the licensee, permit holder, certified training center or certified EMT-basic or EMT-basic IV instructor-coordinator falls within any of the circumstances specified in sub. (1) (a) to (h). The department's issuance of the reprimand shall constitute the final decision of the department and is not subject to a hearing under sub. (5).
Fiscal Estimate
This order revises the Department's rules for licensing emergency medical technicians-basic IV (EMTs-basic IV ). Specifically, these rules are amended to correct the omission of requiring an EMT-basic IV training permit for providers. Although an exact estimate is currently not possible, it is projected that approximately 50 to 100 ambulance service providers will apply for this license level over the course of the 2001-03 biennium. Currently, the specified training permit process is in effect for all other EMT license levels, e.g., EMT-Intermediate and EMT-paramedic. Consequently, this change will not place new responsibilities on providers or individual applicants.
Under the proposed revisions, Department staff will have minimal additional workload to process the EMT-basic IV training permits. As a result, it is projected that the proposed revisions will have no fiscal impact on the expenditures or revenues of state government or local governments.
Initial Regulatory Flexibility Analysis
The rule changes will not affect small businesses as defined in s.
227.114 (1) (a), Stats.
Notice of Hearing
Commissioner of Insurance
