Hearing Date, Time and Location
Date: Tuesday, January 29, 2002
Time: 10:0 p.m.
Location: State Office Building
1 West Wilson Street
Conference Room 372
Madison, Wisconsin
Appearances at the Hearing
The hearing site is fully accessible to people with disabilities. Parking for people with disabilities is available in the parking lot behind the building or in the Doty Street Parking Ramp. People with disabilities may enter the building directly from the parking lot at the west end of the building or from Wilson Street through the side entrance at the east end of the building.
Analysis Prepared by the Department of Health and Family Services
The State of Wisconsin in 1981 established a Health Insurance Risk-Sharing Plan (HIRSP) for the purpose of making health insurance coverage available to medically uninsured residents of the state. HIRSP health insurance coverage includes prescription drug coverage. Two major and longstanding issues affect HIRSP prescription drug coverage.
The first issue is that pharmacies currently have difficulty determining the financial liability of HIRSP policyholders, because they do not have access to information regarding policyholder deductibles and coinsurance obligations. The second issue is that the existing HIRSP system of policyholder reimbursement for prescription drug costs is both lengthy and financially burdensome to policyholders.
The department proposes to implement new coinsurance provisions for HIRSP's drug benefit that will clarify the financial liability of HIRSP policyholders for covered prescription drug costs. The new provisions also eliminate unnecessary delays and burdens in HIRSP reimbursement for prescription drug expenses by establishing policyholders' minimum and maximum out-of-pocket costs for covered prescription drugs.
The proposed rules affect about 12,000 HIRSP policyholders statewide. The impact of these proposed rules was reviewed and approved by the HIRSP Board of Governors on September 13, 2001. By law, the Board is a diverse body composed of consumers, insurers, health care providers, small business and other affected parties.
Contact Person
To find out more about the hearing or to request a copy of the proposed rules, write or phone:
Randy McElhose
Division of Health Care Financing
P.O. Box 309, Room B274
Madison, WI 53701-0309
(608) 267-7127 or, if you are hearing impaired, (608) 266-1511 (TTY)
If you are hearing or visually impaired, do not speak English, or have other personal circumstances which might make communication at the 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 above. A person requesting a non-English or sign language interpreter should make that request 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 February 5, 2002 will be given the same consideration as testimony presented at the hearing.
Fiscal Estimate
The fiscal effect of these proposed rules was developed by an independent actuarial firm under contract to HIRSP. This fiscal effect was reviewed and approved by the HIRSP Board of Governors on September 13, 2001.
It is estimated that the proposed rule will increase HIRSP program expenditures by about $700,000, annually. These expenditures will be funded in the same manner as other HIRSP expenditures. About $420,000 (60%) of this sum will be funded by an increase in policyholder premiums. The remaining $280,000 (40%) will be shared equally between an increased HIRSP levy on health care provider rates and an increased HIRSP assessment on insurers.
An adjustment to the levy and assessment is expected to occur on July 1, 2002 as part of a routine, scheduled HIRSP rule update. A budget-based update of HIRSP rules previously occurred in 1998, 1999, 2000 and 2001. Policyholder premiums will be adjusted as new HIRSP policies are initiated or renewed. The HIRSP program has sufficient cash flow and reserves to fund this proposed rule prior to July 1, 2002, according to the independent actuarial firm under contract to HIRSP.
Initial Regulatory Flexibility Analysis
The rule changes will affect HIRSP policyholders, the Department of Health and Family Services and the Department's fiscal agent. The rule changes will not affect small businesses as “small business" is defined in s.
227.114 (1) (a), Stats. Although the program statutes and rules provide for assessment of insurers to help finance HIRSP, no assessed insurer is a small business as defined in s.
227.114 (1) (a), Stats. Moreover, s.
149.143, Stats., prescribes how the amount of an insurer's assessment to help finance HIRSP is to be determined and, similarly, how the health care provider payment rate is to be calculated.
Notice of Hearing
Pharmacy Examining Board
NOTICE IS HEREBY GIVEN that pursuant to authority vested in the Pharmacy Examining Board in ss.
15.08 (5) (b) and
227.11 (2), Stats., and s.
450.03 (1) (g), Stats., as created by
2001 Wis. Act 16, and s.
450.04 (3) (b), Stats., as amended by
2001 Wis. Act 16, and interpreting ss.
450.03 (1) (g) and
450.04 (3) (b), Stats., the Pharmacy Examining Board will hold a public hearing at the time and place indicated below to consider an order adopting emergency rules relating to a pharmacy internship program.
Hearing Date, Time and Location
Date: February 12, 2002
Time: 9:15 a.m.
Location: 1400 East Washington Avenue
Room 179A
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 Regulation and Licensing, Office of Administrative Rules, P.O. Box 8935, Madison, Wisconsin 53708. Written comments must be received by February 15, 2002 to be included in the record of rule-making proceedings.
Analysis prepared by the Department of Regulation and Licensing.
In this rule-making order the Pharmacy Examining Board creates rules relating to a pharmacy internship program to reflect statutory amendments to s.
450.04 (3) (b), Stats. effective December 31, 2001. Currently, no board rules exist to specify the requirements for the implementation and administration of a pharmacy internship program and establish necessary procedural and substantive guidelines for such a program.
SECTION 1 defines an “intern." This is necessary to maintain the distinction between the interns and technicians encompassed in Wis. Adm. Code ch.
Phar 7. Interns, with limitations, practice pharmacy. Technicians do not practice pharmacy. Five classes of interns are created. SECTION 1 also defines “direct supervision."
The first class of intern, s.
Phar 1.02 (4e) (a), defines an intern as a student who is practicing as part of a practical experience program sponsored by the student's school or college of pharmacy.
The second class of intern, s.
Phar 1.02 (4e) (b), defines a student who practices under the direct supervision of a pharmacist. This type of intern typically engages in the practice of pharmacy within the context of summer internships for no credit under a practical experience program.
The third class of intern, s.
Phar 1.02 (4e) (c), defines foreign graduates applying for original licensure who may not have completed a traditional pharmacy internship therefore needing a means to complete an internship in the practice of pharmacy in this state.
The fourth class of intern, s.
Phar 1.02 (4e) (d), defines recent graduates from an approved pharmacy school who have filed an application for licensure with the board and are awaiting board action. This class of intern may need either to obtain additional hours of internship credit to qualify for original licensure, or may be working under the direct supervision of a pharmacist while awaiting final board action on their application.
The fifth class of intern is a statutory creation, restating in the rule for clarity the provisions of s.
450.03 (1) (g), Stats. These persons have applied for a license under s.
450.05, Stats. (out-of-state licensees) and their practice of pharmacy is limited to performing duties under the direct supervision of a person licensed as a pharmacist by the board and during the period before which the board takes final action on the person's application. This class of intern is not included within the definition of “internship" because this intern does not need to satisfy an internship requirement for licensure under s.
450.05, Stats. However, a definition as an “intern" is still necessary to place such persons and their supervising pharmacists on notice of the requirements and distinctions between interns and technicians created by Wis. Adm. Code ch.
Phar 7.
An internship in the practice of pharmacy is defined to mean the completion of 1500 hours in aggregate in the practice of pharmacy in the delineated categories. Not all of the required 1500 hours need to be completed in any one category, yet a minimum of 1500 hours must be earned and certified. There are five types of categories of internship experience.
The first category is the practice of pharmacy in a practical experience program consisting of the practice of pharmacy sponsored by a professional Bachelor's of Science degree in pharmacy or Doctor of Pharmacy degree granting institution located in this or another state.
The second category is the practice of pharmacy by a qualified student under the direct supervision of a pharmacist. The hours earned in this category may not count as a part of a practical experience program if previously credited therein. Hours earned in this second category are therefore considered in addition to the hours earned in the practical experience program.
The third category allows foreign graduate applicants applying for original licensure to earn internship credits to qualify for original licensure. This internship is limited to a maximum of 2000 hours of credit earned at which time the internship is deemed ended. The applicant may not then further engage in the practice of pharmacy until such time a license is granted by the board.
The fourth category allows applicants for original licensure awaiting board action on their application to practice pharmacy under the direct supervision of a pharmacist during the pendancy of their application. This internship is limited to a maximum of 1500 hours of credit earned at which time the internship is deemed ended. The applicant may not then further engage in the practice of pharmacy until such time a license is granted by the board.
The fifth category is created by statute at s.
450.04 (3) (b), Stats. The statute allows the board to grant credit for practical experience acquired in another state which is comparable to include in an internship and which is approved and verified by the board or by the agency which is the equivalent of the board in the state in which the practical experience was acquired. In determining comparable practical experience the board shall consider the duties performed constituting the practice of pharmacy as described in s.
450.01 (16), Stats.
SECTION 3 creates the definition of a “supervising pharmacist" who supervises an intern in the practice of pharmacy.
SECTION 4 amends the requirement for original licensure removing the statutory reference to Wis. Stats. s. 450.045, which was repealed.
SECTIONS 5 and 6 amend the required proofs necessary to evidence the successful completion of an internship in the practice of pharmacy and the payment of fees under that section.
TEXT OF RULE
SECTION 1. Phar 1.02 (3c) and (4c) are created to read:
Phar 1.02 (3c) “Direct supervision" means immediate on premises availability to continually coordinate, direct and inspect at first hand the practice of another.
SECTION 2. Phar 1.02 (4e) is created to read:
Phar 1.02 (4e) “Internship in the practice of pharmacy" means completion of a minimum of 1500 hours in aggregate of any one or more of the following:
(a) A practical experience program consisting of the practice of pharmacy sponsored by a professional bachelor's of science degree in pharmacy or doctor of pharmacy degree granting institution located in this or another state.
(b) The practice of pharmacy by a person who has successfully completed his or her second year in and is enrolled at a professional bachelor's of science degree in pharmacy or doctor of pharmacy degree granting institution located in this or another state whose practice of pharmacy is limited to performing duties under the direct supervision of a supervising pharmacist, which is not acquired in a practical experience program described in par. (a). The supervising pharmacist shall keep a written record of the hours and location worked by an intern under his or her direct supervision.
(c) For a person who has first filed an application with the board for original licensure under s.
Phar 2.02 and has supplied to the board evidence of having obtained certification by the foreign pharmacy graduate examination committee, the practice of pharmacy which is limited to performing duties under the supervision of a supervising pharmacist. Prior to performing duties as an intern or to receiving credit for hours in an internship in the practice of pharmacy under this section, the supervising pharmacist shall be disclosed in the initial application and any change of a supervising pharmacist shall be disclosed to the board prior to further performing duties constituting the practice of pharmacy as an intern. Upon completing a maximum of 2000 hours of the practice of pharmacy under this paragraph the internship is terminated and a person shall not further engage in the practice of pharmacy until obtaining licensure from the board.
(d) For a person who has first filed an application with the board for original licensure under s.
Phar 2.02 and has supplied to the board evidence of having been graduated from a professional bachelor's of science degree in pharmacy or doctor of pharmacy degree granting institution located in this or another state, the practice of pharmacy which is limited to performing duties under the supervision of a supervising pharmacist. Prior to performing duties as an intern or to receiving credit for hours in an internship in the practice of pharmacy under this section, the supervising pharmacist shall be disclosed in the initial application and any change of a supervising pharmacist shall be disclosed in the initial application and any change of a supervising pharmacist shall be disclosed to the board prior to further performing duties constituting the practice of pharmacy as an intern. Upon completing a maximum of up to 2000 hours of the practice of pharmacy under this paragraph, the internship is terminated and a person shall not further engage in the practice of pharmacy until obtaining licensure from the board.
(e) Practical experience acquired in another state which is comparable to that described in par. (a). In determining comparable practical experience the board shall consider the duties performed constituting the practice of pharmacy as described in s.
450.01 (16), Stats.
SECTION 3. Phar 1.02 (14m) is created to read:
Phar 1.02 (14m) “Supervising pharmacist" means a pharmacist who has responsibility for supervising an intern in the practice of pharmacy.
SECTION 4. Phar 2.01 (2) is amended to read:
Phar 2.01 (2) Has completed an internship program approved by the pharmacy internship under s.
450.045, Stats in the practice of pharmacy.
SECTION 5. Phar 2.02 (1) (d) is renumbered Phar 2.02 (1) (e).
SECTION 6. Phar 2.02 (1) (d) is created to read:
Phar 2.02 (1) (d) Evidence of having completed an internship in the practice of pharmacy which shall consist of one or more of the following:
1. A statement from the dean of the school of pharmacy or the academic records office of the respective educational institution certifying the number of hours that the applicant has successfully completed in a practical experience program described in s.
Phar 1.02 (4e) (a).
2. A statement from a supervising pharmacist certifying the number of hours that the applicant was supervised by that supervising pharmacist in an internship in the practice of pharmacy described in s.
Phar 1.02 (4e) (b),
(c) and
(d).
3. Verification of practical experience acquired by the applicant in another state as described in s.
Phar 1.02 (4e) (e), which is approved and verified by the board or by the agency which is the equivalent of the board in the state in which the practical experience was acquired.
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
