•HFS 120.14 (b) 2. in Section 40 to recognize the fact that data are currently reported quarterly and give the data submitter more flexibility with the timing of their submission;
•HFS 120.14 (1) (b) 4. a. in Section 40 to simplify the administration of the trading partner agreement;
•HFS 120.14 (1) (b) 4. b. in Section 40 to extend to delegated representatives of physicians accountability for failure to submit and edit data;
•HFS 120.14 (1) (b) 5. in Section 40 to correct a typographical error;
•HFS 120.14 (1) (b) 6. in Section 40 to extend to qualified vendors the prohibition of submitting data to the Department that uses specified information as patient account numbers;
•HFS 120.14 (1) (c) 2. (intro) in Section 40 to increase program operating efficiencies by allowing the Department to delete the data it receives rather than returning it to the sender;
•HFS 120.14 (1) (c) 3. and 4. in Sections 41 and 42 to put the provisions in a more appropriate order, to extend applicability of the provision to qualified vendors, and to clarify the requirements under subdivision paragraph 4. b.;
•HFS 120.14 (1) (c) 4. c. in Section 43 to eliminate a provision no longer needed after the order of section
HFS 120.14 (1) (c) 3. and
4. is reversed;
•HFS 120.14 (1) (c) 5. in Section 44 to extend applicability of the provision to persons delegated by the physician to review and verify data;
•HFS 120.14 (1) (e) 1. in Section 44 to require physicians who submit electronic claims data after 1998 to also submit their data to the Department electronically;
•HFS 120.14 (1) (e) 4. in Section 44 to correct a naming error;
•HFS 120.20 (3) (b) in Section 46 to expand applicability of open record exemptions to data covered under section
HFS 120.11 because the section contains a substantial amount of confidential communication between the physician and the Department;
•HFS 120.21 (1) (a) in Section 47 and 120.22 (1) (a) 1. in Section 48 to clarify the name of “annual hospital fiscal year survey" by adding the term "year;"
•HFS 124.05 (3) (h) [Hospitals] in Section 49 to include “in situ carcinoma of the cervix uteri" on the list of non-reportable cancers to reflect federal guidelines modified because the Centers for Disease Control determined that routine collection of such data is incomplete due to the inconsistent collection of other High Grade Neoplasia by cancer registries; moreover, the data are not comparable over time due to changing terminology and diagnostic criteria;
•HFS 124.12 (5) (b) 11. in Section 50 to conform with the policy allowing verification of medical staff orders within 72 hours instead of 24 hours, as expressed in numbered memo BQA-98-050;
•HFS 132.42 (3) (a) [Nursing Homes] in Section 51, 132.42 (4) in Section 52, 132.51 (2) (b) 1. in Section 54 and 132.52 (2) (c) in Section 55 to conform with federal Americans with Disabilities Act requirements;
•HFS 132.44 (1) (b) in Section 53 to delete reference to training requirements because training requirements are specified in both federal regulations, s.
146.40 of the Wisconsin statutes and chapter HFS 129;
•HFS 132.66 (1) (d) in Section 56 to remove an outdated restriction against physician extenders giving orders for skilled care residents for blood, lab and radiology services and thereby make it consistent with federal regulations and Department policy as expressed in numbered memo BQC-91-050;
•HFS 133.03 (8) [Home Health Agencies] in Section 57 to make reference to the Department of Administration's Division of Hearings and Appeals more accurate;
•HFS 134 (title) [Facilities for the Developmentally Disabled] in Section 58, 134.11 in Section 59, 134.12 (1) in Section 60, 134.13 (7) and (note), (12), (13) and (39) (intro) in Section 61, 134.14 (1), (2) (a) (intro) and (5m) in Section 62, 134.815 (1) and (2) (a) in Section 63, and 134.82 (title) in Section 64 to revise a name to be "people with developmental disabilities;"
•HFS 134.12 (1) in Section 60 to clarify the applicability of chapter HFS 134;
•HFS 134.13 (10) (a) in Section 61 to update the provision with current practice by cross referencing the dietitian certification requirements under section 448.78 of the Wisconsin statutes;
•HFS 134.13 (17) in Section 61 to improve the definition of “interdisciplinary team;"
HFS 144.03 (2) (b), (c) and (e) and Tables HFS 144.03-A footnotes 1. and 4. [Immunization of Students] in Section 65 to incorporate a new recommendation made by the federal Centers for Disease Control's Advisory Committee on Immunization Practices allowing a 4-day grace period for receipt of vaccines; the rule would apply only to date-specific vaccine requirements;
•HFS 145.05 (2), (3) and (4) (Note) [Control of Communicable Diseases] in Section 66 to update the applicable edition of the American Public Health Association's document “Control of Communicable Diseases Manual;"
•HFS 155 [Injury Prevention Grants] in Section 67 to repeal the a chapter concerning grants for injury prevention under section 146.56 (3) of the 1991 statutes that no longer exists in Wisconsin statutes;
•TCB 1.04 (1) (d) 1. b. [Tobacco Control Board] in Section 68 to modify the one of the Tobacco Control Board's performance -based standards; and
•TCB 1.07 (1) (a) in Section 69 to give the grant manager discretion to approve the use of grant award monies for the purchase of tobacco use cessation medications.
•By the presentation of this list, the Department is not representing that the list constitutes all possible minor errors and technical changes needed in the Department's administrative code. The Department recognizes its administrative rules frequently need changing due to periodically changing statutes, rules, federal laws and societal change. Consequently, the Department intends to continually collect and propose for promulgation non-substantive and technical rule changes as the Department learns of the need and justification for such changes.
The Department's authority to repeal and recreate these rules is found in ss.
48.67,
49.45 (10),
50.02 (2) (a),
50. 36
(1),
50.95 (1),
51.44 (5) (a),
52.02 (4),
153.75,
227.11 (2) (a),
252.02 (4),
252.04 (1),
(2) and
(10),
252.07 (11),
254.51 (3) and
255.15 (1m) (c), Stats. The rules interpret ss.
48.62,
48.66,
48.68,
48.75,
49.43 to
49.497,
50.02 (2) (a) and
(3),
50.035,
50.36 (1),
50.95 (1),
51.44,
153.05 (5) and
(8),
153.45 (3),
153.75,
252.02 (4),
252.04 (1) to
(7) and
(10),
252.07 (11) and
255.15 (1m), Stats.
Contact Person
If you have any questions about these proposed rule changes or about filing a written petition for a hearing, contact Larry Hartzke, Office of Legal Counsel, P.O. Box 7850, Madison, WI 53707-7850, 608-267-2943 or via email at
hartzlr@dhfs.state.wi.us.
This proposed rulemaking order contains a variety of minor revisions to the Department's administrative rules. These revisions have little substantive effect on those regulated by the rules. The Department is issuing these changes in a single order to conserve limited agency resources while making necessary updates and improvements in the Department's body of administrative code.
Text of Proposed Rules
SECTION 1. HFS 56.02 (2) (a) 1. is amended to read:
HFS 56.02 (2) (a) 1. A licensing agency may grant an exception to any requirement in this chapter if the licensing agency determines that the exception will not jeopardize the health, safety or welfare of the foster children, except that the licensing agency may not grant an exception to any of the following requirements: s.
HFS 56.04 (1),
(2),
(4) (a) 1.,
2.,
3., 4., 5., 8., or 9. or (b) 2., (6), (7) or (8); s.
HFS 56.05 (1) (a),
(b) 2.,
(c) 2.,
3.,
4.,
5.,
6.,
7. or
9.,
(d),
(f) or
, (3) (a)
or (4) (a); s.
HFS 56.07 (3) (a),
(4) (b),
(c),
(d), (e), (f), (g) or (h), (5) (a), (6) or (10) (a); s.
HFS 56.08 (1),
(2),
(3),
(4),
(5),
(6) (c) 1.,
2.,
3. or
4. a.,
(7) (a) 3.,
(8) (a) 1. or
2., or
(c) or
(10); s.
HFS 56.09 (1),
(2) (c),
(3),
(4) (c) or
(d),
(5),
(9),
(11) or
(12) (a),
(c) or
(d); or s.
HFS 56.11.
SECTION 2. HFS 83.05 (1) (c) is amended to read:
HFS 83.05 (1) (c) A CBRF for 21 foror more residents shall be licensed as a large CBRF.
SECTION 3. HFS 90.05 (4) (a) and (c) 1. are amended to read:
HFS 90.05 (4) PROCEDURES FOR RECEIVING AND RESOLVING COMPLAINTS ABOUT OPERATION OF THE PROGRAM. (a) 1. Any individual or organization having reason to believe that one or more requirements of this chapter or Part C and its implementing regulations, 34 CFR Pt. 303, are not being met by the department or a county administrative agency or by any other public agency or private provider involved in the early intervention system under agreement with the county administrative agency may complain to the department. The complaint shall be in writing and be signed and shall consist of a statement setting forth the complaint and the facts upon which the complaint is based. The department shall develop procedures to inform parents and other interested individuals and organizations about their right to file a complaint and how to file a complaint.
2. Complaints under subd. 1. shall not concern events that occurred more than one year before the complaint is made, except if the complainant could not have reasonably known about the event any earlier.
(c) 1. Except as provided under subd. 2., within 60 days after receiving a complaint under this subsection the department shall prepare a written decision stating the reasons for the decision, provide notice that the complainant or agency may request review of that decision by the secretary of the U.S. department of education, and forward the decision to the affected agency or agencies with a copy to the complainant.
SECTION 4. HFS 90.06 (2) (m) is repealed.
SECTION 5. HFS 90.08 (3) (b) 3. and 11. are amended to read:
HFS 90.08 (3) (b) 3. Occupational therapists
certifiedlicensed under ch.
448, Stats.;
11. Special educatorseducation teachers, including early childhood exceptionalspecial education needs (ECEEN) educatorsteachers, vision educators
teachers and hearing educatorsteachers, licensed under ch. 115, Stats., and ch. PI 3through the department of public instruction;
SECTION 6. HFS 90.10 (2) (b) (intro) is amended to read:
HFS 90.10 (2) (b) Provision of services before completing evaluation and assessment. Provision of early intervention services to an eligiblea child and the child's family may be started before the evaluation and assessment are completed if there is a clear and obvious need that can be addressed without waiting for completion of the formal evaluation and assessment and if the following conditions are met:
SECTION 7. HFS 90.11 (1) (b) 7., (3) (b), (6) (a) 4., 10., 11. and 14. are amended to read:
HFS 90.11 (1) (b) 7. Facilitating the development of transition plans under s.
HFS 90.10 (5) (h)(f).
(3) (b) With parent consent a third party may be billed for early intervention core servicesevaluation and assessment activities. The service coordinator shall ensure that the parent, prior to giving consent, is informed and understands that because of third party billing the parent may incur financial loss, including but not limited to a decrease in benefits or increase in premiums or discontinuation of the policy.
(6) (a) 4. Occupational therapists shall be certified
licensed under s. 448.963 (2)ch. 448, Stats.; and occupational therapy assistants shall be certifiedlicensed under s. 448.963 (3)ch. 448, Stats.;
10. Registered nurses shall be licensed under s.
441.06, Stats., and
within 5 years after July 1, 1992, shall have at least a bachelor's degree in nursing from an accredited institution of higher education, and licensed practical nurses shall be licensed under s.
441.10, Stats.;
11. Rehabilitation counselors shall be employed by the department's division of vocational rehabilitation as coordinators of hearing impaired services and have at least a master's degree in rehabilitation counseling or a related field;
14. Special educatorseducation teachers, including early childhood exceptionalspecial education needs (ECEEN) educatorsteachers, vision educators
teachers and hearing educatorsteachers, shall be licensed
under ch. 115, Stats., and ch. PI 3through the department of public instruction
, within 5 years after the effective date of this chapter; and
SECTION 8. HFS 90.12 (6) (e) is amended to read:
HFS 90.12 (6) (e)
Civil action. Either party aggrieved by the decision under par. (d) 4. d. may bring a civil action in state or federal court. An action filed in circuit court shall be commenced within 30 days after the date of the written decision. Pursuant to
20 USC 1439 (a) (1) and s.
51.44 (1m) and
(5) (a) 4., Stats., the court shall receive the record of the administrative hearing, shall hear additional evidence at the request of a party and, basing its decision on the preponderance of evidence, shall grant whatever relief the court determines is appropriate. Sections
227.52 to
227.58, Stats., do not apply to actions under this
paragraph
section.
SECTION 9. HFS 101.03 (49) is amended to read:
HFS 101.03 (49) “Drug index" means the list of covered legend and nonlegend drugs and medical supplies maintained and updated by the department.
SECTION 10. HFS 105.01 (3) (intro) is amended to read:
HFS 105.01 (3) GENERAL CONDITIONS FOR PARTICIPATION. In order to be certified by the department to provide specified services for a reasonable period of time as specified by the department, a provider shall truthfully, accurately, completely and in a timely manner do all of the following:
SECTION 11. HFS 105.39 (4) (b) 2. is repealed.
SECTION 12. HFS 105.39 (4) (b) 3. is renumbered HFS 105.39 (4) (b) 2.
SECTION 13. HFS 105.41 (title) and (intro) are amended to read:
HFS 105.41 Hearing aid dealersCertification of hearing instrument specialists. For MA certification, hearing aid dealersinstrument specialists shall be licensed pursuant to ss. 459.05459.01 to 459.14, Stats.
SECTION 14. HFS 105.52 (1) (L) and (2) (a) (intro), 1., 6., 7. and 8. are amended to read:
HFS 105.52 (1) (L) A certifiedregistered nurse or nurse practitioner;
(2) (a) Definition. In this subsection, “qualified professional" means and is limited to any of the following:
1. A nurse practitioner licensed as a
certifiedregistered nurse pursuant to s.
441.06, Stats., and currently certified by the American nurses' association, the national board of pediatric nurse practitioners and associates or the nurses' association of the American college of obstetricians and gynecologists' certification corporation;
6. A dieticiandietitian certified or eligible for registration by the commission on dietetic registration of the American dietetic association with at least 2 years of community health experience;
7. A certifiedregistered nurse with at least 2 years of experience in maternity nursing or community health services or a combination of maternity nursing and community health services;
8. A social workerAn employee with at least a bachelor's degree and 2 years of experience in a health care or family services program; or
SECTION 15. HFS 105.53 (3) (a) 3. and 4., (c) 1. and (6) (b) are amended to read:
HFS 105.53 (3) (a) 3. Documentation used to develop the recipient's IEP or IFSP and to annually revise the IEP or IFSP; and
4. Annual documentation of the individual's progress toward treatment goals identified in the IEP or IFSP, changes in the individual's physical or mental status and changes in the treatment plan identified in the IEP or IFSP.
(c) 1. For each service provided, a brief description of the recipient's response to the service and progress toward the treatment goals identified in the IEP or IFSP; and
(6) (b)
Coordination with fee–for–service providers. When a recipient receives similar services from both an MA fee–for–service provider and a school–based service provider, the school–based service provider shall document, at least annually, regular contacts with the MA fee–for–service provider, and provide the MA fee–for–service provider with copies of the recipient's IEP
or IFSP and relevant components of the multidisciplinary team evaluation under s.
115.80 (3) and
(5), Stats., upon request.
SECTION 16. HFS 106.03 (2) (c) and (4) (b) and (c) are amended to read:
HFS 106.03 (2) (c) Whether submitted directly by the provider, by the provider's billing service or by another agent of the provider, the truthfulness, completeness, timeliness and accuracy of any claim are the sole responsibility of the provider.
(4) (b) Where the service requiring prior authorization was provided before the recipient became eligible, and the provider applies to and receives from the department retroactive authorization for the service; or
(c) Where time is of the essence in providing a service which requires prior authorization, and verbal authorization is obtained by the provider from the department's medical consultant or designee. To ensure payment on claims for verbally–authorized services, the provider shall retain records which show the time and date of the authorization and the identity of the individual who gave the authorization, and shall follow–up with a written authorization request form attaching documentation pertinent to the verbal authorization.; or
SECTION 17. HFS 106.06 (8) and (25) are amended to read:
HFS 106.06 (8) CRIMINAL CONVICTION. The provider has been convicted of a criminal offense related to providing or claiming reimbursement for services under medicare or under this or any other state's MA program. In this subsection, “convicted" means that a judgment of conviction has been entered by a federal, state or local court has found the provider guilty, irrespective of whether a judgment of conviction has been entered or an appeal from that judgment is pending;
(25) REFUSAL TO REPAY ERRONEOUS PAYMENTS. The provider has failed to repay or has refused to repay amounts that have been determined to be owed the department either under s.
HFS 106.04 (5) or 108.02 (9) or pursuant to a judgment of a court of competent jurisdiction, as a result of erroneous or improper payments made to the provider under the program;
SECTION 18. HFS 107.02 (2m) (a) 10. and (c) are amended to read:
HFS 107.02 (2m) (a) 10. Drugs, except when prescribed by a nurse practitioner under s.
HFS 107.122,
or a podiatrist under s.
HFS 107.14 or an advanced practice nurse prescriber under s. HFS 107.10;
(c) A prescription for specialized transportation services
for a recipient not declared legally blind or not determined to be permanently disabled shall include an explanation of the reason the recipient is unable to travel in a private automobile, or a taxicab, bus or other common carrier.
TheA prescription
for a recipient not declared legally blind or not determined to be indefinitely disabled, as defined under s. HFS 107.23 (1) (c) shall specify the length of time for which the recipient shall require the specialized transportation, which may not exceed 90 days.
SECTION 19. HFS 107.10 (1) and (note) are amended to read:
HFS 107.10 Drugs. (1) COVERED SERVICES. Drugs and drug products covered by MA include legend and non–legend drugs and supplies listed in the Wisconsin medicaid drug index which are prescribed by a physician licensed under s.
448.04, Stats., by a dentist licensed under s.
447.05, Stats., by a podiatrist licensed under s.
448.04, Stats., or by an optometrist licensed under ch.
449, Stats.,
by an advanced practice nurse prescriber licensed under s. 441.16, Stats., or when a physician delegates
prescription
the prescribing of drugs to a nurse practitioner or to a physician's assistant certified under s.
448.04, Stats., and the requirements under s.
N 6.03 for nurse practitioners and under s.
Med 8.08 for physician assistants are met.
