July 8, 2004 NERO Room 152 A
Thursday 200 N. Jefferson Street
10:00 a.m. to 1:00 p.m. Green Bay, WI
The hearing sites are fully accessible to people with disabilities. If you are hearing or visually impaired, do not speak English, or have circumstances that 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 given above at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.
Written comments, on both the proposed permanent rules and the emergency rules, may be submitted in lieu of attending a public hearing, by regular mail or email to the contact person listed below. Written comments for the proposed permanent rules and the emergency rules may also be submitted using the Wisconsin Administrative Rules website at the web address listed below.
The deadline for submitting comments on both the proposed permanent rules and the emergency rules is 4:30 p.m., July 13, 2004.
Analysis Prepared by the Department of Health and Family Services
The Department proposes to establish the scope of community-based psychosocial rehabilitation services programs, standards for certification and criteria for determining the need for psychosocial rehabilitation services, and other conditions of coverage of community-based psychosocial rehabilitation services under the medical assistance program as authorized by ss.
49.45 (30e) and
51.42 (7) (b), Stats. The Department anticipates that the rules created will complement services provided by existing community support programs under s.
51.421, Stats., by making a fuller array of mental health and substance-use and addiction disorder services potentially available to those in need in each county or tribe. The Department further anticipates that the rules will allow for the creation of a broad range of flexible, consumer-centered, recovery-oriented psychosocial rehabilitation services to both minors and adults, including elders, whose psychosocial needs require more than outpatient therapy, but less than the level of services provided by existing community support programs. Certified community-based psychosocial rehabilitation services programs that meet the requirements of s.
49.45 (30e), Stats., and the proposed ch.
HFS 36 and applicable requirements or chs.
HFS 105 and
107 may be fully or partially funded by medical assistance with county or tribal match. These programs may also coordinate with other existing funding sources.
Fiscal Estimate
This order implements a new mental health program created under s.
49.45 (30e) (b), Stats., by
1997 Wisconsin Act 27. The Act 27 provision allows counties to receive federal Medical Assistance (MA) funding for services to individuals with mental health problems that require more than outpatient services and less than Community Support Program services. Counties receive the federal funding if they supply the state match funding. These individuals with mental health problems are now being served by counties under case management services, which provide limited reimbursement from MA, with the state match provided by county and state Community Aids. Many of the case management clients require additional treatment and rehabilitation services that are not covered under the targeted case management provisions of MA. This new mental health program will allow coverage by the MA program for these services if the county elects to allocate the funding. The net effect should be an increase in federal revenue to the State and counties for providing services that are presently funded completely by Community Aids and county tax levy.
The Bureau of Quality Assurance (BQA) with the Division of Health Care Financing certifies, licenses and surveys approximately 46 kinds of health care and residential programs in the State of Wisconsin. BQA has identified the following workload and cost increases related to the implementation of this rule. Since this is a new program, BQA Program Certification staff would be required to certify county community-based psychosocial service programs to receive this new MA reimbursement. BQA estimates that an additional 72 surveys (taking 14 hours to complete) and 5 complaint surveys (taking 6.5 hours to complete), would entail an additional 1.00 FTE's worth of work at a total cost of $60,200 all funds. The costs would be split funded 25% PRO ($15,100) and 75% FED ($45,100), since certifying, licensing and surveying are considered MA-billable functions. Also, given the current number of county programs, BQA estimates that 6 counties (at most) would see a $50 fee increase. Since the Department intends to absorb the additional workload related to the implementation of this rule, this rule will not affect revenues or expenditures beyond what was already assumed in Act 27.
Effect on Small Business
There will be no adverse affect on small businesses. If psychosocial rehabilitation services currently are being provided, then the individual consumer or the county of responsibility is paying for the cost of the services. This rule will permit the county of responsibility to use their existing funds that are being expended for these services as the required match to the federal portion of Medicaid funding (federal financial participation or FFP). The increase in available funding may result in an increase in revenues for a local small business if the county and the consumer select the business as a provider of a component of the psychosocial rehabilitation services for the consumer.
For More Information
A copy of the full text of the rules and the full text of the fiscal estimate, and other documents associated with this rulemaking may be obtained, at no charge, from the Wisconsin Administrative Rules website at
http://adminrules.wisconsin.gov. At this website you can also register to receive email notification whenever the Department posts new information about this rulemaking and, during the public comment period, you can submit comments on the rulemaking order electronically and view comments that others have submitted about the rule.
A copy of the full text of the rule and the fiscal estimate may also be obtained by contacting the Department's representative listed below:
Sally Raschick
Bureau of Mental Health and Substance Abuse Services
1 West Wilson Street
P.O. Box 7851
Madison, WI 53707-7851
(608) 261-9313 or, if you are hearing impaired,
(608) 261-9314 (TTY)
Notice of Hearing
Health and Family Services
(Medical Assistance, Chs.
HFS 100—)
Notice is hereby given that, pursuant to ss.
49.688, Stats., the Department of Health and Family Services will hold a public hearing to consider revisions to ch.
HFS 109, Wis. Adm. Code, relating to operation of the SeniorCare prescription drug assistance program.
Hearing Information
The public hearing will be held:
Date & Time Location
June 30, 2004 Room 751
Wednesday State Office Building
From 10:00 AM to Noon 1 West Wilson St.
Madison WI
The hearing site is fully accessible to people with disabilities. Parking that accommodates people with disabilities is available in the parking lot behind the building, in the Monona Terrace Convention Center Parking Ramp 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
SeniorCare is Wisconsin's Prescription Drug Assistance Program for Wisconsin residents who are 65 years of age or older and who meet eligibility requirements. The Department administers the program under ch.
HFS 109.
2003 Wisconsin Act 33 revised the following cost sharing provisions of SeniorCare:
- It increased the annual enrollment fee from $20 to $30.
- It increased annual program deductibles for persons whose family income is more than 200% of the federal poverty level from $500 to $850.
Through this order, the Department proposes to revise ch.
HFS 109 to conform to these statutory changes.
Contact Person
To find out more about the hearings or to request a copy of the proposed rules, you may write, phone, or e-mail:
Alfred Matano
Division of Health Care Financing
P.O. Box 309, Room 350
Madison, WI 53701-0309
608-267-6848 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 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 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 emergency rules received at the above address no later than July 16, 2004 will be given the same consideration as testimony presented at the hearing.
Fiscal Estimate
Since the provisions of this rule have already been budgeted in Act 33 and implemented, the proposed rule will have no budgetary or fiscal effect. The FY03-05 biennial budget bill, Act 33, increased the SeniorCare enrollment fee from $20 to $30 and increased the deductible for individuals with incomes over 200% of the FPL to $850.
It is estimated that increasing the annual enrollment fee from $20 to $30 will reduce SeniorCare funding by $772,500 (-$419,200 GPR, -$353,300 FED) in FY04 and $720,900 (-$410,700 GPR, -$310,200 FED) in FY05 and increase program revenues by $772,500 PR in FY04 and $720,900 PR in FY05.
Increasing the deductible from $500 to $850 for recipients with incomes over 200% is estimated to reduce SeniorCare funding by $5,659,700 (-$4,255,400 GPR and -$1,404,300 PR) in FY04 and $8,016,500 (-$6,069,600 GPR and -1,946,900 PR) in FY05.
Initial Regulatory Flexibility Analysis
The rules for the SeniorCare program apply to the Department, to families that are applicants or recipients of the health care coverage provided by SeniorCare and to county social service or human service departments that take applications and determine eligibility for SeniorCare. The Department is proposing these rule changes pursuant to statutory changes made by the legislature through
2003 Act 33. None of these changes affect small businesses as “small business" is defined in s.
227.114 (1) (a), Stats.
Notice of Hearing
Health and Family Services
Notice is hereby given that pursuant to ss.
227.16 (1),
227.17 and
227.18, Stats., the Department of Health and Family Services (DHFS) will hold a public hearing to consider proposed changes to chapters HFS 132 and 134, relating to nursing homes and facilities for the developmentally disabled.
Hearing Information
The public hearing will be held:
Date & Time Location
June 30, 2004 Room B139, DHFS
Wednesday 1 West Wilson Street
9:00 AM – 11:00 AM Madison, WI
The hearing site is fully accessible to people with disabilities. If you are hearing or visually impaired, do not speak English, or have circumstances that 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 given below at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.
Deadline for Comment Submission
Written comments for this rule that are submitted using the Department's website or which the Department receives by mail or email to the contact person listed below, no later than 4:30 p.m., Wednesday, July 7, 2004 will be given the same consideration as testimony presented at the hearing.
Purpose of Rulemaking
This proposed rulemaking order contains a variety of revisions to ch.
HFS 132, relating to the licensure and regulation of nursing homes and ch.
HFS 134, relating to the licensure and regulation of facilities serving people with developmental disabilities. Both of these chapters have not been substantially revised for over 10 years. These administrative rule chapters have many similar requirements and both are administered by the Department's Bureau of Quality Assurance. Given the similarity of provisions in both chapters, the Department proposes to promulgate these rule modifications through a single “long-term care" facility rulemaking order.
The Department is proposing these changes for several general reasons. First, the Department wants to modify some errors and ambiguities in the existing rules that have little or no substantive effect on entities regulated under these chapters. Second, it wants to eliminate rules that have become outdated due to changes in federal regulations or related state or federal laws. Third, some existing policies in these rules need to be updated to recognize changes in service delivery and technology. For example, the proposed language for the “Resident and Staff Communication" section replaces the prescriptive requirements of the conventional hard-wired nurse call system. The new language incorporates a generic allowance to provide a means for residents to communicate with facility staff that can be activated from the residents' rooms. The Department will also be encouraging nursing facilities to adopt modern design and new program concepts by proposing to eliminate the requirement for a centralized nurse station. Another example is the Department's proposal for new standards for pain management issues. Currently, no federal regulations specifically address pain management issues. Adopting rules that reflect and expand on current knowledge in this area will facilitate a nursing home's ability to better meet the needs of its residents. Fourth, the Department wants to eliminate overly prescriptive rules where possible. Finally, the Department is striving to make the rules more reflective of and compatible with comparable federal regulations.
Statutory Authority
The Department's authority to amend and create these rules is found in s.
50.02 (2) (a), Stats.
Statutes Interpreted
Fiscal Estimate
Generally the rule changes relieve regulatory requirements, eliminate rules and expand definitions. It is assumed that easing and/or eliminating rules would have a positive effect on the regulated entity.
The proposed s.
HFS 132.46 (7) requires nursing homes to create a 'Quality Assessment and Assurance Committee' of at least 5 members to meet quarterly. This appears to add a modest administrative task however, this increase will be offset with the repealing of s.
HFS 132.65 (3) (a) that required a Pharmacy committee.
The proposed s.
HFS 132.82 and
134.82 (1) adopts the federal Life Safety Code 2000. These standards may require some facilities to make repairs/upgrades. However, the rules provide an alternative solution to avoid costs to the facilities.
The fiscal impact on small business as defined in s.
227.114 (1), Stats., is listed as having no fiscal impact on the private sector. Available department statistics show only 2 of the current 443 licensed nursing homes and FDDs as small business entities and it is indeterminate if the rule changes will affect those 2 facilities.
Effect on Small Business
The fiscal impact on small business as defined in s.
227.114 (1), Stats., will be minimal. As described previously in this order, the majority of the proposed rule revisions either eliminate rules and prescriptive language, expand and update definitions for current terminology, or ease an existing standard. In addition, no new anticipated small business impact will be associated with the parallel Wisconsin proposed adoption of the 2000 edition of the Life Safety Code.
