Feed for /code/register/2006/606a/rulemaking_notices
The proposed rule will have no economic impact on small business.
Fiscal Estimate
The proposed rule will have no fiscal impact.
Contact Person
The agency contact person is Peter G. Davis, General Counsel, Wisconsin Employment Relations Commission. (608 266-2993 /peter.davis@werc.state.wi.
Notice of Hearings
Health and Family Services
NOTICE IS HEREBY GIVEN that pursuant to ss. 49.498 (14), 50.02 (1), (2) (a), (b) 2., (bm), (bn), (d), and (3) (a) to (d), 50.03 (4) (a) 1. a., 50.095 (3) (am), 50.098, and 227.11 (2) (a), Stats. and interpreting ss. 49.498, 49.499, 50.02 (1), 50.03, 50.04, 50.05, 50.065, 50.07, 50.09, 50.095, 50.135, and 50.14, Stats., the Department of Health and Family services proposes to repeal, renumber, renumber and amend, amend, and create rules relating to nursing homes and affecting small businesses.
Hearing Date(s) and Location(s)
Date and Time
Location
July 24, 2006
9:00 a.m. to 3:00 p.m.
Southeastern Regional Office
819 North 6th Street, Room 40
Milwaukee, WI
July 25, 2006
9:00 a.m. to 3:00 p.m.
Wilson Street State Office Building
1 West Wilson Street, Room 751
Madison, WI
July 26, 2006
9:00 a.m. to 3:00 p.m.
Northeastern Regional Office
200 North Jefferson Street
Room 152 A
Green Bay, WI
July 28, 2006
9:00 a.m. to 3:00 p.m.
Northern Regional Office
2187 North Stevens Street
Large Conference Room
Rhinelander, WI
July 31, 2006
9:00 a.m. to 3:00 p.m.
Western Regional Office
610 Gibson Street, Room 123
Eau Claire, WI
The hearing site is fully accessible to people with disabilities. If you are hearing impaired, do not speak English or have circumstances that might make communication at a hearing difficult; you require an interpreter or a non-English large print or taped version of the proposed rules, contact the person at the address or telephone number given below at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.
Place Where Written Comments May be Submitted
Written comments may be submitted at the public hearing or submitted to the Department using the Wisconsin Administrative Rule Website at http://adminrules.wisconsin.gov . Comments may also be submitted to Otis Woods, Director, Department of Health and Family Services, Bureau of Quality Assurance, 1 West Wilson, Room 1150, P.O. Box 2969, Madison, WI 53701-2969, phone: (608) 267-7185, fax: (608) 267-0352, e-mail: Woodsol@dhfs.state.wi.us.
Deadline for Comment Submission
The deadline for submitting comments to the Department is 4:30 p.m. on August 1, 2006.
Analysis Prepared by the Department of Health and Family Services
Nursing homes are regulated by the Department under ch. HFS 132, ch. 50, Stats., and, if a nursing home participates as a provider in the Medicaid and Medicare programs, the nursing home is also regulated by the Department under 42 CFR 483. Nursing home construction and remodeling is regulated by the Department of Commerce under chs. Comm 61 to 65, the Commercial Building Code. Many of the provisions in ch. HFS 132 are outdated and overly prescriptive, or are duplicative of ch. 50, Stats., 42 CFR 483, or chs. Comm 61 to 65. Through this rulemaking order the Department proposes to repeal or revise outdated or overly prescriptive rule provisions, and to repeal provisions that are duplicative of the requirements that are already stated in and monitored under ch. 50, Stats., 42 CFR 483, or chs. Comm 61 to 65.
In addition, the Department also proposes to create rule provisions requiring applicants for nursing home licensure to disclose the qualifications of any person with authority to manage the nursing home; any occurrences that required closure of a residential or health care facility or that required moving its residents; and any financial difficulties that a person or business entity connected with the nursing home has had in operating a residential or health care facility. The Department further proposes to create a quality assurance and improvement committee to distribute funds as allowed under ss. 49.499 (2m), Stats., to nursing homes for innovative projects that improve the efficiency and cost effectiveness of operating a nursing home and that improve the quality of life of residents.
The Department believes that the proposed revisions to ch. HFS 132 will not have an adverse effect on the health, safety, and welfare of existing or future residents of nursing homes as provisions that the Department believes provide greater protection of the health, safety, and welfare of residents than either ch. 50, Stats., 42 CFR 483, or chs. Comm 65 to 66 are retained. The additional application requirements are not expected to result in any increase in costs and the proposed removal of outdated, prescriptive, and duplicative provisions from ch. HFS 132 will make it easier for nursing homes to achieve compliance and provide care to residents in a cost effective manner and ensure residents are protected from unanticipated closures due to financial instability of nursing home licensees and in fact lower costs. The proposed creation of the quality assurance committee and subsequent distribution of funds under s. 49.499 (2m), Stats., is expected to not only improve residents quality of life in nursing homes, but is expected to stimulate innovation and competition within and among nursing homes in a way that will result in the highest quality care to residents.
The proposed removal of outdated, overly prescriptive, or duplicative provisions include provisions relating to residents rights, community organization access, general medical records requirements, oxygen use, resident care planning, medical services, certain dietary standards related to sanitation, meal services and staff hygiene, pharmacy consultant, diagnostic services, emergency dental services, social worker qualification requirements, activity staffing requirements, certain active treatment requirements, requirements regarding short-term care admissions, general housekeeping and maintenance items, building requirements relative to corridor width, doors, locks, exit stairways, oxygen storage services, mechanical systems such as sewage, plumbing, telephone, lighting and ventilation, and certain design areas such as windows, bed capacity, grab bars, dining and activity areas, design of the food service area and ancillary areas. As indicated above, these requirements duplicate other rules or are outdated or overly prescriptive.
The Department proposes to retain provisions that the Department believes provide greater protection of the health, safety, and welfare of residents than either ch. 50, Stats., 42 CFR 483, or chs. Comm 65 to 66 or those that are not addressed in other law or regulations, including provisions relating to the following:
Rules requiring a facility to notify residents of basic services and fees, and practice nondiscriminatory treatment based on pay source were kept as these regulations afford residents greater protection that was not available in either ch. 50, Stats., or federal regulation.
Rules pertaining to locked units were retained as no other regulations address this issue.
Rules pertaining to the nursing home administrator were retained. Although federal regulations address this requirement, ch. HFS 132 is more prescriptive requiring the administrator be full-time and requiring prompt notice to the Department when a vacancy occurs.
Rules addressing admissions of residents who are developmentally disabled, under the age of eighteen and day care clients were also kept as no other rules govern their care.
Rules relating to involuntary discharge. In this area, ch. HFS 132 provides greater protection for residents.
Rules requiring the provision of basic nursing care. These provisions reflect a basic standard of practice not found in other regulations.
Several nurse staffing rules. There are no comparable federal standards. Chapter HFS 132 requires a registered nurse to be on duty based on the number of residents in need of skilled nursing care.
Provisions relating to pharmacy services were also retained because there is no federal counterpart.
Requirements were also kept for specific resident care equipment such as mattresses, pillows, linens, over bed tables, window coverings, etc., as the federal regulations are too broad.
Rules requiring a disaster plan and training for staff were maintained because there is no federal counterpart.
Effect on Small Business (Initial Regulatory Flexibility Analysis)
The Department licenses approximately 340 private and 60 government owned nursing homes to accept patients with specific categories of health care needs. Skilled nursing facilities (SNFs) and intermediate care facilities (ICFs) provide primarily medical care to restore individuals to their rehabilitative potential. Institutions for mental diseases (IMDs) serve residents with psychotic and nonpsychotic mental illness. Ninety percent of these homes are skilled nursing facilities that generally have a permanent core staff of registered or licensed practical nurses and other staff who provide the elderly, and other individuals, with nursing and personal care services that include assistance with activities of daily living such as bathing, toilet use, eating and dressing, skin care, rehabilitative services for mental illness, and special treatment such as tracheostomy care, ostomy care, respiratory treatment, and tube feedings. Analysis of the data compiled in the Wisconsin Department of Health and Family Services, Division of Public Health, Bureau of Health Information and Policy Wisconsin Nursing Homes and Residents, 2004 (PPH 5374-04) September 2005 suggests that at least 40% of all licensed facilities have 85 or fewer beds and average gross annual revenues below $5 million assuming a 100% occupancy rate and annual per bed charges of $56,000. Approximately 81% of these beds are in privately owned facilities. The department approximates, however, that only about 10% of the privately owned facilities meet the definition of small business because some of these facilities are part of large corporations owning several facilities and employing more than 25 employees.
Through this rulemaking order the Department proposes to do the following:
Repeal or revise outdated or overly prescriptive rule provisions;
Repeal provisions that are duplicative of the regulations that are already stated in and monitored under ch. 50, Stats., 42 CFR 483, or chs. Comm 61 to 65;
Create rule provisions requiring applicants for nursing home licensure to disclose, in the application, the qualifications of any person with authority to manage the nursing home; any occurrences requiring closure of a residential or health care facility and relocating its residents; and any financial difficulties that a person or business entity connected with the nursing home has had in operating a residential or health care facility; and
Create a quality assurance and improvement committee to distribute funds as allowed under ss. 49.499 (2m), Stats., to nursing homes for innovative projects that improve the efficiency and cost effectiveness of operating a nursing home and that improve the quality of life of residents.
The Department does not expect the new application requirements to result in any increase in costs and believes that the proposed removal of outdated, prescriptive, and duplicative provisions from ch. HFS 132 will make it easier for nursing homes to achieve and maintain compliance, provide care to residents, and ensure that residents are protected from unanticipated closures due to financial instability of nursing home licensees. The proposed creation of the quality assurance committee and subsequent distribution of funds under s. 49.499 (2m), Stats., is expected to not only improve residents quality of life in nursing homes, but is expected to stimulate innovation and competition within and among nursing homes in a way that will result in cost effective, high quality care to residents.
Pursuant to criteria adopted by the Department, the proposed rule may affect a substantial number of small businesses because at least 10% of the nursing homes affected by the proposed rules may be considered small businesses. However, the proposed rules will not have a significant economic impact on these nursing homes because the proposed rules do not include increased reporting, design or operational standards, or capital requirements and none of the proposed changes are expected to increase operating expenditures, including annualized capital expenditures, or reduce revenues by more than the 2005 consumer price index (CPI) of 3.4%. Any costs that may be associated with the additional application requirements most likely will not meet or exceed the 2005 CPI. The proposed removal of outdated, prescriptive, and duplicative provisions are expected to lower costs for all nursing homes.
Therefore, the Department concludes that the proposed rules may affect a substantial number of small businesses that are nursing homes, but the proposed rules will not have an adverse significant economic impact on those businesses.
Small Business Regulatory Coordinator
Rosie Greer
608-266-1279
Fiscal Estimate
The proposed rules will not affect state or local government costs and will not have a significant economic impact on the private sector.
Obtaining Copies of Rules and Fiscal Estimate
A copy of the full text of the rules and the fiscal estimate can be obtained at no charge from the Wisconsin Administrative Rules Website at http://adminrules.wisconsin.gov or by contacting the contact person listed below.
Contact Person
Otis Woods, Director
Department of Health and Family Services
Bureau of Quality Assurance
1 West Wilson, Room 1150
P.O. Box 2969
Madison, WI 53701-2969
phone: (608) 267-7185, fax: (608) 267-0352
Notice of Hearing
Natural Resources
(Fish, Game, etc.)
NOTICE IS HEREBY GIVEN that pursuant to ss. 23.09 (2) (intro.), 23.091, 23.11 (1), 23.22 (2) (b) 1., 23.28 (3), 27.01 (2) (j) and 227.11 (2) (a), Stats., interpreting ss. 23.09 (2) (intro.), 23.091, 23.11 (4), 23.17, 23.175, 23.22 (2) (a), 23.28 (3), 23.293, 27.01 (2) (i) and (j) and 28.04 (2), Stats., the Department of Natural Resources will hold a public hearing on the creation of s. NR 45.04 (1) (g), Wis. Adm. Code, relating to the regulation of firewood entering and exiting Department lands. The rule prohibits a person from possessing firewood that originates from greater than 50 miles from the campground on that property where the wood would be used, or the property itself if there is no campground, or from outside the borders of the state of Wisconsin. Firewood from sources approved by the Wisconsin Department of Agriculture, Trade and Consumer Protection is allowable. Firewood includes all wood, processed or unprocessed, meant for use in a campfire. The purpose of this rule is to regulate firewood entering properties managed by the Department to reduce the risk of introduction and spread of emerald ash borer and other invasive insects and diseases of trees.
NOTICE IS HEREBY FURTHER GIVEN that pursuant to s. 227.114, Stats., the proposed rule may have an impact on small businesses. The initial regulatory flexibility analysis is as follows:
a. Types of small businesses affected: Any small business that sells firewood for use on state lands
b. Description of reporting and bookkeeping procedures required: Any recordkeeping procedures for small business will be established by the Department of Agriculture, Trade and Consumer Protection
c. Description of professional skills required: None
The Department's Small Business Regulatory Coordinator may be contacted at SmallBusiness@dnr.state.wi.us or by calling (608) 266-1959.
NOTICE IS HEREBY FURTHER GIVEN that the hearing will be held on:
Wednesday, July 5, 2006 at 7:00 p.m.
Video conference participation will be available at:
Room MAC137, UW-Green Bay
2420 Nicolet Drive
Green Bay
Room 227, Pyle Center
702 Langdon Street
Madison
Room 220, UW-Wausau
518 South 7th Avenue
Wausau
NOTICE IS HEREBY FURTHER GIVEN that pursuant to the Americans with Disabilities Act, reasonable accommodations, including the provision of information material in an alternative format, will be provided for qualified individuals with disabilities upon request. Please call Dr. Andrea Diss Torrance at (608) 264-9247 with specific information on your request at least 10 days before the date of the scheduled hearing.
Fiscal Estimate
This rule regulates the movement of firewood into department properties to reduce the risk of introduction and spread of emerald ash borer (EAB) and other invasive pests and diseases of trees. This rule would prohibit firewood from sources greater than 50 miles from the campground or from outside the boundaries of the state of Wisconsin from entering Department properties. Firewood from sources approved by the WI DATCP would be allowable. Workload to institute this rule includes:
development of criteria for allowable firewood with DATCP;
asking if firewood is being brought into the campsite and from where during the check in process;
confiscating and destroying prohibited firewood, estimated increase in LTE costs of $1,050 (1 hour per day, 7 days per week for 15 weeks) annually for 8 major state parks = $8,400 (the Department will have a better estimate of this workload later in the summer of 2006 with the implementation of the emergency rule and the results of a survey of instate campers on their transport of firewood);
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