Scope statements
Health and Family Services
Subject
The Department of Health and Family Services proposes to amend ch.
HFS 107, relating to dental services under Wisconsin Medicaid.
Policy Analysis
The Department proposes to amend ch.
HFS 107 to clarify circumstances under which the Wisconsin Medicaid program will reimburse providers for orthodontia and certain other services provided to recipients under age 21. In s.
HFS 107.07 (2), the prior authorization subsection of the dental services section of the Medicaid Administrative Code, a revision was recently made that caused a result which was not the intention of the Department. To correct this error, the Department proposes to clarify that the Department's intent to require prior authorization for orthodontia and other services provided under early and periodic screening, diagnosis and treatment (EPSDT) services. The medical necessity of these services is determined by the Department based on information submitted by the provider. Thus, it is necessary to require prior authorization to determine the appropriateness of providing these services to an individual recipient.
Permitting the existing rule language to remain in its present form could require reimbursement for orthodontia that is not medically justified.
Statutory Authority
Section
49.45 (10) authorizes the Department to promulgate such rules as are consistent with its duties in administering medical assistance. Section
227.11 (2), Stats., gives state agencies general authority to promulgate rules that are necessary to operate its programs.
Staff Time Required
40 hours. This will include working with the Wisconsin Dental Association and the Medical Assistance Advisory Committee to ensure that adequate public input is received on the proposed rule.
Entities Affected by the Rule
Dentists who serve Medicaid recipients in Wisconsin and Wisconsin Medicaid recipients.
Comparison with Federal Regulations
Section
441.56 of Title 42 of the Code of Federal Regulations specifies the procedures and tests required to provide early and periodic screening, diagnosis and treatment (EPSDT) services to recipients.
This revision will assist the state in complying with the requirements of that provision, by specifying more clearly that the state's intent is to only cover certain services required as a result of a screening, as described in that provision. The provision of dental services to Medicaid recipients is described in
42 CFR s. 440.100. The state regulations are currently in conformance with that provision. This revision will not change that conformance.
Health and Family Services
Subject
The Department of Health and Family Services proposes to amend ch.
HFS 144, rules governing immunization of students. The proposed rule amendment would accomplish the following:
1. Add pneumococcal infection to the list of diseases in ch.
HFS 144 against which students in day care centers are to be immunized because pneumococcal conjugate vaccine has been shown to be highly effective in reducing disease among children less than 5 years of age and because the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) has recommended this vaccine for all children aged 2 through 23 months.
2. Add a new formulation of diphtheria, tetanus and pertussis (whooping cough) vaccine [tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap)] to ch.
HFS 144 Table 144.03-A because this vaccine can be given to adolescents and immunizing older students will prevent pertussis outbreaks in schools and will protect infants too young to be fully immunized. From 1986 through 2004, Wisconsin had the fifth highest incidence of pertussis in the nation. The ACIP has recommended this vaccine for all children at 11-12 years of age.
3 Add a second dose of varicella (chickenpox) vaccine to ch.
HFS 144 Table 144.03-A because two doses of the vaccine have been shown to be more effective than one dose in preventing breakthrough cases and because the ACIP has provisionally recommended two doses of this vaccine for all children 1 through 12 years of age.
4. Remove hepatitis B and varicella vaccine coverage phase-in language because these phase-in time periods have passed and the language is no longer necessary.
5. Add language stating that the Department may temporarily suspend a vaccine requirement if the ACIP determines that there is a national shortage of the vaccine because a student could not possibly obtain a required vaccine in such circumstances.
6. Revise the definition of “written evidence of immunization" to include electronic records because immunization registries used by many providers store immunization data that are accessible to schools electronically.
7. Change the language regarding release of immunization information between vaccine providers and schools or day care centers, and among providers, from discretionary to mandatory to create a clear requirement for disclosure.
Policy Analysis
Under section 252.04 (1) of the Wisconsin statutes, the Department of Health and Family Services is responsible for carrying out a statewide immunization program to eliminate mumps, measles, rubella (German measles), diphtheria, pertussis (whooping cough), poliomyelitis, and other diseases that the Department specifies by rule, and to protect against tetanus. To achieve this goal, any student admitted to a day care center, or a nursery, elementary, middle, junior or senior high school is required to present written evidence of having completed the immunizations for each vaccine required for the student's grade. The immunization requirement is waived if the student's parent, guardian or legal custodian submits a written statement to the school or day care center objecting to the immunization for reasons of health, religion or personal conviction. The most recent additions to the list of diseases against which students are to be immunized are hepatitis B (1997) and varicella (2001).
An alternative to regulatory action is promotion of these vaccine recommendations to parents and immunization providers. Allowing time to elapse between licensure of a vaccine and enacting a school requirement has traditionally allowed market forces to increase the number of immunized children. However, coverage achieved through voluntary compliance with vaccine recommendations is always lower than that achieved through regulation. After vaccine licensure and before states enacted school vaccine requirements, outbreaks of vaccine-preventable diseases continued because vaccine coverage among students was suboptimal. For example, although an effective measles vaccine was licensed in 1967, measles outbreaks involving thousands of Wisconsin children continued to occur until a school requirement was set in place in 1980.
The intended goals of the proposed rulemaking are to:
Prevent pneumococcal infections, pertussis infections and break-through varicella infections among students;
Update the rules by deleting obsolete sections and adding clarifying language; and
Create a clear requirement for disclosure of immunization information.
The proposed rules may affect students in day care centers, nursery, elementary, middle, junior or senior high schools, and their parents.
Statutory Authority
Staff Time Required
The Department will require approximately 80 hours of staff time to develop the rules. Additionally, members of the Wisconsin Council on Immunization Practices will provide input on the technical content of the rules, which may minimize needed revisions to the rules subsequently in the promulgation process.
Entities Affected by the Rule
The proposed rules may affect schools, day care centers, local health departments, medical providers and county attorney offices.
Comparison with Federal Regulations
There appear to be no existing or proposed federal regulations that address the activities to be regulated by the proposed rules.
Health and Family Services
Subject
The Department of Health and Family Services proposes to amend ch.
HFS 145, rules governing control of communicable diseases. The proposed amendment would accomplish the following:
1) Add the following eight diseases to ch.
HFS 145 Appendix A, the list of communicable diseases that must be reported to the local health officer by medical providers, health care facilities and laboratories:
a. Any illness caused by an agent that is foreign, exotic or unusual to Wisconsin, and that has public health implications
b. Influenza-associated pediatric deaths
c. Lymphocytic Choriomeningitis Virus (LCMV) infections
d. Poliovirus infection, nonparalytic
e. Severe Acute Respiratory Syndrome-associated Coronavirus (SARS-CoV)
f. Human Transmissible spongiform encephalitis (TSE)
g. Vancomycin-intermediate Staphylococcus aureus (VISA) infections and Vancomycin-resistant Staphylococcus aureus (VRSA) infections
h. Vibriosis
a. Amebiasis
b. Cat scratch disease (infection caused by Bartonella species)
c. Encephalitis, viral (other than arboviral)
d. Hepatitis non-A, non-B, (acute)
e. Reye syndrome
f. Typhus fever
a. Change Arboviral infection (encephalitis/meningitis) to Arboviral Disease
b. Change E. coli 0157:H7, and other enterohemorrhagic
E. coli, enteropathogenic E. coli, enteroinvasive
E. coli, enterotoxigenic E. coli to E. coli 0157:H7 and other Shiga toxin-producing E. coli (STEC), enteropathogenic
E. coli, enteroinvasive E. coli, and enterotoxigenic E. coli
c. Change Hepatitis E from a category I disease to a category II disease
d. Change Varicella (chickenpox) – report by number of cases only to Varicella (chickenpox)
5) Add language that states that reports of communicable diseases may be in the form of electronic transmission.
6) Cite the most recent editions of the Sexually Transmitted Diseases Treatment Guidelines and the Control of Communicable Diseases Manual.
7) Add language requiring laboratories to forward specimens to the State Laboratory of Hygiene to verify the presence or absence of a communicable disease or condition if requested by the State Epidemiologist.
8) Add language requiring laboratories to report a negative test result on a case or a suspected case to justify release from isolation or quarantine if requested by the State Epidemiologist.
Policy Analysis
Section
252.02 (1), Stats., authorizes the Department to establish systems of surveillance for communicable diseases and s.
252.02 (4), Stats., authorizes the Department to promulgate rules to prevent and control communicable diseases. The Department's surveillance system requires medical providers, health care facilities and laboratories to report the communicable diseases listed in ch.
HFS 145 Appendix A to local health departments or the state epidemiologist. At the national level, the Council of State and Territorial Epidemiologists (CSTE) recommends diseases that should be reported by adding them to the Nationally Notifiable Infectious Diseases (NNID) list. States are encouraged to establish parallel reporting requirements. The diseases CSTE places under surveillance are typically novel pathogens or those with severe manifestations whose transmission is amenable to control by public health measures. Five of the eight diseases this proposed rulemaking adds, and none of the diseases this proposed rulemaking deletes, are on the NNID list. The intended goals of the proposed rulemaking are to make communicable disease reporting requirements in Wisconsin current, consistent with CSTE recommendations and supportive of Wisconsin public health practice.
Instead of regulatory action, medical providers, health care facilities and laboratories could be asked to submit reports voluntarily. However, such reporting would be incomplete and more staff time would be required to solicit the reports. Without this proposed rulemaking, disease reporters would continue to complete and submit reports of some communicable diseases unnecessarily, national communicable disease data would not reflect diseases occurring in Wisconsin, and the rule language would be outdated.
The Department does not anticipate that there will be any adverse impact on the public from deletion of the 6 diseases from mandatory reporting.
Members of the public who may be affected by the proposed rulemaking are those who acquire one of the communicable diseases the proposed rulemaking adds. Other members of the public who may be affected are the individual's family members or other contacts who were spared infection because public health measures were applied.
Statutory Authority
Staff Time Required
The Department will require approximately 40 hours of staff time to develop the rules. Additionally, the Department will solicit comments on the rulemaking from organizations that represent such stakeholders as local health departments, medical providers, health care facilities and laboratories.
Entities Affected by the Rule
The proposed rule may affect local health departments, medical providers, health care facilities and laboratories.
Comparison with Federal Regulations
There appear to be no existing or proposed federal regulations that address the activities to be regulated by the proposed rules.
Natural Resources
Subject
Chapters
NR 10 pertaining to seasons and daily bag limits for migratory game bird hunting, NR 12 relating to wildlife damage and nuisance control, and NR 16 relating to captive wildlife.
Policy Analysis
This rule order will establish the 2007 migratory bird hunting seasons. In late July Department staff attend the Mississippi Flyway Council (MFC) Technical and Council meetings where they will receive proposed season framework options from the U.S. Fish and Wildlife Service (USFWS). Staff will then work with other states in our Flyway to develop recommendations that are voted upon by the MFC. Proposals that are passed at the MFC meeting are forwarded to the FWS for consideration by the Service Regulations Committee (SRC) in late July. Department staff will contact the FWS following the SRC meeting to obtain the latest season recommendations.
Once the USFWS's final framework is available, Department staff can summarize waterfowl status and regulation information for Wisconsin citizens. This information is presented and public comments are received from the Migratory Committee of the Conservation Congress and a public meeting (Post-Flyway Meeting) of interest groups and individuals. The following week, public hearings will be held around the state to solicit additional input. The Department then promulgates a permanent and emergency rule simultaneously in order to open the waterfowl seasons in late September.
The rule may revise procedures for permitting nuisance and damage control practices that are directed towards Canada geese as a result of federal rule changes.
Finally, the rule may add mute swans to the list of harmful wild animals in NR 16. This rule change is necessary in order to regain authority that DNR previously had to require sterilization and pinioning of captive mute swans (DNR's authority over mute swans that occur in the wild was not affected). This loss of authority occurred when the U.S. Fish & Wildlife Service removed mute swans from its list of migratory birds, a list that Wisconsin statutes had incorporated by reference.
Statutory Authority
Staff Time Required
Approximately 500 hours will be needed by the Department to develop the rule prior to and following the hearings.
Entities Affected by the Rule
These rules will impact migratory game bird hunters and those who enjoy viewing waterfowl in the state of Wisconsin, people who possess captive mute swans, and people who respond to nuisance Canada goose problems.
Comparison with Federal Regulations
Under international treaty and Federal law, migratory game bird seasons are closed unless opened annually through the USFWS regulations process. As part of the federal rule process, the service proposes a duck harvest-management objective that balances hunting opportunities with the desire to achieve waterfowl population goals identified in the North American Waterfowl Management Plan (NAWMP). Under this harvest-management objective, the relative importance of hunting opportunity increases as duck populations approach the goals in the NAWMP. Thus, hunting opportunity is maximized when the population is at or above goals. Other factors such as habitat are also considered. The Regular Canada goose season is based on the allowable Mississippi Valley Population (MVP) harvest which will be determined based on the spring breeding population goal for that population and the spring population estimate obtained from an aerial survey of the MVP breeding range. All the proposed modifications included in this rule order are consistent with these parameters and guidelines which are annually established by the Fish and Wildlife Service in
50 CFR 20.
The USFWS has proposed simplifying their permitting process for some Canada goose nuisance control practices. If Wisconsin wishes to continue allowing and monitoring nuisance control practices we may need to revise our own permitting process.
The USFWS has removed mute swans from its list of migratory birds in 50 CFR. Since Wisconsin had incorporated the federal list of migratory birds into its own captive wildlife laws by reference, mute swans must now be added to the list of harmful wild animals in NR 16 if we are to continue to enforce previously existing rules.
Agency Contact
Kent Van Horn
Migratory Birds Specialist
101 South Webster Street
PO Box 7921
Madison, WI 53707-7921
(608) 266-8841
