Notice of Hearings
Notice is hereby given that pursuant to Sections
50.49 (2) (a) and
(b) and
227.11 (2) (a), Stats., and interpreting Section
50.49, Stats., the Wisconsin Department of Health and Family Services proposes
to renumber HFS 133.02 (1);
to amend HFS 133.02 (4) and (11), 133.03 (3) (Note), (5), and (8) (Note), 133.03 (4) (b) 3., 133.05 (2) (b) 1., 133.06 (4) (d) 1. and 3., 133.08 (2) (a), 133.09 (1), (3) (a) 1. 2. and 3. b. and c., and (b), 133.13, 133.14 (2) (c) and (g), 133.15 (1), 133.16, 133.17 (1) and (3), 133.20 (title), (1), (3), and (4) and (title), 133.21 (5) (d), (e), (h) and (i);
to repeal and recreate HFS 133.06 (4) (d) 2., 133.08 (2) (intro.), 133.09 (2), 133.18; and to
create HFS 133.02 (1), (1e), (1s), and (10m), 133.03 (3) (i), 133.06 (4) (d) Note, (g) and (5), 133.08 (2) (i) and (j), rules relating to home health care agencies and affecting small businesses.
Hearing Information
July 18, 2007 Western Regional Office
11:00 am. to 610 Gibson St., Rm. 123
1:00 p.m. Eau Claire, WI 54701-3687
July 19, 2007 Waukesha State Office Bldg.
10:00 a.m. to 141 N.W. Barstow St., Rm 325
12:00 p.m. Waukesha, WI 53188
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 contact person listed below. Comments may also be made using the Wisconsin Administrative Rule Website at
http://adminrules.wisconsin.gov.
Deadline for Comment Submission
The deadline for submitting comments to the Department is 4:30 p.m. on July 26, 2007.
Analysis Prepared by the Department of Health and Family Services
The Department regulates home health agencies under ch.
HFS 133, s.
50.49, Stats., and
42 CFR 484 to enforce standards for the care, treatment, health, safety, welfare and comfort of patients by home health agencies and for the maintenance and operation of home health agencies. Through this rulemaking initiative, the Department proposes to amend ch.
HFS 133 by eliminating or modifying rules that are overly prescriptive or inconsistent with federal certification regulations under
42 CFR 484. The Department proposes to update ch.
HFS 133 by doing the following:
1. Clarifying provisions under s.
HFS 133.08 (2) relating to patient rights and charges for services.
2. Requiring registered nurse (RN) supervisory visits to the homes of patients who receive skilled nursing care to be made every 2 weeks instead of every 2 months. The existing requirement relating to supervisory visits to patients who do not receive skilled nursing care or skilled services is unchanged.
3. Stating the criteria that the Department will use when determining, under s.
50.49 (6) (a), Stats., whether an applicant or home health agency licensee is fit and qualified to hold a home health agency license.
4. Codifying, in rule, the home health agency's responsibilities under s.
50.065, Stats., and ch.
HFS 13 relating to caregiver background checks and abuse reporting and investigation.
5. Requiring home health agencies to provide staff training and proper equipment to minimize the risk of infection and to monitor for compliance.
6. Making the time to complete a discharge summary under s.
HFS 133.21 (5) (i) consistent with the time to complete a discharge summary under s.
HFS 133.09 (3) (b). Currently s.
HFS 133.09 (3) (b) requires agencies to complete a discharge summary within 30 days after a patient is discharged and s.
HFS 133.21 (5) (i), requires agencies to complete a discharge summary within 15 days after a patient is discharged.
7. Increasing the time within which home health agencies are required to obtain a physician's signature (or under proposed rules an advanced nurse prescriber's signature) on an order for treatment or drugs from 20 calendar days to 20 working days.
8. Recognizing advanced nurse prescribers' authority under s.
50.49 (1) (b), Stats., to admit and discharge patients, develop and review plans of care and to order drugs or treatment for patients.
9. Creating and updating definitions to reflect currently used terminology.
10. Making minor, technical changes to rule provisions.
Initial Regulatory Flexibility Analysis
Home health agencies, both publicly and privately owned, are regulated by the Department under ch.
HFS 133 and ch.
50, Stats. These agencies are commonly referred to as state-only licensed home health agencies. If a home health agency participates as a provider in the Medicaid and Medicare programs, the home health agency is also regulated by the Department under
42 CFR 484 and commonly referred to as a state licensed and federally certified home health agency. Of the 172 licensed home health agencies operating in Wisconsin as of April 2007, approximately 162 agencies are state licensed and federally certified and 10 hold state-only licensure. At least 75% of all licensed agencies may be considered small businesses with estimated average gross annual revenues of $1.8 million per agency.
Home health agencies primarily provide services and care to patients in the homes of their patients. These services include skilled nursing services, therapy services, medical social services and home health aide services. Through this rulemaking, the Department proposes to amend ch.
HFS 133 to repeal or revise provisions that may be overly prescriptive, and inconsistent with federal regulations governing home health agencies. Home health care providers, particularly those who are both state licensed and federally certified have expressed concern about the ambiguity between the state and federal regulations. The Department anticipates that revising the rules as specified in the “Plain Language Analysis" section of this rulemaking order will make the rules more consistent with federal regulations.
Most of the proposed changes are non-substantive and technical in nature. The proposed rules, however, makes two substantive revisions that may affect costs of home health agencies.
The first such revision requires agencies to provide staff training and proper supplies to minimize the risk of infection and monitor for compliance. This requirement is expected to affect a minimal number of agencies because most agencies already meet this standard. Any agency that does not have a training program may establish one using the Centers for Disease Control guidelines that are downloadable from the Internet or accessed through the mails. Costs for sundry supplies (e.g., gloves, masks, etc.) are also expected to be minimal as it is likely that most agencies also already have such supplies.
The second substantive revision would require agencies to decrease the intervals within which a registered nurse (RN) makes supervisory visits to patients who receive skilled care from every 2 months to every 2 weeks. This proposed requirement is consistent with the provisions under
45 CFR 484.36 (d) (2), the RN supervisory requirements under which federally certified agencies operate, and would only affect the 10 state-only licensed agencies (and any newly licensed agency that chooses state-only licensure). Requiring all agencies to conduct RN supervisory visits under the same standards is expected to create continuity and consistency among state-only licensed, and state and federally licensed agencies. In addition, the increased visits will help to ensure the health, safety, and welfare of patients who increasingly need skilled care for conditions such as open wounds or skin lesions, chronic pain, cognitive or behavioral disabilities, or terminal care.
The costs that the proposed increase in RN supervisory visits would have on state-only licensed facilities are difficult to estimate because of the multiple variables that would need to be considered. These variables include the number of patients in an agency receiving skilled care; the span of time over which each patient receives skilled care; the actual number of visits per patient conducted previous to the proposed rules; the number of visits that would need to increase over those currently being conducted; and the actual schedule each agency uses to conduct the visits. Consequently, the costs for this requirement will continually fluctuate due to these variables. Therefore, we can assume that an agency may see no change in costs or that at any given time an agency may see an increase or decrease in costs.
Because detailed data for the state-only licensed agencies is not yet available, the Department used the 2005 annual survey data for the four state-only licensed agencies that responded to the survey and would have been impacted by proposed increase in RN supervisory visits. Using this data, the Department was able to estimate costs on a per patient basis. Assuming a rate of $26.46 per RN supervisory visit, and accounting for variables previously noted, the Department estimates the proposed increase in RN visits would be $91 per skilled nursing patient for a total of $5,849 per year (or $1,462 per year, per agency) for the four sample agencies. It is likely that any increased costs relating to this requirement would be passed from the agency to the patient or private insurance for subsequent reimbursement.
The 10 state-only agencies affected by the increase in the RN supervisory visits would represent only about 5.8% of all agencies licensed in Wisconsin and if we accept that the estimated $1,462 cost increase for the 2005 state-only sample agencies would be representative of the cost increases for the 10 state-only agencies, such increase would be 0.001 percent of the average, annual gross revenue of $1.8 million for home health agencies.
Despite the possible fluctuations in costs, the Department believes that the proposed requirement would not increase annual costs above the 2006 CPI rate of 3.2% or decrease revenues more than that rate. Consequently, the proposed RN supervisory requirement would not have a significant economic impact on home health agencies.
Overall, the proposed revisions are expected to lower costs for home health agencies in Wisconsin.
Small Business Regulatory Coordinator
Fiscal Estimate
Home health agencies (HHAs) provide services and care to patients in their homes. Services include skilled nursing care, home health aide services, therapies, personal care and other supportive services. At a minimum, HHAs are licensed by the State of Wisconsin, Department of Health and Family Services, under ch.
HFS 133 and s.
50.49, Stats. These agencies are referred to as state-only licensed HHA providers. In addition, many HHAs participate as providers in the Medicare and Medicaid programs. Therefore, they must operate under federal regulations
42 CFR 484 governing the operations of HHAs. These providers are known as federally certified HHA providers. As of April 2007, there are 172 licensed HHAs in Wisconsin. This total includes both in-state and out-of-state providers who operate in Wisconsin.
The Department proposes to amend ch.
HFS 133 to repeal or revise provisions that may be overly prescriptive, and inconsistent with the federal regulations governing HHAs. Most of the proposed rule changes are non-substantive and technical in nature. The proposed rule, however, makes two substantive revisions that may affect the costs of HHAs:
Minimize Risk of Infection
The first substantive revision requires agencies to provide staff training and proper supplies to minimize the risk of infection and to monitor for compliance. This requirement is expected to result in minimal costs to agencies because most of the 172 HHAs operating in Wisconsin already provide staff training and monitoring to meet current standards of practice and Centers for Disease Control (CDC) guidelines. Any agency that does not meet this standard is able to access information from CDC's web site to train their staff and start their monitoring program. Additional costs for sundry supplies (e.g., gloves, masks, etc.) is expected to be minimal.
Two Week RN Supervisory Visits
The second substantive revision to ch.
HFS 133 would require state only licensed HHAs to decrease the minimum interval for a registered nurse (RN) to make a supervisory visit to a patient who receives skilled nursing care from once every two months (i.e. every eight weeks) to once every two weeks. This time period is consistent with the requirements of
42 CFR 484.36 (d) (2) and will help to ensure the health, safety, and welfare of patients who need skilled nursing care.
State Fiscal Effect
Most HHAs in Wisconsin are both state-licensed and federally certified. Those with the latter designation already operate under the two week interval for a RN supervisory visit as a condition of being a provider for the Medicaid and or Medicare programs. For federally certified HHAs, there would be no increased costs to these providers or the Medicaid or Medicare programs resulting from this proposed revision to ch.
HFS 133.
Local Government Fiscal Effect
All of the HHAs operated by local government are state-certified and federally licensed and are presumed to follow the two week interval proscribed in
42 CFR 484.36 (d) (2). There would be no increased costs to HHAs operated by local governments.
Effect on the Private Sector (small businesses only)
Of the 172 HHAs currently operating in Wisconsin, the majority may be considered small businesses as that term is defined in s.
227.114 Stats. All would be affected by the proposed rules. The Department has determined, however, that the provisions relating to the RN supervisory visits will affect only about 10 state-only licensed HHAs. Costs for these HHAs would fluctuate depending on a number of variables which could result in no change in costs or, at any given time, costs may increase or decrease. Because detailed data for the state-only licensed agencies is not yet available, the Department used the 2005 annual survey data for the four state-only licensed agencies that responded to the survey and would have been impacted by proposed increase in RN supervisory visits. Using this data, the Department was able to estimate costs on a per patient basis. Assuming a rate of $26.46 per RN supervisory visit, and accounting for variables previously noted, the Department estimates the proposed increase in RN visits would be $91 per skilled nursing patient for a total of $5,849 per year (or $1,462 per year, per agency) for the four sample agencies. It is likely that any increased costs relating to this requirement would be passed from the agency to the patient or private insurance for subsequent reimbursement.
The 10 state-only agencies affected by the increase in the RN supervisory visits would represent only about 5.8% of all agencies licensed in Wisconsin and if we accept that the estimated $1,462 cost increase for the 2005 state-only sample agencies would be representative of the cost increases for the 10 state-only agencies, such increase would be 0.001 percent of the average, annual gross revenue of $1.8 million for home health agencies.
Despite the possible fluctuations in costs, the Department believes that the proposed requirement would not increase annual costs above the 2006 CPI rate of 3.2% or decrease revenues more than that rate. Consequently, the proposed RN supervisory requirement would not have a significant economic impact on home health agencies.
Overall, the proposed revisions are expected to lower costs for home health agencies in Wisconsin.
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 person listed below.
Contact Person
Pat Benesh
Department of Health and Family Services
Division of Quality Assurance
1 West Wilson St., Rm. 1150
Madison, WI 53701-7185
Phone (608) 264-9896
Fax (608) 267-0352
e-mail
Benespa@dhfs.state.wi.us
Notice of Hearing
Marriage and Family Therapy, Professional Counseling and Social Work
Examining Board
[
CR 07-048]
Notice is hereby given that pursuant to authority vested in the Marriage and Family Therapy, Professional Counseling and Social Work Examining Board in ss.
15.08 (5) (b),
227.11 (2) and
457.03, Stats., and interpreting s.
457.13, Stats., the Professional Counselor Section of the Marriage and Family Therapy, Professional Counseling and Social Work Examining Board will hold a public hearing at the time and place indicated below to consider an order to repeal MPSW 10.01 (2) and (3); and to repeal and recreate MPSW 11.015, relating to training licenses for professional counselors.
Hearing Date, Time and Location
July 31, 2007
1:15 p.m.
1400 East Washington Ave.
(Enter at 55 N. Dickinson St.)
Room 121A
Madison, WI
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 Legal Counsel, P.O. Box 8935, Madison, Wisconsin 53708. Written comments must be received by August 1, 2007, to be included in the record of rule-making proceedings.
Analysis prepared by the Department of Regulation and Licensing.
Statutes interpreted: s.
457.13, Stats.
Explanation of Agency Authority
Section
457.13, Stats., was recently amended by
2005 Wisconsin Act 422. This section previously required a 24 month training certificate, which was non-renewable and also required that the certificate holder be employed full-time or have an offer of full-time employment. The new law changed the requirement for a training certificate to a training license and increased the duration of the license to 48 months, with the possibility for an extension. It also eliminated the requirement for employment and instead requires that an individual have a position on or an offer for a position as a professional counselor.
Related Statute or Rule
There are no other related statutes or rules other than those identified above.
Plain language analysis
Training certificates are required in order to obtain 3000 hours of supervised professional counseling practice before being eligible to receive a professional counselor license. Section
MPSW 11.015 sets forth the current requirements for obtaining a training certificate, including a provision that an applicant have an offer of full-time employment. The present certificates are issued for 24 months and are non-renewable. With the enactment of
2005 Wisconsin Act 422, the term “training certificate" is changed to “training license." Additionally, the employment requirement has been eliminated and the amount of time for the credential expanded. Under the proposed new rule, training licenses will be issued for 48 months, with the possibility for an extension. Supervised hours may also be accumulated in an unpaid position.
SECTION 1 repeals the definitions of “employed full-time" and “offer of full-time employment."
SECTION 2 requires applicants to submit a signed application and to pay the required fee. Applicants must also submit evidence that they have a position or an offer for a position in a supervised clinical professional counseling practice or its approved equivalent. In addition, the training license is valid for 48 months and may be renewed at the discretion of the professional counselor section.
Summary of, and Comparison with, Existing or Proposed Federal Regulation
There is no existing or pending federal regulation relating to training licenses for professional counselors.
Comparison with Rules in Adjacent States
Illinois:
Illinois does not appear to require a training certificate; rather, the applicant must have received counseling experience under a licensed professional counselor prior to licensure.
Michigan:
Michigan does not offer a training license; rather, appears to offer limited professional counselor licenses under the supervision of a full licensed professional counselor to get the requisite practice experience.
Minnesota:
Minnesota does not appear to offer a training certificate for professional counseling; rather, as per their statutes, 148B.53 Requirements for licensure, licensed professional counselors must get supervision affidavits after receiving their full licensure.
Iowa:
Iowa does not offer a training certificate/level license for professional counseling.
Summary of Factual Data and Analytical Methodologies
The primary methodology for the development of the proposed changes is based upon the requirements set forth in
2005 Wisconsin Act 422. Previously, licensing law governing the professional counselor training certificate required a full-time position to obtain, the certificate lasted a maximum of 24 months, and was non-renewable.
2005 Wisconsin Act 422 changed the training certificate to a training license, removed the requirement for full-time employment and increased the maximum duration of the license to 48 months with the possibility for an extension.
Analysis and Supporting Documents used to Determine Effect on Small Business or in Preparation of Economic Impact Report:
