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:
The proposed rules do not increase restrictions or barriers to licensure, affect practice within clinics, or have any provisions related to costs (no additional fees, educational or operational costs are imposed.) The rules primarily eliminates several provisions within the licensing law which applicants and training certificate holders found to be unduly burdensome or difficult to comply with. This proposed rule change should have no negative effect on small business, and in effect may have a positive effect by increasing the availability of qualified training license holders available for employment.
Section
227.137, Stats., requires an “agency" to prepare an economic impact report before submitting the proposed rule-making order to the Wisconsin Legislative Council. The Department of Regulation and Licensing is not included as an “agency" in this section.
Anticipated Costs Incurred by Private Sector
The department finds that this rule has no significant fiscal effect on the private sector.
Fiscal Estimate
The department estimates that the proposed rule will have no significant fiscal impact.
Effect on Small Business
These proposed rules will have no significant economic impact on small businesses, as defined in s.
227.114 (1), Stats. The Department's Regulatory Review Coordinator may be contacted by email at
larry.martin@drl.state.wi.us, or by calling (608) 266-8608.
Agency Contact Person
Pamela Haack, Paralegal, Department of Regulation and Licensing, Office of Legal Counsel, 1400 East Washington Avenue, Room 152, P.O. Box 8935, Madison, Wisconsin 53708-8935. Telephone: (608) 266-0495. Email:
pamela.haack@drl.state.wi.us.
Place where Comments are to be Submitted and Deadline for Submission
Comments may be submitted to Pamela Haack, Paralegal, Department of Regulation and Licensing, 1400 East Washington Avenue, Room 152, P.O. Box 8935, Madison, Wisconsin 53708-8935, or by email at
pamela.haack@drl.state.wi.us. Comments must be received on or before August 1, 2007 to be included in the record of rule-making proceedings.
Text of Rule
SECTION 1. MPSW 10.01 (2) and (3) are repealed.
SECTION 2. MPSW 11.015 is repealed and recreated to read:
MPSW 11.015 Application for a professional counselor training license. (1) The professional counselor section shall grant a professional counselor training license to any individual who does all of the following:
(a) Submits a completed, signed application form.
(b) Pays the fee specified in s.
440.05 (6), Stats.
(c) Satisfies the requirements in s.
457.12 (2), Stats.
(d) Submits evidence satisfactory to the professional counselor section of one of the following:
1. The applicant is in a position or has an offer for a position as a professional counselor in a supervised clinical professional counseling practice.
2. The applicant is in a position or has an offer for a position in which the applicant will, in the opinion of the professional counselor section, receive training and supervision equivalent to the training and supervision received in a supervised clinical professional counseling practice.
(2) A professional counselor training license is valid for 48 months and may be renewed at the discretion of the professional counselor section.
Notice of Hearing
Marriage and Family Therapy, Professional Counseling and Social Work
Examining Board
[
CR 07-047]
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),
440.035 (1) and
457.11, Stats., and interpreting s.
457.11 (1) and
(2), Stats., the Marriage and Family Therapist 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 renumber and amend MPSW 17.03 (1) (d); to amend MPSW 17.03 (title), (1) (intro.) and (2); to repeal and recreate MPSW 17.03 (1) (c); and to create MPSW 17.03 (1) (d) 1. and 2., relating to training licenses for marriage and family therapists.
Hearing Date, Time and Location
July 30, 2007
9:15 a.m.
1400 East Washington Avenue
(Enter at 55 N. Dickinson St.)
Room 121A
Madison, WI
Appearances at the Hearing
