WISCONSIN DEPARTMENT OF HEALTH SERVICES
PROPOSED ORDER TO ADOPT PERMANENT RULES
The Wisconsin Department of Health Services proposes an order to: repeal DHS 110.04 (11), (29), (30), (33), (34), (41), and (48), 110.06 (1) (c) 2., (g) and (h), 110.40 (3), and 110.50 (3) (b); renumber DHS 110.04 (1) and (10), 110.06 (1) (h) (note), and 110.22; renumber and amend DHS 110.32 (1), 110.46, and 110.50 (1) (d) 1. and 3.; consolidate, renumber and amend DHS 110.06 (1) (c) (intro.) and 1.; amend DHS 110.01 (1) and (2), 110.02 (1), (2), (3), and (5), 110.04 (12), (16), (17), (24), (25), (26), (27), (28), (31), (35), (40) (intro.) and (c), (42), (45), (47), (49), (50), (59), (72), (77) and (78), 110.05 (1) (intro.) and (2), 110.06 (title), (1) (intro.), (d) and (note), (e) (intro.) and 2. and (f), 110.07 (1) (intro.), (a), (c), (c) 1. to 7., (d), 110.08 (1) to (3), 110.09 (intro.), (1), and (2) (a) 2. and 3., 110.11 (2), 110.12 and (note), 110.13 (3) and (5) and (note), 110.14 (1) to (3), 110.15 (title) and (1) (b) to (d), (2) (a) and (c), and (3) (a) and (b), 110.16 (1) (d), 110.17 (2) (a) and (3) (a), 110.18 (1) and (3), 110.20 (1) to (3), 110.21 (title) and (1) to (3), 110.24 (3) (intro.), 110.27 (1) and (2) (c), 110.28 (1), (2) (a) and (c) and (4) (a) and (b), 110.31 (2), 110.32 (2), (3), and (4), 110.34 (intro.), (2), (3), (5), (7), (8) and (note), and (9), 110.35 (intro.), (2) (f), 110.37 (1), 110.40 (intro.), 110.41 (1) (intro.), 110.44 (intro.), (1), (2), (8), (9), (10), (11), and (13), 110.46 (title), 110.47 (1), (2), and (7), 110.48 (3), 110.49 (1) (a) to (c) and (f), and (2) (a), (b), (f) and (j), 110.50 (1) (intro.) and (a) to (c), (d) 2. and 4., (e) to (g), (2) and (note), and (3) (intro.), 110.51 (2) (a) and (b), 110.52 (1) and (3) to (6) and (8), 110.54 (7), (13), and (17), and 110.59 (note); repeal and recreate DHS 110.07 (1) (d), 110.44 (17), and 110.52 (7); and create DHS 110.04 (1g), (14e), (14m), (14s), (21e), (21m), (21s), (43m), (51m), (61m), and (74m), 110.05 (1) (c) to (e), 110.066, 110.07 (1) (c) 6g. and 6r., 110.088, 110.13 (4m), (6) and (7), 110.15 (1) (dm), 110.16 (1) (g), 110.22 (2) and (3), 110.32 (1) (a) to (c), (3m), and (5), 110.34 (9m), 110.35 (2) (e) 7. to 9., and (g), 110.395, 110.44 (9m), (20g), and (20r), 110.46 (2), 110.49 (1) (fm), 110.495, 110.50 (1) (d) 1. a. to c., and 3. a. to c., (2m) and (4),110.526, and 110.54 (26e), (26m), and (26s); relating to emergency medical services licensing, certification, and training requirements.
The department is directed by ss. 256.08 (4) (g) and 256.15 (6) (b) 2., Stats., to promulgate any rule changes necessary to implement recommendations from the emergency medical services (“EMS”) board and by various legislative acts to promulgate rules to implement statute.
Explanation of agency authority
The department is directed by ss. 256.08 (4) (g) and 256.15 (6) (b) 2., Stats., to promulgate any rule changes necessary to implement recommendations from the EMS board and by various legislative acts to promulgate rules to implement statute.
Section 256.08 (1), Stats.:
[T]he department shall review all statutes and rules that relate to emergency medical services…” and s. 256.08 (4) (g), Stats., provides [The department shall] “Review recommendations of the board. The department may promulgate any rule changes necessary to implement those recommendations and may pursue any statutory changes necessary to implement those recommendations.” Furthermore, s. 256.15 (13), Stats., reads:
(a) The department may promulgate rules necessary for administration of this section.
(b) The department shall promulgate rules under subs. (8) (b), (c) and (e) and (8m).
(c) The department shall promulgate rules that specify actions that emergency medical services practitioners may undertake after December 31, 1995, including rules that specify the required involvement of physicians in actions undertaken by emergency medical services practitioners.
Section 256.15 (6) (b) 2., Stats.:
The department, in conjunction with the technical college system board, shall promulgate rules specifying training, education, or examination requirements, including requirements for training for response to acts of terrorism, for license renewals for emergency medical services practitioners.
Related statute or rule
Plain language analysis
The department is charged with making the appropriate changes to administrative rules based on recommendations from the EMS Board as well as changes required by recent legislative acts.
The proposed changes to Chapter DHS 110 modify the administrative rule to conform to recent statutory changes with respect to the certification and licensing of individuals with criminal conviction records, licensing exemptions for out-of-state emergency medical service providers, the naming convention for all levels of emergency medical services professionals, and the transition from a two-year certification to a three-year certification and licensing cycle for emergency medical services providers and professionals of all levels.
The proposed changes also create new administrative rules in response to recent legislation for opioid antagonist training and the licensing of community emergency medical service providers, community emergency medical services practitioners, and community paramedics.
The proposed changes increase consistency within the administrative rule regarding cardiopulmonary resuscitation requirements for initial and renewal certification and licensing of emergency medical services professionals.
Additionally, the proposed changes add additional flexibility in ambulance staffing configurations and additional operational plan and special event plan requirements for emergency medical service providers. The proposed changes also update definitions and language throughout the administrative rule to conform to the common medical terminology or national standards.
No reasonable alternatives exist to rulemaking. Without proposed revisions to Chapter DHS 110, administrative rules regarding emergency medical services in Wisconsin will be outdated and not in accordance with state statutes and national standards.
Summary of, and comparison with, existing or proposed federal regulations
There do not appear to be existing or proposed federal regulations that address the activities to be regulated by the proposed rule.
Comparison with rules in adjacent states
Illinois statute confers upon the Illinois Department of Public Health (“IDPH”) the authority and responsibility to oversee and regulate emergency medical services in the state. The IDPH EMS Division is the responsible agency and handles a number of their rules similarly to Wisconsin. Their licensure period is four years compared to our current two-year certification and proposed three year time frames. They do not provide for flexible staffing nor do they require two paramedics on an advanced life support ambulance, leaving staffing decisions to the locality. They are in a transition phase now on several rules including accreditation of paramedic training centers, community EMS, and providing emergency care to domestic animals. Applicable law and administrative rule are found in 210 ILCS 50 and 77 Ill. Adm. Code 515.
Iowa statute designates the Iowa Department of Public Health as the lead agency for coordinating and implementing the provision of emergency medical services in the state. The Bureau of Emergency and Trauma Services is the responsible agency. There are several differences between Iowa and Wisconsin – Iowa does not require two paramedics on an advanced life support ambulance, nor do they require agency operational plans, utilize special events plans, require a specific patient care reporting system or have community EMS programs. Iowa utilizes a different licensure period than Wisconsin does and they have a form of flexible staffing as well as accredited paramedic training centers. Applicable law and administrative rule are found in Iowa Code § 147A and Iowa Adm. Code 641.
Michigan Public Health Code 333.20910 authorizes the Michigan Department of Health and Human Services to develop, coordinate, and administer a statewide emergency medical services system. Michigan has a three-year licensure period and paramedic training programs must be accredited. In addition, the state provides the patient care reporting system at no charge while also allowing agencies to choose their own report format as long as it is National Emergency Medical Services Information System (NEMSIS) compliant. Michigan does not yet have community EMS and are in the midst of their rule-writing process on several issues. Applicable law and administrative rule are found in Michigan Public Health Code § 333.20910 and Mich. Admin. Code R 325.
Minnesota statute authorizes the emergency medical services regulatory board to administer and enforce both statute and administrative rule regarding emergency medical services through the executive director and appointed staff. Minnesota did not respond to requests for information for this comparison. Staff have determined that Minnesota has a two-year licensure period for individuals and services although services utilize eight separate licensure periods based on date and geographic location. It is unclear what Minnesota uses for patient care reporting but they do require National Emergency Medical Services Information System (NEMSIS) compliant data submission. Minnesota currently has a community paramedic program under statute. Applicable law and administrative rule are found in Minnesota State Statute Chapter 144E and Minnesota Administrative Rule Chapter 4690.
Summary of factual data and analytical methodologies
The department relied on the following sources to draft the proposed rule: A. 2013 Wisconsin Act 200 regarding Naloxone and opioids. B. 2015 Wisconsin Acts 26 and 83 regarding out of state practitioners responding into or transporting patients into or out of Wisconsin. C. 2015 Wisconsin Act 113 regarding ambulance staffing configurations. D. 2017 Wisconsin Act 12 regarding naming conventions to align with National Registry of emergency medical technicians nomenclature. E. 2017 Wisconsin Act 66 regarding community EMS. F. 2017 Wisconsin Act 96 regarding funding for emergency medical responder and emergency medical services practitioner training and certification. G. 2017 Wisconsin Act 97 regarding rural ambulance services utilizing flexible staffing. H. 2017 Wisconsin Act 166 regarding EMS practitioners rendering aid to domestic animals. I. 2017 Wisconsin Act 278 regarding discrimination based on arrest or conviction record. J. 2017 Wisconsin Act 350 regarding changing the licensure period from two years to three years. K. The department formed an advisory committee consisting of members of the EMS board and one additional member who represent various stakeholder groups including the Professional Ambulance Association of Wisconsin, the Professional Fire Fighters of Wisconsin, the Wisconsin EMS Association, physicians, field practitioners, educators, and EMS administrators. The committee members reviewed the initial draft language and their review and input guided the development of the final proposed rule text.
Analysis and supporting documents used to determine effect on small business
Wisconsin State Fire Chiefs Association, Professional Fire Fighters of Wisconsin, the Wisconsin EMS Association, and the Professional Ambulance Association of Wisconsin all participated in the drafting of the proposed revision and were asked to provide comments. In addition, public comment was solicited as required and posted. Over 340 public comments were received during the 14-day economic impact public comment period.
The department solicited input and advice from our advisory committee and from those who attended the advisory committee meetings representing fire-based EMS, municipal EMS, volunteer EMS, and stakeholder associations who may be affected by the proposed rule for use in analyzing and determining the economic impact that the proposed rules and rule revisions would have on EMS services, businesses, individual practitioners, and local governments May 1, 2019 through December 1, 2019
Effect on small business
Based on the foregoing, the rule is not anticipated to have any effect on small businesses.
Agency contact person
Statement on quality of agency data
The data sources referenced and used to draft the rules and analyses are objective, accurate, and reliable as discussed in the “Summary of Factual Data and Analytical Methodologies.”
Place where comments are to be submitted and deadline for submission
Comments may be submitted to the agency contact person that is listed above until the deadline given in the upcoming notice of public hearing. The notice of public hearing and deadline for submitting comments will be published in the Wisconsin Administrative Register and to the department’s website, at https://www.dhs.wisconsin.gov/rules/permanent.htm. Comments may also be submitted through the Wisconsin Administrative Rules Website, at: https://docs.legis.wisconsin.gov/code/chr/active.
SECTION 1. DHS 110.01 (1), (2) are amended to read:
DHS 110.01 (1) Certifying, training, and credentialing first emergency medical responders.
DHS 110.01 (2) Licensing, training, and credentialing emergency medical technician services practitioners.
SECTION 2. DHS 110.02 (1), (2), (3), (5) are amended to read:
DHS 110.02 (1) First Emergency medical responders.
DHS 110.02 (2) Emergency medical technicians - basic.
DHS 110.02 (3) Emergency Advanced emergency medical technicians– Intermediate Technicians.
DHS 110.02 (5) Emergency medical technician – paramedics Paramedics.
SECTION 3. DHS 110.04 (1) is renumbered DHS 110.04 (1r).
SECTION 4. DHS 110.04 (1g) is created to read:
DHS 110.04 (1) “Advanced emergency medical technician" or “AEMT" has the meaning given in s. 256.01 (1k), Stats.
SECTION 5. DHS 110.04 (11) is repealed.