Scope statements
Corrections
Subject
Establishing an annual fee to partially offset the costs of monitoring persons who are required to register as sex offenders and who are in the custody of the Department of Corrections or who are on probation, parole, or extended supervision.
Policy analysis
Objective of the rule. The objective of the rule is to establish an annual fee to partially offset the costs of monitoring persons who are required to register as sex offenders and who are in the custody of the Department of Corrections or who are on probation, parole, or extended supervision.
Description of existing policies relevant to the rule and of new policies proposed to be included in the rule, and an analysis of policy alternatives:
2005 Wisconsin Act 25, Section
2223 created section
301.45 (10), Stats., which gives the Department of Corrections authority to establish an annual fee to partially offset the costs of monitoring persons who are required to register as sex offenders and who are in the Department's custody or who are on probation, parole or extended supervision. The annual fee is not to exceed $50.00.
The alternatives to the proposed policy would result in not establishing the annual fee as provided under the recently passed legislation.
Comparison with federal regulations
There is no current or proposed federal regulation which addresses the subject of the proposed rule.
Statutory authority
Staff time required
The Department estimates that it will take approximately 10 hours to develop this rule, including drafting the rule and complying with rulemaking requirements.
Health and Family Services
Subject
The Department of Health and Family Services proposes to amend chs.
HFS 110 and
HFS 111, relating to emergency medical technicians (EMTs).
Policy analysis
There are two levels of emergency medical services care in Wisconsin. They are basic life support and advanced life support. These two levels are distinguished by the skills and medications that can be used by emergency medical services personnel when performing pre-hospital care.
Requirements for basic life support are codified in chs.
HFS 110 and
HFS 113. At the basic life support level, the department licenses individuals as emergency medical technician-basic (EMT-Basic) and emergency medical technician-intravenous (EMT-Basic IV) and certifies individuals as First Responders. Requirements for advanced life support are codified in chs.
HFS 111 and
HFS 112. At the advanced life support level, the department licenses individuals as provisional emergency medical technician- intermediate (Provisional EMT- Intermediate), emergency medical technician-intermediate (EMT-Intermediate), and emergency medical technician-paramedic (EMT-Paramedic).
Licensure, certification, title, and service level designations of emergency medical service personnel are based on the training and competency requirements of the “Wisconsin Revision of the National Standard Curriculum" (Wisconsin Curriculum). The Wisconsin Curriculum is based on the National Standard Curriculum developed by the National Highway Traffic Safety Administration (NHTSA). To receive and maintain licensure as an emergency medical services professional in Wisconsin, an individual must meet the training and competency requirements of the Wisconsin Curriculum for the appropriate discipline.
In 2001, based on national recommendations, the department revised the Wisconsin Curriculum for the EMT-Intermediate level and adopted higher training and competency standards for EMT-Intermediate licensure. EMT-Intermediate licensees who were trained under the 1989 (or earlier) National Standard Curriculum for EMT-Intermediate, while still considered advanced life support, were renamed Provisional EMT-Intermediate and given until December 31, 2005 to meet the new training and competency requirements. As required under s.
HFS 111.045, licensees who did not meet the December deadline will be renamed EMT-Basic IV effective July 1, 2006.
The training and competency requirements for the EMT-Basic IV license are the training and competency requirements from the 1989 (or earlier) version of the National Standard Curriculum for EMT-Intermediate which makes the EMT-Basic IV skill set and competencies identical to the skill set and competencies of the Provisional EMT-Intermediate, an advanced life support level of care. Nevertheless, the department codified the EMT-Basic IV service level as basic life support under ch.
HFS 110 instead of advanced life support under ch.
HFS 111.
The department's placement of the EMT-Basic IV designation as basic life support under ch.
HFS 110 has had an inadvertent and negative impact on ambulance service providers and may eventually negatively impact the communities that they serve.
At least 70% of the revenues ambulance service providers generate come from government (Medicare and Medicaid) and non-government insurers that base the level of reimbursement on the level of skilled service the patient receives, that is, whether the patient receives emergency medical services from an individual who is licensed at the basic life support level of care under ch.
HFS 110 or
113 or an advanced life support level of care under ch.
HFS 111 or
112. As a result, ambulance service providers that employ individuals licensed at the EMT-Basic IV level bear the higher equipment, salary, and training costs associated with maintaining the advanced life support level of care, but are reimbursed at rates for basic life support level of care.
Statutory authority
Staff time required
The department estimates that it will take approximately 80 hours to develop the proposed rules. The Department will use the assistance of the Emergency Medical Services Advisory Board to develop the continuing education requirements in ch.
HFS 110.
Entities affected by the rule
The citizens of Wisconsin, counties, emergency medical technicians, and ambulance service providers
Comparison with federal regulations
There are no federal regulations that are governing or applicable to these rules.
Health and Family Services
Subject
The Department of Health and Family Services proposes to modify ch.
HFS 129, relating to the certification of programs and requirements for training and testing of nurse aides, home health aides, and hospice aides.
Policy analysis
Chapter
HFS 129 establishes conditions of certification of instructional programs, including standards for instructors, curriculum and criteria for the competency evaluation programs for persons who work as nurse aides in hospitals, nursing homes, facilities for the developmentally disabled, home health agencies or hospices. HFS 129 also establishes standards for the development of a registry of persons who have satisfactorily completed the training program, competency program or who otherwise are eligible for listing in the registry.
This Statement of Scope replaces the Statement of Scope published in May 2003 to include notice of additional changes that the department proposes to make due to recent modifications to the program including the requirements for the training and testing of feeding assistants as set forth under
42 CFR 483.35 and
483.160, medication aides as set for the under
42 CFR 60, and the process to waive the two-year prohibition of a nurse aide training program under Public Law 105-15 (H.R. 968).
The Department proposes to revise ch.
HFS 129 for several reasons:
1. To include requirements for the training and testing of feeding assistants and medication aides.
Feeding assistants differ from nurse aides in that a feeding assistant may only assist residents who have no feeding complications with the activities of eating and drinking. A medication aide is a nurse aide who is also approved to administer medications under the supervision of a licensed nurse.
2. To reflect the Department's decision to standardize the administration and operation of nurse aide competency evaluation statewide by contracting for this service.
Federal regulations set forth under CFR 483.152 and 483.154 authorize states to choose to offer a nurse aide training and competency evaluation program, or to review, and approve or disapprove program applications upon request. The Department has been reviewing, and approving or disapproving nurse aide training and competency evaluation programs based on standards in ch.
HFS 129.08. Anyone who meets those standards may conduct a testing program.
However, the Department believes that specifying standards for competency evaluation programs cannot assure the maintenance of neutral and objective facility-sponsored instructional and competency evaluation tests that are free from possible conflicts of interest posed by the need to meet facility staffing requirements. Therefore, the Department proposes to modify ch.
HFS 129 to reflect the Department's contracting out the implementation of such competency testing.
3. To improve the accuracy and integrity of the nurse aide registry.
Under
42 CFR 483.152 (2), s.
146.40 (4g), Wis Stats., and ch.
HFS 129.10 of the Wisconsin Administrative Code, the Department is required to maintain a list, known as a “registry," of all persons deemed qualified to work in Wisconsin as a nurse aide. Aside from committing an offense that would bar a person from remaining on the list, the Department intends to add state provisions for removing a person's name from the list. The Department believes that the list of qualified nurse aides, currently numbering over 183,000, contains many persons who no longer are available to or interested in working as a nurse aide. Therefore, the Department intends to modify ch.
HFS 129 to require nurse aides to periodically update their registration information and, in the process, allow the Department to maintain a more accurate list of nurse aides. Periodic updating will also provide the Department the opportunity to verify the information provided by nurse aides.
4. To clarify who may be included on the registry and who is eligible to work as a nurse aide and, specifically, as a medication aide. The Department will also clarify the circumstances under which a person not currently included on the registry may work in a health care facility, such as an RN, LPN, etc.
5. To make ch.
HFS 129 more consistent with current federal regulations governing nurse aides.
The Department proposes to update aspects of ch.
HFS 129 to reflect federal requirements established since ch.
HFS 129 was originally promulgated April 1992. Specifically, the Department will propose to incorporate federal requirements relating to:
Withdrawal of Department approval of a nurse aide training and competency evaluation program or a nurse aide competency evaluation program if the entity providing the program refuses to permit unannounced visits by the Department.
Nurse aide training needing to be performed by or under the general supervision of a RN who possesses a minimum of 2 years of nursing experience, at least 1 year of which must be in the provision of long term care facility services.
The inability of a facility to charge fees for training and competency testing to a person who is employed by or has received an offer of employment from a health care facility. In addition, in the case of a person becoming employed by federally certified nursing home within 12 months after completing a training and testing program, the requirement for the Department to reimburse the person for the costs of such training and testing.
Requiring that the skills demonstration part of the evaluation be performed in a facility or laboratory setting comparable to the setting in which the person will function as a nurse aide and be administered and evaluated by a RN with at least 1 year's experience in providing care for the elderly or the chronically ill of any age.
Requiring a competency testing program to use a system that prevents disclosure of both the pool of questions and the individual competency evaluations.
Requiring that the skills demonstrated must consist of a demonstration of randomly selected items drawn from a pool consisting of the tasks generally performed by nurse aides.
Establishing what happens if a person does not complete the evaluation satisfactorily, and impose a maximum number of three times that person may attempt to complete the evaluation successfully.
