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)
