Scope Statements
Commerce
Elevators, Escalators and Lift Devices, Ch.
Comm 18
Subject
Revises Chapter
Comm 18, relating to conveyance systems, elevators, escalators and lift devices.
Objectives of the Rule
The objective of the potential rulemaking project is to clarify and update Chapter
Comm 18. This update may be incorporated into more than one rule package and may include revisions to other chapters affected by the proposal.
In keeping with the statutory requirement to use nationally recognized standards, the update of chapter Comm 18 may include incorporating by reference the 2010 edition of the ASME A17.1, Safety Code for Elevators and Escalators, and the 2008 edition of the ASME A18.1, Safety Standard for Platform Lifts and Stairway Chairlifts. In addition, sister ASME elevator standards such as A17.2, Guide for Inspection of Elevators, Escalators and Moving Walks, A17.6, Standard for Elevator Suspension, Compensation and Governor Systems, and A17.7, Performance Based Safety Code for Elevators and Escalators, may be included.
Policy Analysis
Currently, chapter Comm 18 applies to the design, installation and inspection of conveyance systems, elevators, escalators and lifts in public buildings, places of employment and one- and 2-family dwellings. Effective January 1, 2009, the last update of chapter Comm 18 references the 2007 edition of the ASME A17.1, Safety Code for Elevators and Escalators, and the 2005 edition of the ASME A18.1, Safety Standard for Platform Lifts and Stairway Chairlifts. Under the code, the department uses several compliance strategies including the review of plans for installation of new elevators and escalators, acceptance inspection of new conveyance systems, periodic inspection of existing conveyance systems and issuance of permits to operate.
This rule project will update the state conveyance code to the latest editions of the ASME A17.1, ASME A18.1, and other related ASME elevator and lift standards while creating administrative rules in keeping with the statutory mandates for the protection of public health and safety.
The alternative of not updating the rule would result in chapter Comm 18 not being up-to-date with current nationally recognized standards for the design, installation and operation of conveyance systems, elevators, escalators and lift devices.
Statutory Authority
Comparison with Federal Regulations
An Internet-based search of the Code of Federal Regulations (CFR) and the Federal Register did not find any federal regulations relating to the activities to be regulated under the rule.
Entities Affected by the Rule
The rule will affect any building, structure or premises where the installation of an elevator, escalator or lift device will be undertaken. Also, the rulemaking project will affect any designer, installer or inspector of conveyance systems along with owners and frequenters of buildings, structures or premises where elevators, escalators or lift devices are installed. Any entity involved with the conveyance industry will be affected.
Estimate of Time Needed to Develop the Rule
The staff time needed to develop the rules is expected to be about 1,000 hours, depending upon the associated complexity. This includes research, rule drafting, and processing the rules through public hearings, legislative review, and adoption. There are no other resources necessary to develop the rules.
Health Services
Community Services, Chs.
DHS 30—
Subject
Revises Chapter
DHS 40, relating to mental health day treatment services for children.
Objectives of the Rule
To update ch.
DHS 40 to current practice, trends, and advances in admission criteria, treatment planning, treatment, and discharge planning in mental health day treatment services for children.
Policy Analysis
Mental health day treatment services for children include non-residential care provided on prescription of a physician in a clinically supervised setting that provides case management and integrated individual, family and group counseling, therapy, or other services designed to alleviate emotional or behavioral problems of children due to mental illness or severe emotional disturbance. Chapter
DHS 40 was promulgated to establish standard definitions, program criteria and patient characteristics for mental health day treatment services for children. In addition to specifying program certification and operational requirements, the rule specifies services requirements, including admission, assessment, treatment planning, treatment, and discharge planning.
The current rule was promulgated in 1996. It is out of date in terms of how children are viewed diagnostically and how they meet admission requirements. Children do not fit neatly into diagnostic boxes, and often have other related mental health issues that need to be considered and addressed. The current rule specifies the standards for 3 levels of day treatment programming, but these levels have become blurred over the years. Children have been admitted to level I services who were more appropriate for level II services, and, therefore, may not have received the services that they needed. In addition, there have been advances in other community treatment program options for children (e.g., Comprehensive Community Services (CCS), Coordinated Services Teams (CST), crisis programs, and others) that should be considered before a child is admitted into day treatment. Under proposed rules, the department intends to address these admissions criteria.
The department also intends to address treatment concerns regarding children and families with AODA issues, and to also provide family therapy in the home. Trauma-informed care will be considered when evaluating and treating children. In recent years, to better address behavioral problems, positive behavioral supports interventions have been developed to reduce the use of seclusion and restraint.
Children with mental illness and their families may be affected by the rule changes in terms of admission criteria; treatment planning that includes trauma-informed care, and better strategies to deal with behavioral problems.
Chapter
DHS 40 and the proposed changes are not intended to regulate other forms of day services for children such as those operated by alcohol and other drug abuse treatment programs under ch.
DHS 75.
Statutory Authority
Comparison with Federal Regulations
There are no federal regulations or rules that govern mental health day treatment programs for children.
Entities Affected by the Rule
The existing 51 day treatment programs, which include school-based, community-based and hospital-based programs.
Estimate of Time Needed to Develop the Rule
An estimated total of 400 hours of staff time may be needed to update ch.
DHS 40.
Medical Examining Board
Subject
Creates a rule in Chapter
Med 18 that will require informed consent from patients that will be undergoing chelation therapy for off-label purposes of treatment. The informed consent documentation will be amended by the board from the current form used for chelation therapy in Missouri.
Objectives of the Rule
Adding a rule that would require any practitioner of Ethylinediaminetetracetic Acid (EDTA) chelation therapy to obtain documentation of informed consent from the patient for all uses other than those approved by the Federal Drug Administration (FDA).
Policy Analysis
Chelation refers to a method of removing excess heavy metals from the body by injecting chelating agents, which bind with molecules of calcium, lead, zinc, iron, and other metals and combines with them chemically so that they are excreted, usually via the kidneys. Currently, the only FDA-approved use of chelation therapy is for heavy metal poisoning. Since heavy metals poisoning can be responsible for major diseases, in alternative therapy, chelation has been used to treat heart disease, cancer, gangrene, thyroid disorders, multiple sclerosis, muscular dystrophy, psoriasis, diabetes, arthritis, Alzheimer's disease, and the improvement of memory, sight, hearing, and smell.
Although EDTA binds harmful, toxic metals like mercury, lead, and cadmium, it also binds some essential nutrients of the body, such as copper, iron, calcium, zinc, and magnesium. Large amounts of zinc are lost during chelation. Zinc deficiency can cause impaired immune function and other harmful effects. Supplements of zinc are generally given to patients undergoing chelation, but it is not known whether this is adequate to prevent deficiency. Also, chelation therapy does not replace proper nutrition, exercise, and appropriate medications or surgery for specific diseases or conditions.
The need for this rule is to provide a safeguard to the public. To date, there has been no credible study showing chelation therapy to be of benefit against heart disease or any condition other than heavy metal poisoning. Alternative uses of chelation therapy have also not been recommended by the American Medical Association, the American Osteopathic Association, the American College of Cardiology, the American Heart Association, nor any other recognized independent medical association.
Statutory Authority
Comparison with Federal Regulations
As set forth in Title 21, code of Federal Regulations, Section 312: a licensed physician can use chelation therapy for an unapproved use in investigational or research work. FDA clearance is required for such work.
Entities Affected by the Rule
M.D.s, D.O.s, and others licensed to practice medical procedures.
Estimate of Time Needed to Develop the Rule
It is estimated that 160 hours will be needed to promulgate the rule.
