None known.
Text of Proposed Rule
SECTION 1. DHS 138.03 (2), (3) and (14) are amended to read:
DHS 138.03 (2) “Department" means the Wisconsin department of health and family services.
(3) “Dependent" means a spouse,
domestic partner under ch. 770, Stats., or an unmarried child under the age of 19 years, an unmarried child who is a full-time student under the age of 21 years and who is financially dependent upon the parent, or an unmarried child of any age who is medically certified as disabled and who is dependent upon the parent.
(14) “Medicare" means coverage under part A
or, part B
or part D of Title XVIII of the federal
social security actSocial Security Act,
42 USC 1395 to
1395zz1395hhh.
SECTION 2. DHS 138.04 (1) (b) 2. and (d), (2) (a) (intro.) and 7. Note and (b) are amended to read:
DHS 138.04 Participation in the health insurance premium subsidy program. (1) (b) 2. For a subsidy under s.
252.17, Stats., have a family income that does not exceed
200
300% of the federal poverty line for a family the size of the individual's family;
(d) Have health insurance coverage under a group health plan or, an individual health policy or Medicare part D, or is eligible for health insurance coverage under a group health plan or, an individual health policy or Medicare part D;
(2) APPLICATION PROCESS. (a) Any individual who satisfies the eligibility conditions under sub. (1) and wants to participate in the health insurance premium subsidy program shall complete and submit to the department an application form, DOH 4614F-44614, which shall provide the following information:
7. Note: To obtain a copy of DOH 4614F - 44614, write or phone the Wisconsin Division of Public Health, AIDS/HIV Program, P.O. Box 2659, Madison, WI 53701-2659, (608) 267-5287. The completed form should be returned to the same office.
(b) Any individual who does not satisfy sub. (1) (b), (d) or (e), may submit an application form, DOH 4614F - 44614, that the department will hold until the individual satisfies all the applicable requirements under sub. (1). The department may not contact the individual's employer, former employer or health insurer until the individual satisfies all the applicable requirements under sub. (1) unless the individual authorizes the department, in writing, to make that contact and to make any necessary disclosure regarding the individual's HIV infection.
SECTION 3. DHS 138.05 (1) (a) 1. and 2. are amended to read:
DHS 138.05 (1) (a) 1. For a subsidy under s.
252.17, Stats., the department shall pay the
full amount of the premium
amount owed by the individual due for coverage under a group health plan during an unpaid medical leave
;
for an individual whose family income does not exceed 200% of the federal poverty line.
2. For a subsidy under s.
252.16, Stats., the department shall pay the full amount of the premium due for health insurance coverage for an individual whose family income does not exceed 200% of the federal poverty
level; and line.
SECTION 4. DHS 138.05 (1) (a) 4. and (dm) are created to read:
DHS 138.05 (1) (a) 4. For a subsidy under s.
252.17, Stats., the department shall pay the full amount of the premium, subject to a premium contribution assessment under par. (dm), due for health insurance coverage during an unpaid medical leave for an individual whose family income exceeds 200% but does not exceed 300% of the federal poverty line.
(dm)
Upon approval of an application for a subsidy under s.
252.17, Stats., the department shall assess a premium contribution to be paid by an eligible individual whose family income exceeds 200% but does not exceed 300% of the federal poverty line. The amount of the contribution shall equal 3% of the annual policy premium prorated for the number of months that the individual is on an unpaid medical leave. The annual policy premium shall be determined by annualizing the first monthly premium that is due for the benefit year.
SECTION 5. DHS 138.05 (1) (b) and (e) are amended to read:
DHS 138.05 (1) (b) The department may not refuse to pay a premium because the health plan coverage that is available to the individual who satisfies s.
DHS 138.04 (1) includes coverage of the individual's spouse
or domestic partner under ch. 770, Stats., and dependents.
(e) The obligation of the department to make payments under this section is subject to the availability of funds in the appropriation
account under s.
20.435 (1) (am), Stats.
Agency Contact Person
Kathy Rogers
Department of Health Services
Phone: (608) 267-6875
Notice of Hearings
Health Services
NOTICE IS HEREBY GIVEN that pursuant to ss.
256.08 (4) (k),
256.15 (4) (c),
(5) (b),
(6) (b) 2.,
(9m) and
(13), and
227.11 (2) (a), Stats., the Department of Health Services will hold a public hearing on proposed permanent rules to consider repealing Chapters
111,
112,
113, and
119, and repealing and recreating Chapter
DHS 110, relating to emergency medical services, including first responders, emergency medical technicians (EMTs), first responder service providers, non-transporting EMT service providers, and ambulance service providers.
Hearing Information
Date and Time
|
Location
|
August 2, 2010
Monday
6:00 PM to 7:00 PM
|
North Central Technical College
Health Sciences Building
Auditorium
1000 W. Campus Drive
Wausau, WI 54401
Phone: 715.675.3331
|
August 4, 2010
Wednesday
2:00 PM to 3:00 PM
|
Department of Health Services
1 W. Wilson Street
Madison, WI 53701
Phone: 608.266.1568
|
August 4, 2010
Wednesday
6:00 PM to 7:00 PM
|
Blackhawk Technical College
Room 1315 – Blackhawk Room
6004 South County Road G
Janesville, WI 53546-9458
Phone: 608.758.6900
|
August 5, 2010
Thursday
6:00 PM to 7:00 PM
|
Moraine Park Technical College
A-112 World Link Room
235 N. National Avenue
Fond du Lac, WI
Phone: 920.922.8611
|
August 6, 2010
Friday
6:00 PM to 7:00 PM
|
Wisconsin Indian Head
Technical College
Conference Center
2100 Beaser Avenue
Ashland, WI 54806
Phone: 715.682.4591
|
Accessibility
English
DHS is an equal opportunity employer and service provider. If you need accommodations because of a disability or need an interpreter or translator, or if you need this material in another language or in an alternate format, you may request assistance to participate by contacting Brian Litza at 608-261-6870. You must make your request at least 7 days before the activity.
Spanish
DHS es una agencia que ofrece igualdad en las oportunidades de empleo y servicios. Si necesita algún tipo de acomodaciones debido a incapacidad o si necesita un interprete, traductor o esta información en su propio idioma o en un formato alterno, usted puede pedir asistencia para participar en los programas comunicándose con Brian Litza al número 608-261-6870. Debe someter su petición por lo menos 7 días de antes de la actividad.
Hmong
DHS yog ib tus tswv hauj lwm thiab yog ib qhov chaw pab cuam uas muab vaj huam sib luag rau sawv daws. Yog koj xav tau kev pab vim muaj mob xiam oob qhab los yog xav tau ib tus neeg pab txhais lus los yog txhais ntaub ntawv, los yog koj xav tau cov ntaub ntawv no ua lwm hom lus los yog lwm hom ntawv, koj yuav tau thov kev pab uas yog hu rau Brian Litza ntawm 608-261-6870. Koj yuav tsum thov qhov kev pab yam tsawg kawg 7 hnub ua ntej qhov hauj lwm ntawd.
Copies of the Proposed Rule
A copy of the rules may be obtained from the department at no charge by downloading the documents from
www.adminrules.wisconsin.gov or by contacting:
Brian Litza, EMS Section Chief
1 W Wilson Street, Room 133
Madison, WI 53701
Phone: (608) 261-6870
Submittal of Written Comments
Comments may be submitted to Brian Litza, listed above, or to the Wisconsin Administrative Rules Website at
www.adminrules.wisconsin.gov until
August 6, 2010, 7:00 p.m.
Analysis Prepared by Department of Health Services
Statutes interpreted
Statutory authority
Explanation of agency authority
•
Section
227.11 (2) (a), Stats., gives state agencies general rulemaking authority.
•
Section
256.08 (4) (e) and
(k), Stats., requires the Department to set standards for organizations offering training to first responders and EMTs regarding the topics that should be included in initial and continuing training, and to promulgate rules that set forth the authority and duties of medical directors.
•
Section
256.08 (4) (g), Stats., authorizes the Department to promulgate any rule changes necessary to implement recommendations of the emergency medical services board.
•
Section
256.15 (4) (c), Stats., authorizes the Department to promulgate rules that establish standards for staffing ambulances in which the primary services provided are those which an emergency medical technician-intermediate or an emergency medical technician - paramedic is authorized to provide.
•
Section
256.15 (5) (b), Stats., requires the Department to promulgate rules establishing a system for issuing training permits and specifying the period for which an individual may hold a training permit.
•
Section
256.15 (6) (b) 2., Stats., requires the Department, in conjunction with the Wisconsin Technical College System Board (WTCS), to promulgate rules specifying training, education, or examination requirements, including requirements for training for response to acts of terrorism and for license renewals for EMTs.
•
Section
256.15 (6) (c), Stats., authorizes the Department to promulgate rules establishing qualifications for licensure as an ambulance service provider.
•
Section
256.15 (6g), Stats., requires the Department to promulgate rules setting standards for certifying qualified individuals to perform defibrillation.
•
Section
256.15 (9m), Stats., requires the Department to promulgate rules requiring EMTs, first responders, and individuals who provide instruction to EMTs and first responders to successfully complete training on the use of an automated external defibrillator (AED). Section
256.15 (9m), Stats., requires the rules to specify the content of the training, qualifications for providers of the training, and the frequency with which EMTs, first responders, and individuals who provide instruction to EMTs or first responders must complete the training.
•
Section
256.15 (13) (a), Stats., authorizes the Department to promulgate rules necessary for the administration of s.
256.15, Stats.
•
Section
256.15 (13) (b), Stats., requires the Department to establish by rule initial and renewal certification requirements, training requirements, including training for response to acts of terrorism, and requirements for use of AED and other medical techniques for first responders. Section
256.15 (13) (b), Stats., also requires the Department to develop by rule qualifications for medical directors serving ambulance service providers. Section
256.15 (3) (c), Stats., requires the Department to promulgate rules that specify actions that EMTs may take and the required involvement of physicians in actions undertaken by EMTs.
Related statute or rule
Plain language analysis
Currently, rules for each of the 5 levels of emergency medical care, including for ambulance service providers and non-transporting service providers, are in separate rule chapters. Over the years, previous rule revisions have unintentionally resulted in inconsistent standards, inconsistent application of standards, and other conflicts between the rules. In addition, several advances in the emergency medical services (EMS) have occurred that make existing rules outdated.
In this order, the department proposes to clarify and update existing standards, establish new standards, and consolidate existing rule chs.
DHS 110 to
113 and
119, relating to EMS, which include rules regulating the operations of ambulance services, non-transporting services, first responders, and EMTs, into a single administrative rules chapter. The department also proposes to do the following:
•
Create a critical care level of emergency medical care as an endorsement to the EMT-paramedic license. The proposed rules outline the requirements for the endorsement and the requirements for an ambulance service provider to be qualified to provide this level of care.
•
Establish an endorsement to the EMT license for tactical EMS.
•
Create an additional level of instructor. The creation of the EMS Instructor I level is based on the need to assure that all people who assist in a classroom are properly qualified. The rule outlines the qualifications and documentation that will be required by the certified training center to assure that EMS instructors are qualified and have verifiable qualifications.
•
Create rules for air medical services. The focus on qualifications is the basis for the development of the proposed air medical services rules. There has been a national focus on air medical services and the air medical consortia in Wisconsin have asked the department to develop rules. The proposed rules set out basic parameters for service operation which are in addition to the existing ambulance service requirements for which air medical services are currently responsible.
•
Remove rules specifying scopes of practice, including required skills, medication, and treatments, for EMS personnel. Current rules specify treatments, skills, and procedures that are no longer current or that may not be in the best interest of the patient. In order to maximize the department's ability to keep up with the frequent advances in treatment, skills, procedures and other standards, the department will establish the scopes of practice in a document that may be modified as needed in conjunction with the Governor-appointed EMS Advisory Board and the Physician Advisory Committee.
•
Create administrative fees to offset the costs of administering the EMS program. With the increased flexibility and expansion of emergency medical care, there is an increased need to assure that EMS personnel are properly qualified and licensed. Currently, no licensing fees are assessed to EMS personnel or ambulance services. The department's EMS section has limited revenue resources to support the 19,000 licensed individuals in the state. Increasingly, significant time is required to review the applicants for any criminal history or driver license issues. Applicants from other states must be reviewed to assure they are legally qualified to hold a license in Wisconsin. In order to recover these costs, the department proposes to assess administrative fees that are indexed to the consumer price index for urban consumers (CPI-U) for late renewal of a license, reinstatement of a lapsed license, returned renewal notification, and verification of out-of-state license to another state. The department also proposes to assess a fee to be licensed in Wisconsin based on training and licensure from another state (reciprocity), and a manual processing fee for manually processing applications outside of the department's electronic licensing system.
Comparison with federal regulations
There appear to be no existing or proposed federal regulations that address the activities to be regulated by these rules, with the exception of s.
256.15 (8) (b) 3. and
(c), Stats., which require individuals applying for initial or renewal certification as a first responder to complete an initial and refresher course that meets or exceeds the guidelines established by the National Highway Traffic Safety Administration (NHTSA) under
21 CFR 1205.3 (a) 5. The department's EMS system, including licensing and certification requirements, is operated under the standards set forth by the Highway Safety Act of 1966 (P.L.
89-564, 80 Stat. 731) as administrated by NHTSA.
Comparison with rules in adjacent states
The licensing standards in Wisconsin and the adjacent states are generally the same. Wisconsin and the other 49 states operate an EMS system under standards set forth by NHTSA. In addition, most of the adjacent states (Iowa, Minnesota, and Michigan) use the licensing examination of the National Registry of Emergency Medical Technicians (NREMTs)as their state's licensing examination
Illinois:
Similarities:
Illinois rules specify requirements for licensure or certification and training of first responders, EMTs, paramedics, ambulance service providers, including helicopter and air medical service providers (critical care) , and specify enforcement provisions, including suspension, revocation, and administrative fees similar to the requirements specified in the department's existing and proposed rules.
Differences are as follows:
1. The department proposes to endorse the licenses of EMTs as tactical EMS if the individual participates with law enforcement or military teams and receive the appropriate training. Illinois has no similar license provisions.
2. Illinois' administrative fees are limited to late renewal fees.
Iowa:
Similarities:
Iowa rules specify requirements for licensure or certification and training of first responders, EMTs, paramedics, critical care paramedic (called paramedic specialist), ambulance service providers, including helicopter and air medical service providers, and specify enforcement provisions, including suspension, revocation, and administrative fees similar to the requirements specified in the department's existing and proposed rules.
