Codify, in rule, the statewide variances that have been issued by the Department to outpatient mental health providers.

Increase flexibility for clinic operations including allowing certified clinics to alternatively meet the standards of one of several national accrediting bodies when applying for renewal certification; permitting clinics to provide either clinical supervision, clinical collaboration or clinical consultation as part of the clinic's quality improvement process; allowing mental health professionals to provide the recommendation for psychotherapy for consumers who are not medical assistance recipients; allow persons other than a physician or psychiatrist to provide mental health services; and allow clinics to provide psychotherapy services in the clinic, a branch office, or alternate location.

Establish certification and enforcement processes that are similar in both organization and content to the certification and enforcement processes set out in rules for other certified community mental health programs.

Clarify the minimum staff requirements for a clinic; and the role of professional staff of a clinic, including for persons who prescribe medication within a clinic.

Clarify record keeping requirements for psychotherapy notes.

Establish training requirements for clinic staff.

Add or expand language on admission, assessment, consent for treatment, treatment planning and medication administration; standards for electronic records, and consumer rights.

Incorporate the provisions under s. 50.065, Stats., and chs. HFS 12 and 13 that require caregiver background checks on clinic staff and reporting of clinic staff misconduct.

Increase consumers' participation in treatment planning resulting in treatment that is recovery-based and consumer-directed.

The Department proposes to revise ss. HFS 105.22 and 107.13 (2), to ensure that the language in these rules are consistent with the language in the proposed ch. HFS 35 and that these rules current practices and needs, such as, indexing the number of visits and dollar amounts before a prior authorization is required. Covered services are not proposed to change.

The Department is required under s. 51.42 (7) (b), Stats., to promulgate rules which govern the administrative structure deemed necessary to administer community mental health services; prescribe standards for qualifications personnel; prescribe standards for quality of professional services; govern eligibility of patients to the end that no person is denied service on the basis of age, race, color, creed, location or inability to pay; and to establish medication procedures to be used in the delivery of mental health services. Section 51.04, Stats., allows treatment facilities to apply to the Department for certification of the facility for the receipt of funds for services provided as a benefit to medical assistance recipients under s. 49.46 (2) (b) 6. f., Stats., or to a community aids funding recipient under s. 51.423 (2), Stats., or provided as mandated private insurance coverage under s. 632.89 (2), Stats. Section 51.42 (7) (a), Stats., requires the Department to review and certify county departments of community programs and community mental health programs to assure that the county department and programs are in compliance with the purpose and intent of s. 51.42 Stats., to enable and encourage counties to develop a comprehensive range of services offering continuity of care; to utilize and expand existing governmental, voluntary and private community resources for provision of services to prevent or ameliorate mental disabilities, including mental illness, developmental disabilities, and alcoholism and drug abuse; to provide for the integration of administration of those services and facilities organized under s. 51.42, Stats., through a county department of community programs; and to authorize state consultative services, review and establishment of standards and grants-in aids for such program of services and facilities.

The rules promulgated under s. 51.42 (7) (b), Stats., are currently codified under ss. HFS 61.91 through 61.98. These rules initially were effective on January 1, 1980 with the most recent revisions effective on May 1, 1981. The rules were written primarily for public mental health clinics, which were assumed to have access to an interdisciplinary team (e.g., psychiatrist, nurse, psychotherapists, etc.). During the past 25 years, many private providers have sought to become a certified outpatient mental health clinic in order to bill insurance companies for services provided under s. 632.89 (2), Stats.

Under the current regulations, a certified clinic must include a psychiatrist or a licensed psychologist, as well as a master's level social worker or a registered nurse with a master's degree with a psychiatric specialty. Other mental health professionals with training and experience in mental health may be employed as necessary, including persons with master's degrees and course work in clinical psychology, psychology, school psychology, counseling and guidance, or counseling psychology. The clinic is required to ensure continuity of care for persons with mental disorders or alcohol and drug abuse problems by rendering or arranging for the provision of and documentation of services such as evaluation to determine the extent to which the patient's problem interferes with normal functioning; residential facility placement for patients in need of a supervised living environment; partial hospitalization to provide a therapeutic milieu or other care for non–residential patients for only part of a 24–hour day; pre–care prior to hospitalization to prepare the patient for admission; aftercare for continuing treatment in the community to help the patient maintain and improve adjustment following a period of treatment in a facility; emergency care for assisting patients believed to be in danger of injuring themselves or others; rehabilitation services to achieve maximal functioning, optimal adjustment, and prevention of the patient's condition from relapsing; habilitation services to achieve adjustment and functioning of a patient in spite of continuing existence of problems; supportive transitional services to provide a residential treatment milieu for adjustment to community living; professional consultation to render written advice and services to a program or another professional on request. The current rule also requires the clinic to provide a minimum of 2 hours each of clinical treatment by a psychiatrist or psychologist and a social worker for each 40 hours of psychotherapy provided by the clinic. Specified personnel employed by a clinic are required to be under the supervision of a physician or licensed psychologist who meets the requirements of s. HFS 61.96 (1) (a) for a specified time relating to the number of hours of psychotherapy provided and frequency of a consumer's treatment sessions. The current rule further requires that each consumer receive an initial assessment and have a treatment record that contains a treatment plan, progress notes and discharge summary.

Through this order, the Department proposes to repeal ss. HFS 61.91 through 61.98 and create ch. HFS 35. Private and public clinics have reported difficulty in meeting the requirement of having a psychiatrist or psychologist to work in the clinic or to accept referrals from the clinic. To address this issue, the Department is adding 2 options for minimum staffing requirements that do not require a psychiatrist or psychologist to be a staff member of the clinic. The proposed rule also will respond to the issue of clinical supervision by a psychiatrist or psychologist. Many clinics report that this oversight model is costly, and that the process does not yield meaningful feedback to staff. To address this issue, the proposed rules will permit clinical collaboration, which is a process by which staff within the clinic review the treatment effectiveness and together identify possible changes in treatment approaches, staff training, policy changes, etc., as an alternative to clinical supervision.

The private sector outpatient mental health clinics that will be affected by the proposed rules are those that contract with county departments under s. 46.23, s. 51.42 or 51.437, Stats., to implement its community mental health services programs or to receive reimbursement for outpatient mental health services from the Wisconsin medical assistance program or private insurance under s. 632.89, (2) Stats. As of June 2006, there are 837 certified outpatient mental clinics located throughout Wisconsin with the largest concentrations in the metropolitan areas of the central and southeastern parts of the state. The majority, 92 percent (772 clinics) are privately owned non-profit or for-profit entities. The remaining 8 percent are government owned. The privately owned clinics (as represented in the WABHS survey and assumed by the Department to be representative of the “average" clinic) are staffed primarily by licensed clinical social workers, licensed marriage and family therapists, or licensed professional counselors and support staff who provide approximately 788 hours of mental health services (and 237 hours of psychotherapy services) per week to children, adolescent, adults, and senior adults of various degrees of mental health issues and diagnoses, such as disorders relating to legal and illicit drug use; eating and sleeping disorders; depressive, bipolar, anxiety disorders; and personality disorders. Staff of these clinics also may include medical doctors, psychiatrists, psychologists, advanced practice nurse prescribers, persons with a master's in social work, persons with a master's of science, and substance abuse counselors. The current and proposed rules do not apply to or individual practitioners licensed by the Department of Regulation and Licensing to provide psychotherapy; these individuals can apply their trade as permitted by their license without being certified as an outpatient mental health clinic.

More than 10% of the certified outpatient clinics that will be affected by the proposed rules may be small businesses as defined under s. 227.11 (2) (a), Stats., as the average private clinic may be independently owned and operated and employs less than 25 employees or has gross annual revenues under $5,000,000. As discussed below, the Department believes that the proposed rules will decrease costs to the average outpatient mental health clinic. The cost elements discussed in this analysis are staffing; documentation and reporting; recordkeeping; and the certification process. Any costs other than those specified in this analysis appear to be negligible and are inherent in the conduct of clinic business or are the result of required compliance with ch. 51, Stats, as a mental health provider.

The requirements in the proposed rule relating to reporting, record keeping, and the certification process and the associated costs are unchanged compared to the current rule, except that under the renewal certification process clinics that are accredited by nationally recognized bodies may request a waiver of part of the bi-annual process. In addition clinics, under specified conditions, may also be certified as exceptional clinics. Certification for exceptional clinics renews every three years. A grant of a waiver of certification requirements or receipt of exceptional certification may reduce a clinic's costs. Although the rules require additional specificity in regard to documentation in the content of assessment and treatment plan records, the costs of documentation are not expected to increase. There is no data or basis that indicates that the time involved completing the documentation of the assessment and treatment plan will increase. There are no capital costs imposed by the proposed rules.

The proposed rules are minimum requirements that give maximum flexibility under regulations that are required by statute and the intent and purpose of s. 51.42, Stats. The Department believes that the benefits of the proposed rules will outweigh any costs that they may impose because the proposed rules will benefit both consumers and clinics by improving access, protection, and quality of care and quality of life to consumers receiving or seeking mental health services and will reduce costs and the burden of regulation on outpatient mental health clinics that choose to be certified. For example, under the existing rule, services must be provided at the clinic office or a branch office identified in the certificate issued by the Department unless it is demonstrated to the Department that there are specific barriers to care if services are not delivered outside the clinic. In addition, there currently are limitations in the use of a branch office, such as branch offices must be located within 30 miles of the main office and all treatment records must be stored in the main office. In the proposed rule, service delivery will be more flexible as clinics will be allowed to offer services where needed without having to seek additional certification and other limitations on the use of branch offices are also removed. This should increase the profitability of the clinic or reduce the costs of clinics by increasing the numbers of consumers that may be served and eliminating any costs that may be incurred in certifying and maintaining a branch office. The existing rules were written for comprehensive, publicly operated clinics. The proposed rules have eliminated the requirements that clinics provide, or provide access to residential facilities, partial hospitalization, pre-care for hospitalization, rehabilitation services, habilitation services, and supportive transitional services. The services under the proposed rule allow for services to be provided, contracted or provided by agreement. It is assumed that the therapist would expedite services as required for individual clients. The time and cost of procuring these services or agreements has been eliminated. The existing rule requires that every consumer have a referral from a physician for psychotherapy services. The proposed rule allows a licensed therapist to make the recommendation for therapy if the consumer is a non-Medicaid recipient, which reduces cost to the consumer and increases accessibility to services. This would be an estimated cost savings to the consumers (who are not Medicaid recipients) of $100. However, recommendations for psychotherapy for Medicaid recipients must be by a physician as required under s. 49.46 (2) (b) 6. f., Stats.

Personnel requirements have been changed to allow alternatives to the existing rule and to recognize and reduce a clinic's staffing costs and the difficulty clinics reportedly have in obtaining staff. Existing rules require a minimum of two hours of clinical treatment by a psychiatrist or psychologist for each 40 hours of psychotherapy provided in a clinic. The proposed rule eliminates this requirement with an estimated minimum savings of $19,000 per year for the small clinic. Larger clinics likely will save proportionally increased amounts. As reported in the WABHS survey, the average clinic already meets the minimum staffing requirements under the proposed rules. These clinics have sufficient numbers of staff working sufficient number of hours to meet the current and proposed minimum staff requirements. Although the Department estimates that approximately 150 currently certified clinics may not currently meet the minimum staff requirements or the proposed regulations, the Department believes that these and all other clinics will be able meet one of the options for minimum staffing without difficulty and without increased costs. The proposed rules provide two options for minimum staffing that do not require a psychiatrist or psychologist to be a staff member of the clinic, which acknowledges the shortage of psychiatrists and psychologists. A third option for minimum staffing is similar to the current regulations, but is more stringent in that it requires staff to be available to provide psychotherapy at least 37.5 hours per week, but is less stringent in that it requires only four hours of direct services from a psychiatrist, psychologist or advanced practice nurse prescriber. The proposed rule permits existing clinics to be “grandfathered" for a two-year period of time, to comply with the minimum staffing requirements in the proposed rules. If a clinic submits data regarding its reasonable, bona fide efforts to comply with the minimum staffing requirements, then the Department may grant a waiver request regarding the minimum staffing requirements for the clinic. The proposed staffing requirements may be met either through contract or employment. Also, under the existing rule clinics are required to provide supervision by a psychiatrist or psychologist at the rate of 30 minutes for every 40 hours of therapy provided. The current rules require clinics to have clinical supervision from a psychiatrist or psychologist. As reported in the WABHS survey the oversight model type most used by clinics is clinical supervision from a psychiatrist or psychologist which costs the average clinic approximately $701 per month and $593 per month, respectively. The proposed rules will allow clinical collaboration, which is a process by which staff within the clinic review the treatment effectiveness and together identify possible changes in treatment approaches, staff training, policy changes, etc., as an alternative to clinical supervision. Clinics that already use clinical collaboration (which is currently allowed under a statewide waiver) have an average reported cost of $551 per month. Based on the average costs for clinical supervision versus clinical collaboration, the cost-savings for using clinical collaboration is estimated to be approximately $500 to $1800 per year. The average clinic has annual gross revenues of $593,000 per year (based on the revenue information reported in the WABHS survey). For the average clinic, the estimated cost savings of $19,000 plus $1,800 per year represent a 3.5 percent potential decrease in costs for a clinic if the clinic chooses clinical collaboration as an oversight model.

The proposed rules include waiver and variance provisions to allow clinics to use alternatives to rules when compliance is difficult because of availability of staff or remote geographic locations or strict enforcement of the requirement would result in unreasonable hardship on the outpatient clinic or consumer. A waiver or variance can also be used if there are more creative ways to meet a requirement or if “deemed status" from a national accrediting organization is recognized, which would eliminate duplicate costs to the agency for staff time to prepare for survey by both the national accrediting organization and Department staff. A waiver or variance would not be allowed if quality of care is adversely affected. The proposed rules allow for a provisional certification for a clinic that has no major deficiencies but has one or more minor deficiencies for up to one year, a regular certification for a clinic that has no major or minor deficiencies for up to two years, and an exceptional certification for a clinic that has no major or minor deficiencies and meets additional standards for up to three years.

Pursuant to the foregoing analysis, the proposed rules may decrease costs to the small businesses affected by the proposed rules. The proposed rules will affect a substantial number of small businesses, but will not have a significant economic impact on those businesses. Further, any increase in operating costs or decreases in revenues that may be caused by the proposed rules are expected to be less than the 2005 Consumer Price Index of 3.4%.

Small Business Regulatory Coordinator

Rosie Greer

608-266-1279

State fiscal effect - The rule does not mandate any changes to fees charged to outpatient mental health clinics, increase the number of State surveyors, or otherwise create new or different requirements for the department. The rule does not change the provider requirements for who may bill Medicaid for outpatient services. In addition, the rule does not propose to change the services that are Medicaid reimbursable as an outpatient mental health service. Therefore, no increases or decreases are anticipated in the Medicaid budget as a result of the rule changes.

Summarized below is the analysis of the potential fiscal impact the rule may have on county and private sector outpatient mental health clinics:

1. The proposed rule has no specific space, design, or organizational requirements for outpatient mental health clinics. The capital costs for the clinic are based on individual preferences, such as the number of staff, staff service time, and location of offices. The number of support staff would also be related to the size of the operation.

2. Ongoing operational costs would include the cost of contracting for services from a psychiatrist, psychologist or other mental health professional for the purpose of clinical collaboration on treatment. The proposed rule has added alternatives to reduce this cost over the existing rule. Specifically, the current rule requires clinical supervision from a psychiatrist or psychologist at an average reported cost in the survey of clinics of $701/month and $593/month, respectively. The proposed rule permits an oversight model of either clinical supervision or clinical collaboration, which has an average reported cost of $551/month.

3. Ongoing transaction costs would include normal clinical data keeping which is factored into the hourly fee charged to the client. Typically, a therapeutic hour is calculated to be 45 minutes with the remaining 15 minutes used for documentation related to the therapy session and other record keeping. The cost of preparing for the actual compliance review would assume that the psychotherapist has a full schedule of therapy sessions, and would need to disrupt the normal schedule. However, most clinics do not function on a full 40 hours of therapy per week, a typical schedule would be 50% direct face-to-face time.

4. Start-up costs would vary with the skills of the individual. The tasks would include creation of policies and procedures, design of documentation and filing systems.

The expected average compliance cost may range from $500 to $1,000 depending on the size and nature of the operation. Other costs to consider:

1. Ability to finance compliance costs: The cost of compliance is primarily composed of individual time. There are no capital costs required by the rules.

2. Financial hardship: The rule is designed to reduce cost over the existing rule.

3. Competitiveness of enterprises and sectors: When a clinic elects to be certified under the existing or proposed rules, they have access to additional funding which would not otherwise be available. This includes funding from mandated insurance under WI Stats. 632.89 and Medicaid. The funding provides up to $500 of coverage for those individuals with insurance or Medicaid. There is also the advantage of being recognized as complying with standards established by the state mental health authority.

4. Barriers to entry and expansion: The individual clinic seeking certification is required to meet minimum standards of compliance. This requires compliance with accepted standards of service. The primary barrier would be the therapist's ability to comply with the accepted standards. There are no restrictions on the number and locations of agencies. The addition of staff which is the principal method of expansion simply requires the notification of the certifying agency of the qualifications of new staff. The same is true for adding additional branches to the clinics. The clinical operation is in control of the type and style of office they wish to a create or add.

Employment effects: There should be no effect on the present employment within clinics. The rules have been structured to allow qualified staff of existing operations to continue. There may be minimal effect on those operations, which were marginally operating under the existing standards. The proposed rules allow the hiring of additional staff for specific functions within the clinic. There are provisions to allow persons who are in the process of training and those with alternative qualifications to be employed by the clinic.

Specific cost saving changes: The proposed rules only apply to those clinics who choose to be certified. Individuals who are licensed to provide psychotherapy can apply their trade as permitted by their license. The proposed rules only apply to those clinical operations electing to be approved as an outpatient clinic as defined by the rules.

The following changes have been made to improve the quality of care and at the same time reduce costs and the burden of regulation.

1. The location of service delivery has been changed to be more flexible. Under the existing rule, services could only be provided at the clinic offices unless it was demonstrated there were specific barriers to care. This should increase the profitability of the clinic by increasing the numbers of persons that can be accessed.

2. “Deemed status" from a national accrediting organization is recognized. This would not duplicate costs to the agency for staff time to prepare for a survey by both the national accrediting organization and Department staff, potentially saving money during the certification period.

3. A waiver or variance of a requirement is permitted to allow clinics alternatives to rules when compliance is difficult due to availability of staff, remote geographic locations, or strict enforcement of the requirement would result in unreasonable hardship on the outpatient clinic or consumer. The waiver or variance would not be allowed if quality of care is adversely affected.

4. The personnel requirements have been changed to allow alternatives to the existing rule to reduce costs and difficulty of obtaining staff. Existing rules require a minimum of two hours of clinical treatment by a psychiatrist or psychologist for each 40 hours of psychotherapy provided. The new rule eliminates this requirement with a minimum savings of $19,000 per year of cost for the small clinic. Larger clinics will save proportionally increased amounts.

5. Under the existing rule, clinics are required to provide supervision by a psychiatrist or psychologist at the rate of 30 minutes for every 40 hours of therapy provided. The cost for a small clinic would be approximately $5,000 per year. The new rule allows clinical collaboration with other licensed staff to provide for this function.

6. Service requirements have been extensively reduced to recognize the wider variety of clinics and methods of providing care. The existing rules were written for publicly operated clinics. Private clinics have been allowed to apply for certification if they agree to comply with the rules. The proposed rules have eliminated the requirements that clinics provide, or provide access to residential facilities, partial hospitalization, pre-care for hospitalization, rehabilitation services, habilitation services, and supportive transitional services. The services under the proposed rule may be provided, contracted or provided by agreement. It is assumed that the therapist would expedite services as required for individual clients. The time and cost of procuring these services or agreements has been eliminated.

7. The existing rule requires that every consumer must have a referral from a physician for psychotherapy services. The proposed rule allows the licensed therapist to make the recommendation for therapy, which reduces cost to the consumer and increases accessibility to services. This would be an estimated cost savings to the consumers (who are not Medicaid recipients) of $100.

A copy of the full text of the rules and the fiscal estimate can be obtained at no charge from the Wisconsin Administrative Rules Website at http://adminrules. wisconsin.gov or by contacting the person listed below.

Dan Zimmerman
Department of Health and Family Services
Bureau of Mental Health & Substance Abuse Services
Room 455
1 W. Wilson St.
Madison, WI 53707
zimmeds@dhfs.state.wi.us
(608) 266-7072

NOTICE IS HEREBY GIVEN that pursuant to ss. 146.50 (4) (c), (5) (b), (6) (b) 2., (8m), (13), and 227.11 (2), Stats, Stats., and interpreting ss. 146.50 (1) (d) to (g), (4) (c), (5) (b) and (d), (6), (9), (10), (13) and 146.53 (5) (g), Stats., the department proposes to modify rules relating to licensing emergency medical technicians and affecting small businesses.

The hearing site is fully accessible to people with disabilities. If you are hearing impaired, do not speak English or have circumstances that might make communication at a hearing difficult; you require an interpreter or a non-English large print or taped version of the proposed rules, contact the person at the address or telephone number given below at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.

Written comments may be submitted at the public hearing or submitted to the contact person listed below. Comments may also be made using the Wisconsin Administrative Rule Website at http://adminrules.wisconsin.gov.

The deadline for submitting comments to the Department is 4:30 p.m. on July 31, 2006.

Wisconsin has two levels of emergency medical services. 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. 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. 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). The requirements for basic life support are codified in chs. HFS 110 and HFS 113. Requirements for advanced life support are codified in chs. HFS 111 and HFS 112.

The training and competency requirements for the EMT-basic IV license are identical to the training and competency requirements for the provisional EMT- intermediate license. But because the EMT-basic IV requirements are codified in the basic life support code, ambulance service providers are reimbursed at the basic life support level of care instead of the advanced life support level of care. The ambulance service provider industry report that this situation is having a negative fiscal impact on ambulance service providers that use EMT-basic IV licensees to provide emergency medical services and may eventually cause a reduction of services in the communities that they serve.

To maintain the level of emergency medical services that are currently being provided and to avoid confusion about the skills and level of care provided by the EMT-basic IV licensee, the department proposes to change the name of the EMT-basic IV license to EMT-intermediate technician and move the licensing requirements to ch. HFS 111. No changes to skills and competency requirements are being proposed. The department also proposes to modify the continuing education requirements under ch. HFS 110 to allow ambulance service providers flexibility in providing refresher training to EMT-basic licensees. This change will reduce financial and scheduling burdens on providers by allowing them to use their training dollars more cost effectively, and it will create uniformity between the basic refresher requirements and the refresher requirements that are in place for the other skill levels.

The department will implement these changes in a substantially identical emergency rule to become effective on July 1, 2006, because under current s. HFS 111.045, individuals who are licensed as provisional EMT-intermediate licensees will become EMT-basic IV licensees effective July 1, 2006. If this occurs, it's likely that the currently reported negative affects on the ambulance provider industry will increase.

In Wisconsin there are approximately 430 ambulance service providers. Approximately 80% are volunteer (not for profit) or owned by private for profit entities. The remaining 20% are government owned. A total of 129 ambulance service providers and 2812 licensed individuals in 48 counties currently provide emergency medical services at the EMT-basic-IV (74) or EMT-provisional intermediate (55) level to approximately 2.65 million Wisconsin residents.

The provider industry estimates that these ambulance service providers are losing approximately $1.5 million dollars in reimbursement revenues annually due to the codification of the EMT-basic IV services in ch. HFS 110 as basic life support. The loss is likely to increase when the provisional EMT-intermediate is renamed EMT-basic IV effective July 1, 2006, and an estimated 95% of the individuals who are currently licensed and titled as provisional EMT-intermediate will be renamed EMT-basic IV. Consequently, the level of emergency medical services provided in over half of the state's 72 counties may be reduced or become non-existent unless the proposed changes are implemented.

The department believes the proposed changes will have a positive fiscal effect on ambulance service providers as the proposed changes are likely to increase revenues through increased reimbursement. The proposed rules do not do not require any additional reporting or record keeping, or other requirements that may increase costs or decrease revenues.

Pursuant to the foregoing analysis the proposed rules will have a positive fiscal effect on ambulance service providers, including those that may be small businesses.

Small Business Regulatory Coordinator

Rosie Greer

608-266-1279

Currently the department sets standards for different categories of Emergency Medical Technicians (EMT) in rule. By amending this administrative rule, the Department proposes to eliminate the category of EMT-basic IV, retain the category of provisional EMT- intermediate (which is due to sunset on June 30, 2006), and rename both categories of providers as EMT-intermediate technicians. This change will allow providers with specific skill levels, including advanced life support, to be classified appropriately. This change in rule allows these categories of EMT providers to be placed in the appropriate rule, which defines their scope of practice more adequately. As a result, ambulance service providers will be able to charge for the more complex skill sets at a higher rate based on the treatment modalities that are utilized and individual ambulance providers will be able to increase their revenues. The addition of more flexible renewal requirements will allow services to better budget and use their training dollars more efficiently. This is a significant issue with regard to reduced local budgets.

Ambulance service providers report that they cannot continue to cover the costs of training and operating at the advanced life support level of care while being reimbursed at the basic life support level of care. The provider industry estimates that Wisconsin ambulance service providers are losing approximately $1.5 million dollars in reimbursement revenues annually due to the codification of the EMT-basic IV services in ch. HFS 110 as basic life support rather than in ch. HFS 111 as advanced life support. The loss of revenue would increase if the current provisional EMT-intermediate were renamed EMT-basic IV when the category of provisional EMT-intermediate sunsets, as would happen under the current rule. However, this rule change will reclassify both categories as EMT-intermediate technicians, which will allow ambulance service providers to charge for both at the higher rate of reimbursement. Medical insurance providers and other entities responsible for health care costs may see some increase in expenses as a result of this change.

In many cases now, Medicaid reimburses ambulance providers for the actual level of services required. As a result, there are not likely to be significant increased expenses for Medicaid as a result of this rule change. Without this rule change and the potential for rate increases, some EMT providers may not be able to continue to operate. The level of services provided in some communities would be likely to decrease or disappear. This rule change will help to ensure that an adequate emergency medical services system remains in place in Wisconsin.

A copy of the full text of the rules and the fiscal estimate can be obtained at no charge from the Wisconsin Administrative Rules Website at
http://adminrules.wisconsin.gov or by contacting the person listed below.

Dan Williams

Department of Health and Family Services

Division of Public Health - Emergency Medical Services

1 West Wilson Street Room 118

P.O. Box 2659