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

Madison, WI 53701-2659

608-261-6870

NOTICE IS HEREBY GIVEN that pursuant to ss. 227.11 (2), 250.04 (1) and (7) and 254.47, Stats., interpreting ss. 254.47 and 254.85, Stats., the Department of Health and Family Services will hold a public hearing to consider the Department's proposal to repeal and recreate ch. HFS 172 relating to pools and water attractions, and affecting small business.

Two public hearings will be held, as follows:

Wednesday, August 9, 2006 Time: 10:00 AM	Dept. of Health and Family Services 1 West Wilson Street Room B 139 Madison, WI 53703
Thursday, August 10, 2006 Time: 10:00 AM	Marathon County Health Dept. 1200 Lakeview Drive Room 200 Wausau, WI 54403-6797

The hearing site is fully accessible to people with disabilities. If you are hearing or visually impaired, do not speak English, or have circumstances that might make communication at a hearing difficult and if you, therefore, require an interpreter or a non-English, large print or taped version of the hearing document, contact the person at the address or phone number given above 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 in lieu of attending a public hearing written comments can be submitted by regular mail or email to:

Tracynda Davis

1 W. Wilson Street, Room 150

Madison, WI 53702

Phone: 608-266-8924

Fax: 608-267-3241

Email: davistl@dhfs.state.wi.us

Written comments may also be submitted to the Department using the Wisconsin Administrative Rules Internet website at http://adminrules.wisconsin.gov.

The deadline for submitting comments is 4:30 p.m., on Friday, August 17, 2006.

The Department of Commerce has authority related to the design and construction of public pools and water attractions, including plan approval and supervision of construction. When a facility has been properly designed and built, the Department of Health and Family Services (DHFS) then reviews the pool for operation, safety and maintenance and gives the pool a permit to operate if all conditions of ch. HFS 172 are met.

DHFS proposes revisions to ch. HFS 172 based on recent scientific research and extensive input from pool designers and operators. The rule will generally not have an effect on standard rectangular pools and whirlpools that have not made changes resulting in increased risk. Waterslides that were previously regulated by the Department of Commerce, are included in these rule revisions, requiring permitting, either separately or as a pool appurtenance, and annual inspection by DHFS for operation and safety. A certified structural engineer will be required to evaluate the physical condition of the slide every 5 years for bolt degradation and physical stress load capabilities.

The rule also proposes changes related to lifeguard and attendant staffing, to add flexibility in these plans.

Chapter HFS 172, Wis. Adm. Code, is proposed to correspond to the recent changes made by the Department of Commerce in ch. Comm 90, Wis. Adm. Code.

The Certified Pool Operator (CPO) requirement is proposed only for operators of water attractions. Traditional pools used for swimming, diving, wading, relaxation, or therapy would not require certified operators. Water attractions include activity pools, leisure rivers, plunge pools, water slides, vanishing edge pools, vortex pools, and wave pools. CPO training and registration can be obtained through two national organizations, and the Department will evaluate other organizations upon request. Currently, there are 4000 licensed pools in WI; over 50% are managed by a CPO, including nearly all water attractions. Thus, the requirement to have a CPO will have minimal impact, as the industry already recognizes the importance of and has trained operators accordingly.

Since the last revision to ch. HFS 172 in 1989, the water recreation industry has changed significantly. The newly revised code addresses many pool types, and is designed to allow sufficient flexibility for the development of new types of water attractions in the future. Also, as of May 2004, pool and water slides, formerly inspected by the Department of Commerce, will now fall under the purview of DHFS. A Memorandum of Understanding is being developed between the Department of Commerce and DHFS to ensure ongoing seamless approval and inspection of pool slides. The new rule provisions also address additional appurtenances such as climbing and walking features.

These code provision changes should have a minimal impact on small business. The water recreation industry and the operators of small businesses with pools were well represented on the advisory committee, and consensus was obtained before these final rule changes were proposed.

This rule revision will not impose significant increases in licensing and operating fees. 90% of the 4,000 pools in Wisconsin will not be affected by these revisions. The 10% of pools that will be affected include the largest facilities, most of which already meet the CPO and life guarding requirements, and potentially include poorly or illegally operated pools.

The following issues from the revision of ch. HFS 172 may potentially affect small business operators:

• Lifeguard requirements

• CPO requirements

• Fees for inspections, pre-inspections, re-inspections, and operating without a license

• Lifeguards: There are nearly 4,000 licensed individual pools in Wisconsin, but only half of those pool facilities include 2 or more pools. DHFS has no current definitive breakdown of the number of facilities the new lifeguarding requirements would affect, but estimates that perhaps 200 to 300 facilities will fall under the provisions of this rule, and most of these facilities are already in full compliance. These rule revisions alter the codified lifeguard requirements, but are not necessarily more stringent. There will be ongoing costs related to the turnover in lifeguard positions, but water attraction operators build lifeguard costs into their business plans. Labor and training costs are detailed below.

• Revenue analysis of lifeguard staffing plans: The range of revenues regarding pool operations is vast. Many pools show no direct income; e.g., hotels or apartment complexes that do not charge for admission to the pool. Nor is there a definable difference in occupancy rates between properties with a pool versus properties without. Alternatively, there are large water attractions in Wisconsin that generate millions of dollars in revenue from their extensive water attractions.

• While 98% of pool operators qualify as small businesses, the biggest 5% of pool operators have facilities requiring life guarding and therefore the majority of operators will not be affected by these rule changes, as these facilities are already in compliance. Moderately sized hotels have recently begun expanding their pools by adding slides, interactive play features, etc. These facilities will feel the impacts of the rules the most, because they are approaching the line distinguishing a public pools from a water attraction. These facilities will need to hire staff members to supervise their pools and either hire already certified lifeguards or train existing staff. DHFS estimates 20 hotels per year would fall into this category.

Costs to agencies: There is no additional cost to state or local agencies related to meeting the lifeguard requirements.

DHFS will absorb minimal costs associated with training inspectors to properly inspect water slides. Each inspection of pool slides should take no more than 20 to 30 additional minutes while the inspector is already present.

• Certified Pool Operator (CPO) Requirements: Wisconsin has a large pool of certified pool operators, and regularly adds more. From April 2001 to April 2006, 2041 persons graduated from Wisconsin Certified Pool Operator courses. Thus, the industry should feel little impact from these new rule provisions, as most facilities that need a CPO either already have a CPO or can choose from the pool of qualified individuals.

• Inspection, Pre-inspection and Re-inspection fees: The addition of pre-inspection and re-inspection fees, as well as higher fees associated with waterslide inspections may have an economic impact related to this rule. A pre-inspection is an examination of the facility prior to the facility's opening to ensure compliance with applicable statutes and administrative rules. Re-inspections occur when a facility presents a potential hazard to the general public if conditions are not corrected, and therefore an additional inspection is necessary.

• Water slide inspection fees: DHFS follows a system of rating, inspecting, and charging establishments according to the relative risk related to and the complexity of the operation. Accordingly, a revised fee structure has been created with the following changes:

S Traditional pool or hot tub	no change
S Water attraction without slides	plus $25 annually
S Water attraction with 1 or 2 slides	plus $100 annually
S Additional water slides	plus $150 annually
S Additional pool slides (smaller)	plus $50 annually

DHFS estimates there are 400 water attractions without slides, 200 with 1 or 2 slides, an additional 20 water slides, and an additional 20 pool slides. Increased revenue to DHFS under the new rule is estimated to be:

  400 * $25 = $10,000

  200 * $100 = $20,000

  20 * $150 = $3,000

  20 * $50 = $1,000

  Total revenue increase = $34,000

• Operating without a license: A fee equal to the annual licensing fee has been added to the rule for facilities found to be purposefully operating without a license. This fee will not apply to someone who is merely late in renewing, or who inadvertently misplaces the fee notice.

Pool operators understand the need to keep the public safe, and the goal of keeping their operations open. These administrative rule revisions address both of those issues.

• Serious but flexible lifeguard plans will help pool operators keep their operations safe.

• A Certified Pool Operator is an expert at maintaining water quality and pool safety, establishing policies and procedures to provide a constant safe environment, and training staff. Certified Pool Operators are also trained in monitoring and testing pool water, in order to maintain proper pool chemical balances.

• The test kit reagent required in these rule revisions is less expensive than kits currently used. Since pools are tested up to 4 or more times per day, over time, this will mean a considerable savings to the industry.

• The new fees require services to be paid for by the operators who require the services rather than by dividing them among all operators.

Operations that are built or redesigned so that pools will be direct sources of income will face additional training and labor costs as outlined above. Most pools in Wisconsin are simple swimming pools or spas designed and operated as an amenity to lodging. These operations will feel little or no impact from the proposed revisions.

The DHFS proposes to repeal and re-establish HFS 172 regulating the operation and maintenance of public pools and water attractions. Presently, the DHFS or agent local health departments are required by statute to perform a pre-inspection - a detailed examination of a new public pool or water attraction to ensure administrative code compliance - prior to issuing a license. The proposed changes in this rule would establish a pre-inspection fee to recover the program costs associated with the pre-inspection. The DHFS also proposes to establish fees for re-inspection of facilities to recover costs associated with facilities that are found to have significant violations of administrative code which would require a follow-up inspection. The proposed rule changes also incorporate the transfer of responsibility for the routine safety inspection of waterslides from the Department of Commerce to the Department of Health and Family Services or agent local public health departments and include fees to recover the costs associated with these inspections. The proposed fees are scaled to the complexity of the facility to reflect the amount of time and cost associated with the inspection. It is estimated that the fee changes described above will result in approximately $100,000 additional program revenue to the DHFS annually.

The proposed rule changes would require additional responsibilities of the local agent public health departments. Staff would be required to verify lifeguard staffing plans for public pools and water attractions, and inspect waterslides within their jurisdiction. Local agent public health departments are able to set annual license fees to recover the costs of these additional responsibilities.

It is estimated that total annual costs to the industry for the new pre-inspection fees for approximately 200 to 400 newly constructed facilities and facilities changing ownership would be $50,000 to $60,000. It is estimated that 100 to 200 facilities will require re-inspections annually due to significant compliance problems resulting in annual costs to the industry of $7,500 to $15,000. The proposed pre-inspection and reinspection fees will not impact existing and compliant public pools and water attractions. An estimated 200 new facilities with water or pool slides will apply for permits and be charged fees of between $50 to $150, for a total estimated cost to the industry of $20,000 annually. Total charges to the industry from permit fees, pre-inspection fees, and re-inspection fees are estimated to be approximately $100,000 annually.

There will be fiscal impacts to existing public pools and water attractions associated with proposed new health and safety operational requirements. Facilities may require an additional lifeguard or attendant. It is difficult to estimate the number of facilities impacted by this proposed change; however it is estimated that only about 200 to 300 of the 4,000 licensed individual facilities in Wisconsin may be affected and most of those are likely already in full compliance. Additionally, the rule proposes that water attractions employ a certified pool operator. While most existing water attractions are already in compliance with this proposed change, it is estimated that approximately 20 new or expanded facilities will be constructed annually.

A copy of the full text of the rules and the full text of the fiscal estimate, and other documents associated with this rulemaking may be obtained, at no charge, from the Wisconsin Administrative Rules website at http://adminrules.wisconsin.gov or by contacting:

Tracynda Davis

1 W. Wilson Street, Room 150