•
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 In addition, several advances in the emergency medical services (EMS) have occurred that make existing rules outdated.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.
Differences are as follows:
The department proposes to endorse the licenses of EMTs as tactical EMS if the individual participates with law enforcement or military teams and receives the appropriate training. Illinois has no similar license provisions.
Michigan:
Similarities:
Michigan rules specify requirements for licensure or certification and training of first responders, EMTs, paramedics, 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.
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. Michigan has no similar license provisions.
2. The department proposes to endorse the license of a paramedic as critical care provided they complete the appropriate training. Michigan has no similar license provisions.
3. Michigan charges application fees.
4. Administrative actions are handled through a formal hearing process and do not allow the state EMS office to make any disciplinary decisions without a formal hearing.
Minnesota:
Minnesota does not address emergency medical services in administrative rules.
Summary of factual data and analytical methodologies
The department did all of the following to revise and consolidate the EMS rules:
2. Worked with the Governor appointed EMS Advisory Board to identify proposed changes, and to review and comment on draft language.
3. Solicited and reviewed comments and ideas for changes from emergency medical services personnel and other system stakeholders through state-wide public meetings.
Analysis and supporting documents used to determine effect on small business
The proposed rules will affect EMS training centers and emergency medical service providers, including first responder service providers, non-transporting EMT providers, and ambulance services providers. The department does not currently keep records that specifically identify the size of an enterprise or whether an emergency medical services provider or training center is government owned and operated or privately owned and operated. The department has discerned, however, through its licensing and certification records, that the majority (approximately 96% of the 488 ambulance service providers and approximately 80% of training providers) are owned and operated by local government (Wisconsin Technical College System) or municipally owned. Regardless of the size or ownership status of the provider or training center, the proposed rules should have little to no negative fiscal impact on providers or training centers because the proposed rules consolidate, clarify, and by inserting new standards of care, update existing rules. These changes should make compliance easier and more efficient for small and large private sector providers.
Small Business Impact
The proposed rules will not have a negative fiscal impact on small or large private sector emergency medical service providers or training centers.
Small business regulatory coordinator
Rosie Greer
Phone: (608) 266-1279
Fiscal Estimate
Summary
The rule revision will include license processing fees. These fees are focused on individuals who have a special request or fail to meet a deadline. The specific fees are:
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Late renewal of a license - $50
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Reinstatement of a lapsed license - $100
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Returned renewal notice- $30
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Verification of license to another person or entity - $35
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Reciprocity application fee - $75
•
Manual processing fee - $35.
Based on the program's past experience, it is estimated that the new fees will generate $58,000 PR annually.
State fiscal effect
Increase existing revenues.
Fund sources affected
PRO.
Local government fiscal effect
None.
Private sector fiscal effect
None.
Long-range fiscal implications
There should not be a long-range fiscal impact.
Agency Contact Person
Brian Litza, EMS Section Chief
1 W. Wilson Street, Room 133
Madison, WI 53701
(608) 261-6870
Notice of Hearing
Insurance
NOTICE IS HEREBY GIVEN That pursuant to the authority granted under s.
601.41 (3), Stats., and the procedures set forth under s.
227.18, Stats., the Office of the Commissioner of Insurance (OCI) will hold a public hearing to consider the adoption of a proposed rule revising sections
Ins 6.05 and
6.07, Wis. Adm. Code, relating to policy form language simplification and readability and affecting small business.
Hearing Information
Date: July 27, 2010
Time: 1:00 p.m., or as soon thereafter as
the matter may be reached
Location: OCI, Room 227, 2nd Floor
125 South Webster Street
Madison, WI
