On November 5, 2003, the Wisconsin Department of Health and Family Services submitted a proposed rule to the Wisconsin Legislative Council Rules Clearinghouse.

Reason for Rules, Intended Effects, Requirements:

Section 146.83 (3m), Stats., as created by 2001 Wisconsin Act 109 and s. 908.03 (6m) (d), Stats., as amended by 2001 Wisconsin Act 109, requires the Department prescribe by rule fees for reproducing patient medical records that are the maximum amount a health care provider may charge. The fee limits are to be based on an approximation of actual costs. The statutes allow health care providers to also charge for postage or other delivery costs.

To develop these rules, the Department formed a 14-member advisory committee in early February, 2003. The committee consisted of equal representation of those who maintain medical records and those who request records. Over the following three months, the Department also created a website on which it posted pertinent documents for review by interested parties and encouraged persons to register to receive email notifications of new Department postings on the website.

The Department began its effort by distributing a four-page project plan to advisory committee members on February 18th. The plan stated the Department's intent “to develop a rule that complies and is consistent with what it believes to be applicable state and federal law, and is based on an approximation of actual medical record reproduction costs." Toward that end, the Department identified and shared what it considered to be the major factors and considerations. These were:

1. The recent federal Health Insurance Portability and Accountability Act (HIPAA) regulations and federal commentary related thereto, particularly the issues of:

a. Who, and the circumstances under which, a person will be considered someone's “personal representative" for the purposes of requesting a copy of that person's medical record; and

b. Whether the costs associated with record retrieval should be included in fee limits for subject persons or their personal representatives.

2. The Department's desire to approximate total medical record reproduction costs by attempting to identify the component tasks and estimated costs associated with medical record reproduction. Issues bearing on doing so include the following:

a. Whether and how the medical record medium affects the length of time to reproduce a record;

b. Whether the medical care provider setting (i.e., hospital, clinic, etc.) or subject patient group (e.g., children, elderly, etc.) affects the time and effort needed to reproduce records; and

c. The steps involved in reproducing medical records and whether those steps are different for different record mediums and record maintainer settings.

The Department invited all committee members, and those who were “virtual" participants via the Department's website postings, to submit documents to the Department on these major factors and considerations, asking that the documents be submitted, if possible, by March 7th. Specifically, the Department requested the following input:

1. Committee members' thoughts regarding whether the appropriateness and acceptability of the Department's intended approach. If it is not, how it is not, and how and why the commenter would propose it to be different.

2. Information on the following subjects:

-How HIPAA bears on the revision of ch. HFS 117.

-Whether the categories of paper, electronic, microfilm, microfiche and traditional x-ray comprise the universe of medical record mediums for the purposes of this project, and if not, what other mediums should be addressed.

-Whether the steps involved in the reproduction of medical records within a particular medical record maintainer setting or for a particular patient group are sufficiently different to suggest a significantly different reproduction cost.

-The sequence of steps and time associated with each of step typically required for medical record reproduction, by medical record medium, setting or patient group, as appropriate.

-Existing medical record fee limit policies.

After reviewing, analyzing and compiling information from about 20 documents, the Department circulated a preliminary report to committee members on March 31, 2003. The preliminary report included an initial draft of ch. HFS 117, as did the Department's subsequent iterations of the report. The Department asked that committee members and others submit comments on the Department's preliminary report by April 14th.

In response to comments it received on its preliminary report, the Department revised its preliminary report (known in its second iteration as the “interim" report) and created a table of comments and Department responses. The Department subsequently modified the comment and response table to reflect comments the Department received through April 30th. The Department circulated these documents to committee members prior to convening the first and only meeting of the advisory committee on April 25th.

In the course of the advisory committee meeting, a variety of outstanding issues were discussed. However, with one exception, there was virtually no consensus on any of the issues between members representing medical record maintainers and members representing medical record requesters. The one exception was that members encouraged the Department to develop a single fee structure to the extent possible.

Following the April 25th advisory committee meeting, the Department chose its positions on the remaining outstanding issues, revised its interim report to become its “final" report, and created a “final" iteration of its comment and response table. This initial proposed rulemaking order is the result of these efforts.

The rules limit the fee a health care provider may charge to provide duplicate medical records. The fee limit varies depending on the person making the request. If an individual (or the individual's personal representative on behalf of the individual) is requesting his or her own records, the provider may charge no more than $0.31 per page. Postage is extra. If anyone other than the individual is requesting the another's records, the provider may charge no more than $15.00 per request plus $0.31 per page. The $15.00 amount may be deemed a retrieval fee that individuals need not pay for copies of their own records.

Public hearings under ss. 227.16, 227.17 and 227.18, Stats.; approval of rules in final draft form by the DHFS Secretary; and legislative standing committee review under s. 227.19, Stats.

Larry Hartzke, 267-2943

On October 24, 2003, the Wisconsin Department of Natural Resources submitted a proposed rule to the Wisconsin Legislative Council Rules Clearinghouse.

The proposed rule amends ss. NR 6.03 and 6.08, relating to snowmobile noise testing procedures.

The Bureau of Law Enforcement is primarily responsible for promulgation of this rule. Public hearings are scheduled for December 15 and 18, 2003.

Karl Brooks, Bureau of Law Enforcement

608-267-7455

On October 24, 2003, the Wisconsin Department of Natural Resources submitted a proposed rule to the Wisconsin Legislative Council Rules Clearinghouse.

The proposed rule amends ss. NR 20.20 (73) and 25.06, relating to fishing for yellow perch in Green Bay.

The Bureau of Fisheries Management and Habitat Protection is primarily responsible for promulgation of this rule. A public hearing is scheduled for December 11, 2003.

Bill Horns, Bureau of Fisheries Management and Habitat Protection

608-266-8782

On October 24, 2003, the Wisconsin Department of Natural Resources submitted a proposed rule to the Wisconsin Legislative Council Rules Clearinghouse.