•
In the case of an offense that causes death or serious injury, a felony punishable by a fine of not less than $5,000 or more than $25,000, or imprisonment for not more than 4 years, or both.
Minnesota:
The state of Minnesota requires certifications for a person or business that contracts with property owners to construct or improve dwellings for habitation by one- to four-families and where the person or business is involved with two or more special building skills. The Residential Contractor license and Remodeler license are annual licenses. The fees, which are based upon gross receipts, are $260 to $360. The application for the license requires a qualifying person to take the required examination and fulfill the continuing education requirements for the business.
Effective January 1, 2009, the Minnesota Independent Contractor Certification Law requires building contractors to certify that they are independent contractors versus employees using a “9 Items" test related to Worker's Compensation. The fee for a 2-year certification is $250.
Minnesota assesses a penalty of up to $5,000 for each violation if a person performs work without first obtaining a certificate or falsifies or alters a certificate. The penalty also applies to anyone who uses coercion, misrepresentation or fraudulent means to require another individual to adopt independent contractor status.
Factual data and analytical methodologies
The proposed rules were developed by reviewing the provisions under
2009 Wisconsin Act 28 in conjunction with the current rules relating to contractor registration under s.
Comm 5.30. For consistency, the proposed forfeitures are modeled after other penalties currently used by the department to enforce compliance with other construction-related licenses, certifications and registrations.
Small Business Impact
The proposed rules implement the mandates imposed by
2009 Wisconsin Act 28. The effect on small businesses is minor and ensures that the construction trades comply with Wisconsin worker's compensation insurance and unemployment tax requirements. Identifying contractor businesses will help prevent unfair competition which is a common problem for contractors.
An economic impact report has not been required pursuant to s.
227.137, Stats.
Fiscal Estimate
Assumptions used in arriving at fiscal estimate
The department estimates that there would be about 400 new businesses that would be required to register. The building contractor registration is $100 for 4 years. There is also a $15 initial application fee that would be waived if the applicant applies and pays for the registration via the Internet. The department estimates that it would realize about $10,750 in revenue annually.
The department anticipates that the workload associated with the registration and the enforcement of the program can be managed with current information technology and within current staff levels.
State fiscal effect
None. Increase costs — may be possible to absorb within agency's budget.
Local government costs
None.
Fund sources affected
PRO.
Long-range fiscal implications
None are anticipated.
Agency Contact Person
James Quast, Program Manager
Phone: (608) 266-9292
Notice of Hearing
Health Services
NOTICE IS HEREBY GIVEN that pursuant to ss.
50.93 (1) (c),
50.95 (1),
(2),
(4),
(5) and
(6), and
227.11 (2) (a), Stats., the Department of Health Services will hold a public hearing on proposed permanent rules to consider revisions to Chapter
DHS 131, relating to hospices, and affecting small businesses.
Hearing Information
Date and Time
|
Location
|
April 26, 2010
10:00 AM – 12:00 PM
|
Dept. of Health Services
Wilson St. State Office Bldg.
1 West Wilson Street
Room 950B
Madison, Wisconsin
|
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 Pat Benesh at 608-264-9896. 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 Pat Benesh al número 608-264-9896. 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 Pat Benesh ntawm 608-264-9896. Koj yuav tsum thov qhov kev pab yam tsawg kawg 7 hnub ua ntej qhov hauj lwm ntawd.
Submission of Written Comments
Comments may be submitted to the agency contact person listed above or to the Wisconsin Administrative Rules Website at
www.adminrules.wisconsin.gov until
April 27, 4:30 p.m.
Copies of the 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:
Pat Benesh, Quality Assurance Program Spec-Senior
DHS Division of Quality Assurance
1 West Wilson St., Rm. 534
Madison, WI 53701
Phone: 608-264-9896
Fax: 608-267-0352
Analysis Prepared by the Department of Health Services
Statute interpreted
Statutory authority
Explanation of agency authority
Section
50.93 (1) (c), Stats., gives the Department the authority to promulgate rules to establish a provisional licensing fee. Section
50.95 (1), Stats., requires the Department to promulgate rules to establish standards for the care, treatment, health, safety, rights, welfare and comfort of individuals with terminal illness, their families and other individuals who receive palliative care or supportive care from a hospice. Section
50.95 (2),
(4),
(5), and
(6), Stats., requires the Department to promulgate rules establishing provisional hospice licensure fees or the methods of computation of fees, criteria for determining financial hardship for the waiver of licensing fees, criteria for determining that the applicant is fit and qualified and a procedure for the waiver of and variance from standards under ch.
DHS 131.
Section
227.11 (2) (a), Stats., allows agencies to promulgate rules interpreting the provision of any statute enforced or administered by the agency if the agency considers it necessary to effectuate the purpose of the statute.
Related statute or rule
See the “Statutes interpreted" section.
Plain language analysis
The proposed order repeals and recreates ch.
DHS 131 relating to hospices. Hospice is an organization that provides palliative care and supportive care to an individual with a terminal illness where he or she lives or stays. To meet the needs of an individual, the hospice will arrange for or provide short-term inpatient care and treatment or provide respite care. The primary goals of hospice are to provide comfort and alleviate pain and other symptoms, relieve physical, emotional and spiritual suffering, and promote dignity and quality of life of terminally ill persons.
On June 5, 2008, the Centers for Medicare Medicaid Services (CMS) published revised Medicare Hospice Conditions of Participation which became effective on December 2, 2008. The new federal regulations focus on a patient-centered, outcome oriented and transparent process that promotes quality patient care for every patient every time. Significant changes were made in the areas of patient rights, attending physician, pharmacy requirements and quality assessment and performance improvement. These changes are discussed in greater detail in the bulleted list at the end of this section.
Through this rulemaking order the Department proposes to align ch.
DHS 131 with the revised federal Medicare regulations by adopting many of the new federal requirements. This will eliminate the inconsistencies between the state and federal regulations that have occurred since the new federal regulations went into effect. During this interim period the Department has issued waivers to address the differences between state and federal standards. The proposed rule will eliminate the need for these waivers and provide a uniform set of standards for hospice providers to follow. The Department also proposes to eliminate outdated regulations and to reflect current professional standards of practice. The proposed changes are not expected to compromise the health, safety, and welfare of hospice patients.
To accomplish these goals, the proposed rule will:
•
Require proof of financial responsibility to operate a hospice for at least 90 days for all new applicants and require licensed hospices to report to the Department within 10 days any transfer of 50% or more of stock, ownership or change in partners or partnership interest in the hospice. This is a new provision that is not a part of the recently promulgated federal regulations.
•
Afford patients the right to receive effective pain management and symptom control and to be free from mistreatment, neglect, abuse and misappropriation of patient property. These are new provisions that are not included in the recently promulgated federal provisions.
•
Revise the standards for the completion of the initial comprehensive assessment of the hospice patient including time frame for completion, content of the assessment, functional status, imminence of death, severity of symptoms, drug profile and bereavement needs of the patient's family to be consistent with federal regulations. The provisions also include a schedule for reviewing and revising the assessment based on the patient's progress towards desired outcomes.
•
Revise the standards for the completion of an initial and comprehensive plan of care, including time frames for completion, content of the plans and provisions for review of the comprehensive plan of care to be consistent with federal standards. The plan of care is to include a bereavement care plan and address the specific needs of the family and caregivers, intervention strategies, identification of staff responsible for delivering care and timeframes for evaluating and updating the interventions.
•
Require hospices to develop and implement a data-driven quality assessment and performance improvement program to be consistent with federal standards. The program is to be capable of showing improvement related to improved palliative outcomes and hospice services. The program is to use quality indicator data and monitor the effectiveness of services and identify.
•
Require hospices to establish an infection control program to protect patients, visitors and employees by preventing and controlling infections and communicable diseases. The program is to include a method of identifying problems and implement appropriate actions expected to result in disease prevention. The hospice is required to provide initial and ongoing education for all staff and volunteers in the modes of transmission and prevention of infections and the need for routine use of current infection control measures recommended by the U.S. Centers for Disease Control and Prevention. These are new state provisions proposed to reflect current standards of practice. These standards are not included in the recent promulgated federal regulations.
•
Establish standards that require new employees and existing employees to be certified in writing by a physician, physician assistant or registered nurse as having been screened for tuberculosis and clinically apparent communicable disease. These are new state provisions proposed to reflect current standards of practice. These standards are not included in the recent promulgated federal regulations.
•
Require that each hospice have its own bereavement program.
•
Revise the standards regarding the provision of spiritual counseling to be provided in accordance with the patient's and family's acceptance of the service including making all reasonable efforts to facilitate visits by local clergy, pastoral counselors or other individuals who can support the patient's spiritual needs. These changes will make the standards regarding spiritual counseling consistent with recently promulgated federal regulations.
•
Require that if the hospice provides nurse aide services nurse aides are given written patient care instructions prepared by the registered nurse to be consistent with recently promulgated federal regulation. The registered nurse is required to make an on-site visit to the patient's home every 14 days to assess the quality of care and services provided by the nurse aide and to ensure that services meet the needs of the patient.
•
Amend the definition of the attending physician to include a nurse practitioner. This will make Wisconsin's definition consistent with the federal definition of the attending physician and eliminate the need for waivers of the provisions in ch.
DHS 131.
•
Change the current provision that requires a plan of care be reviewed at least every 2 weeks to allow the plan of care to be reviewed at least every 15 days to be consistent with federal standards. This will eliminate the need for waivers of the provisions in ch.
DHS 131.
•
Change the current provision and require the use of standard precautions similar to the federal standard. Currently, ch.
DHS 131 requires the use of universal precautions which is no longer an acceptable standard of practice. This will eliminate the need for waivers of the provisions in ch.
DHS 131.
Comparison with federal regulations
Title
42 CFR 418 contains the Federal Medicare Hospice Conditions of Participation. These regulations establish conditions and standards for the operation of hospices that primarily provide palliative and supportive care to an individual with terminal illness where he or she lives and if necessary arranges for or provides short-term inpatient care and treatment or respite care. State regulations are comparable and the intent of these regulations is to foster safe and adequate care and treatment of patients by hospice agencies.
Comparison with rules in adjacent states
Wisconsin:
Patient rights
• written policies and procedures, copy provided to patient
• right to informed consent
• right to receive effective pain management and symptom control
• right to participate in care
• right to privacy
• right to be treated with dignity and respect
