Under 2009 Wisconsin Act 16, s. 101.136, Stats., on and after July 1, 2011, only individuals licensed as insulation mechanics or working under the supervision of licensed insulation mechanics may install or maintain thermal system insulation. Thermal insulation was statutorily defined as a product that is used in a heating, ventilating, cooling, plumbing or refrigeration system to insulate any hot or cold surface, including a pipe, duct, valve, boiler, flue, or tank, or equipment on or in a building. 2011 Wisconsin Act 32 repealed s. 101.136, Stats.

The proposed rules repeal the credentialing procedures established for thermal system insulators under s. 101.136, Stats., as mandated under 2009 Wisconsin Act 16.

An internet search on U.S. federal regulations and U.S. federal register yielded no results regarding the licensing of thermal insulators.

An Internet-based search of thermal insulation mechanic licenses in the states of Illinois, Iowa, Michigan and Minnesota found that none of the states have specific rules or programs regarding these types of licenses.

The proposed rules were developed because of 2011 Wisconsin Act 32 which repealed s. 101.136, Stats.

The proposed rule action follows the direction provided by 2011 Wisconsin Act 32.

The small business regulatory coordinator for the Department of Safety and Professional Services is Bill Wendle, who may be contacted at telephone (608) 266-8608, or Email at bill.wendle@wisconsin.gov.

Notice is hereby given that the department has considered the environmental impact of the proposed rules. In accordance with Chapter SPS 301, the proposed rules are a Type III action. A Type III action normally does not have the potential to cause significant environmental effects and normally does not involve unresolved conflicts in the use of available resources. The department has reviewed these rules and finds no reason to believe that any unusual conditions exist. At this time, the department has issued this notice to serve as a finding of no significant impact.

SECTION 1. SPS 305.02 Table 305.02 lines 50r. to 50t. are repealed.

SECTION 2. SPS 305.06 Table 305.06 lines 45r. to 45t. are repealed.

SECTION 3. SPS 305.74 and 305.741 to 305.743 are repealed.

James Quast, Program Manager, jim.quast@wisconsin.gov, (608) 266-9292

STATE OF WISCONSIN DEPARTMENT OF ADMINISTRATION DOA 2049 (R 07/2011) ADMINISTRATIVE RULES FISCAL ESTIMATE AND ECONOMIC IMPACT ANALYSIS
Type of Estimate and Analysis
X Original Updated Corrected
Administrative Rule Chapter, Title and Number
Chapter SPS 305, Licenses, Certifications and Registrations
Subject
Thermal System Insulators
Fund Sources Affected			Chapter 20 , Stats. Appropriations Affected
GPR FED X PRO PRS SEG SEG-S
Fiscal Effect of Implementing the Rule
X No Fiscal Effect Indeterminate	Increase Existing Revenues Decrease Existing Revenues		Increase Costs Could Absorb Within Agency's Budget Decrease Costs
The Rule Will Impact the Following (Check All That Apply)
State's Economy Local Government Units		Specific Businesses/Sectors Public Utility Rate Payers
Would Implementation and Compliance Costs Be Greater Than $20 million? Yes X No
Policy Problem Addressed by the Rule
Section 101.136, Stats., as created by 2009 Wisconsin Act 16, mandates as of July 1, 2011 only individuals licensed as insulation mechanics or working under the direct supervision of licensed insulation mechanics may install or maintain thermal system insulation. The department promulgated rules under Chapter SPS 305 effective February 1, 2011 that implemented the licensing mandates of 2009 Wisconsin Act 16. Subsequently, 2011 Wisconsin Act 32, has repealed s. 101.136, Stats., and therein eliminated the licensing mandates for thermal system insulators.
Summary of Rule's Economic and Fiscal Impact on Specific Businesses, Business Sectors, Public Utility Rate Payers, Local Governmental Units and the State's Economy as a Whole (Include Implementation and Compliance Costs Expected to be Incurred)
It was estimated that the credential rules implemented pursuant to 2009 Wisconsin Act 16 regarding thermal insulators would most likely affect HVAC contractors, plumbing contractors, and mechanical refrigeration contractors. Fees for the various credentials ranged from $15 for apprentices and helpers to $250 for mechanics. In light of the Act 32, the thermal insulator credentials were not implemented and the associated fees not collected.
Benefits of Implementing the Rule and Alternative(s) to Implementing the Rule
The proposed repeal of the credential rules for thermal insulators will clarify and allow individuals to continue to install and maintain thermal system insulation without the necessity of acquiring a specific credential. An alternative of leaving the rules in place and requiring the credentials under the broad authority of Chapter 101, Stats., would not reflect the latest direction provided by 2011 Wisconsin Act 32.
Long Range Implications of Implementing the Rule
No long range implications are anticipated.
Compare With Approaches Being Used by Federal Government
An internet search on U.S. federal regulations and U.S. federal register yielded no results regarding the licensing of thermal insulators.
Compare With Approaches Being Used by Neighboring States (Illinois, Iowa, Michigan and Minnesota)
An Internet-based search of thermal insulation mechanic licenses in the states of Illinois, Iowa, Michigan and Minnesota found that none of the states have specific rules or programs regarding these types of licenses.
Name and Phone Number of Contact Person
James Quast, program manager, (608) 266-9292

NOTICE IS HEREBY GIVEN That pursuant to sections 15.08 (5) (b), 227.11 (2), 448.05 (5), 448.20 (3) (a), 448.40 (2) (f), Stats., and interpreting sections 448.21 (2) and (3), Stats., the Medical Examining Board will hold a public hearing at the time and place indicated below to consider an order to repeal section Med 8.10 (2); to renumber section Med 8.02 (1); to renumber and amend sections Med 8.01 and Med 8.10 (3) and (4); to amend sections Med 8.05 (2) (title), Med 8.05 (2) (b), Med 8.05 (2) (b) (7), Med 8.05 (2) (c), Med 8.07 (1), Med 8.07 (2) (a) and (e), Med 8.08 (title), Med 8.08 (1), Med 8.08 (3) (b), Med 8.10 (title), Med 8.10 (1); to repeal and recreate sections Med 8.08 (2) and Med 8.08 (3) (a) and to create sections Med 8.01 (2), Med 8.02 (1), Med 8.02 (4m), Med 8.02 (7), Med 8.05(2) (e), Med 8.07 (1) (a) and (b), and Med 8.08 (1) (a), (b), (c) and (d), and Med 8.08 (3) (c) and (d), relating to definitions, practice prescribing limitations, employment requirements and supervising physician responsibilities.

Interested persons are invited to present information at the hearing. You may make a presentation in person or submit a brief statement regarding facts, opinions and arguments, or both. You may also submit a brief statement of facts, opinions and arguments in writing without a personal appearance by mail addressed to Shawn Leatherwood, Department of Safety and Professional Services, Division of Board Services, P.O. Box 8935, Madison, WI 53708. Written comments will be accepted until February 15, 2012.

Comments may be submitted to Shawn Leatherwood, Paralegal, Department of Safety and Professional Services, 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708-8935, or by email to Shancethea.Leatherwood@wisconsin.gov. Comments must be received on or before February 15, 2012, to be included in the record of rule-making proceedings.

Copies of the proposed rule are available upon request to Shawn Leatherwood, Paralegal, Department of Safety and Professional Services, Division of Board Services, 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708 or by email at
Shancethea.Leatherwood@wisconsin.gov.

Sections 448.21 (2) and (3), Stats.

Sections 15.08 (5) (b), 227.11 (2) (a), 448.05 (5), 448.20 (3) (a), 448.40 (2) (f), Stats.

The legislature, via Wis. Stats. ss. 15.08 (5) (b), and 227.11 (2) (a), conferred upon the Medical Examining Board general powers to promulgate rules for the guidance of the profession and to interpret the provisions of statutes it enforces. Section 448.05 (5) authorizes the Board to promulgate rules that establish licensing and practice standards for physician assistants. Section 448.40 (2) (f), Stats., directs the board to promulgate rules regarding the prescriptive practice of physician assistants. Therefore, the Medical Examining Board is both generally and specifically authorized to promulgate these proposed rules.

Section 448.20 (3) (a) confers upon the Council on Physician Assistants the authority to advise the Medical Examining Board on revisions of standards in licensing, practice, education and training of physician assistants.

Sections 448.01 (6), 448.20 (3), Stats., Wis. Admin. Code section Med 10.02 (2) (t).

Physician assistants practice as part of a physician-led team with physicians supervising the health care services they provide. Currently, one physician may supervise no more than two physician assistants at one time without permission from the Medical Examining Board (Board). The proposed rule increases the maximum number of physician assistants a physician may concurrently supervise from 2 to 4.

Under current law the Board may, in an exercise of discretion, authorize a physician to supervise more than two physician assistants concurrently. A physician requesting an increase in the numbers of physician assistants to be supervised must submit a written plan for the Board's review. The Board may grant the request if the Board is satisfied that the increased number of physician assistants will not compromise patient safety. The proposed rules retain the Board's authority to increase the number of physician assistants a physician may concurrently supervise on a case-by-cases basis.

The proposed rule defines terms necessary to clarify responsibilities in the physician-led teams in which physician assistants work. It further eliminates any reference to the outdated term, “substitute supervising physician."

Current law provides that applicants for licensure as physician assistants may be required to submit to an oral examination. The existing term is outdated and does not reflect that during a personal appearance the Board may also require an applicant to submit to an interview, or a review of credentials, or both. The proposed rule clarifies that the Board may require, as a prerequisite to licensure, successful completion of an oral examination or a personal appearance or both.

Finally, the proposed rule explains that the periodic review of physician assistant prescribing practices must occur at least annually, with more frequent review optional, depending upon applicable standards of care and other factors.

SECTION 1. Renumbers and amends Med 8.01

SECTION 2. creates a statement of intent and add it to the authority and purpose provision.

SECTION 3. Renumbers Med 8.02 (1) to 8.02 (1m).

SECTION 4. Defines the terms “adequate supervision", “general supervision" and “supervising physician".

SECTION 5. Clarifies that in addition to written and oral examinations, the Board may require satisfactory performance of a personal appearance for the purpose of an interview, a review of credential, or both.

SECTION 6. Amends Med 8.05(2) (b) (7) to remove outdated references to particular mental health disorders.

SECTION 7. Amends Med 8.05 (2) (c) to allow a personal appearance as well as an oral examination if required by the application review panel.

SECTION 8. Creates Med 8.05 (2) (e) a provision regarding the components of a satisfactory personal appearance.

SECTION 9. Amends Med 8.07(1) by clarifying that a physician assistant's practice may be supervised by one or more supervising physicians.

SECTION 10. Creates Med 8.07 (1) (a) and (b) regarding physician assistant's scope of practice.

SECTION 11. Amends Med 8.07 (2) (a) and (e) by striking repetitive and ambiguous language.

SECTION 12. Amends Med 8.08 (title) and Med 8.08 (1) to specify that the supervising physician and the physician assistant shall review guidelines for supervised prescriptive practice at least annually and clarifies the requirement that the guidelines for supervised prescriptive practice shall include the process and schedule for the supervising physician's review.

SECTION 13. Creates Med 8.08 (1) (a), (b), (c) and (d) specifying the contents of the written guidelines for the required supervised prescriptive practice.

SECTION 14. Repeals and recreates Med 8.08 (2) to simplify when physician assistants are authorized to prescribe.

SECTION 15. Repeals and recreates Med 8.08 (3) (a).

SECTION 16. Amends Med 8.08 (3)(b) to require supervising physicians to document review of the physician assistant's prescriptive practice in the patient records.

SECTION 17. Creates Med 8.08 (3) (c) and (d) regarding documenting the periodic review.

SECTION 18. Amends Med 8.10 (1) by increasing the number of physician assistants a physician may supervise from 2 to 4, and clarifying the nature of supervision.

SECTION 19. Repeals Med 8.10 (2) eliminating the provision regarding substitute supervising physicians.

SECTION 20. Amends Med 8.10 (3) and (4) striking repetitive language regarding supervising physicians.

There is no comparative existing or proposed federal rule.

Illinois: The state of Illinois limits the physician assistant to physician ratio to 2:1; unless the supervising physician designates an alternate supervising physician. An alternate supervising physician may supervise more than two physician assistants at the same time when the supervising physician is unable to fulfill the duties. 225 Ill. Comp. Stat. 95/7

Iowa: The state of Iowa limits the physician assistant to physician ratio to 2:1. 645 IAC 326.8 (3) (148 C)

Michigan: The state of Michigan allows a physician assistant to physician ratio of 4:1 when the supervising physician is a solo practitioner who practices in a group of physicians and treats patients on an outpatient basis. Physicians who have privileges at a health facility or agency or a state correctional facility may supervise more than four physician assistants; but the physician assistant to physician ratio is 2:1 if the physician supervises a physician assistant at more than one location. MCLS s. 333.17048

Minnesota: The state of Minnesota allows a physician to supervise five physician assistants simultaneously. In the case of an emergency a physician may supervise more than five physician assistants at any given time. Minn. Stat. s. 147A.01

In recognition of physician work-force shortages and at the request of the Council on Physician Assistants, the Medical Examining Board created a work group to research and advise the board on whether or not to increase the supervision ratio of physician assistants to physicians, and if so under what circumstances. The work group consisted of members of the Medical Examining Board, who are licensed physicians, the chairperson of the Council on Physician Assistants and consultation from the State Medical Society, the Wisconsin Council of Physician Assistants and the Wisconsin Hospital Association. Members of the work group examined the statutes and regulations of other states as well as recommendations of the Federation of State Medical Boards, the American Medical Association, the American Association of Family Practitioners and the American Academy of Physician Assistants.

The national trend, as recognized by the Federation of State Medical Boards and the American Academy of Physician Assistants, is to increase the number of physician assistants a physician may supervise. Both organizations have, as a national model, recommended that regulatory bodies refrain from specifying a particular number of physician assistants a physician may concurrently supervise. Rather, the recommendation is that supervising physicians make the determination based on prevailing standards for competent medical practice, day-to-day realities, and the nature of the physician's actual practice.

The work group presented its findings to the Medical Examining Board with a recommendation that the board increase the ratio from 1:5. The board considered several factors including practice setting in which physician and physician assistants carry out their duties and patient care issues such as a growing shortage of health care practitioners in underserved communities. The board emphasized the need for adequate physician supervision of physician assistant's practice and adopted the work group's recommendation to increase the ratio of physician assistants a physician may supervise. However, after extensive discussion, the board decided to authorize a physician to physician assistant supervision ratio of 1:4. The proposed rule would continue to allow the board, in its discretion, to increase the ratio in individual circumstances.