The holder of an APRN license may append the title “A.P.R.N.” to his or her name, as well as a title corresponding to whichever specialty designations that the person possesses. The bill prohibits any person from using the title “A.P.R.N.,” and from otherwise indicating that he or she is an APRN, unless the person is licensed by the board as an APRN. The bill also prohibits the use of titles and abbreviations corresponding to a recognized role unless the person has a specialty designation for that role.
Under the bill, when an APRN renews his or her APRN license, the board must grant the person the renewal of both the person’s RN license and the person’s APRN license. The bill requires all APRNs to complete continuing education requirements each biennium in clinical pharmacology or therapeutics relevant to the APRN’s area of practice and to satisfy certain other requirements when renewing a license.
Practice of nurse-midwifery
The bill repeals licensure and practice requirements specific to nurse-midwives and the practice of nurse-midwifery, including specific requirements to practice with an obstetrician. Under the bill, “certified nurse-midwife” is one of the four recognized roles for APRNs, and a person who is licensed as a nurse-midwife under current law is automatically granted an APRN license with a certified nurse-midwife specialty designation. The bill otherwise allows nurse-midwives to be licensed as APRNs if they satisfy the licensure requirements, except that the bill also requires that a person applying for a certified nurse-midwife specialty designation be certified by the American Midwifery Certification Board. The bill also requires an APRN with a specialty designation as a certified nurse-midwife to file with the Board of Nursing, and obtain the board’s approval of, a plan for ensuring appropriate care or care transitions in treating certain patients if the APRN offers to deliver babies outside of a hospital setting.
Prescribing authority
Under current law, a person licensed as an RN may apply to the Board of Nursing for a certificate to issue prescription orders if the person meets certain requirements established by the board. An RN holding a certificate is subject to various practice requirements and limitations established by the board and must possess malpractice liability insurance in an amount determined by the board.
The bill eliminates certificates to issue prescription orders and generally authorizes APRNs to issue prescription orders. A person who is certified to issue prescription orders under current law is automatically granted an APRN license with his or her appropriate specialty designation. RNs who are practicing in a recognized role on January 1, 2023, but who do not hold a certificate to issue prescription orders on that date and who are granted an APRN license under the bill may not issue prescription orders. As under current law, an APRN issuing prescription orders is subject to various practice requirements and limitations established by the board.
The bill repeals a provision concerning the ability of advanced practice nurses who are certified to issue prescription orders and who are required to work in collaboration with or under the supervision of a physician to obtain and practice under a federal waiver to dispense narcotic drugs to individuals for addiction treatment.
Malpractice liability insurance
The bill requires all APRNs to maintain malpractice liability insurance in coverage amounts specified under current law for physicians and nurse anesthetists. Additionally, the bill requires APRNs who have qualified to practice independently and who practice outside a collaborative or employment relationship, but not including those APRNs who only practice as a certified nurse-midwife, to participate in the Injured Patients and Families Compensation Fund. Under current law, only physicians and nurse anesthetists are mandatory participants in the Injured Patients and Families Compensation Fund. The Injured Patients and Families Compensation Fund provides excess medical malpractice coverage for health care providers who participate in the fund and meet all other participation requirements, which includes maintaining malpractice liability insurance in coverage amounts specified under current law.
Other changes
The bill directs DHS to require a hospital that provides emergency services to have sufficient qualified personnel available at all times to manage the number and severity of emergency department cases anticipated by the location. At a minimum, the bill directs DHS to require a hospital that provides emergency services to have on-site at least one physician who, through education, training, and experience, specializes in emergency medicine.
The bill makes numerous other changes throughout the statutes relating to APRNs, including various terminology changes.
Professional licensure
Licensure of dental therapists
The bill provides for the licensure of dental therapists, who are health care practitioners who may engage in the limited practice of dentistry.
Under current law, dentists and dental hygienists are licensed by the Dentistry Examining Board to practice dentistry and dental hygiene, respectively. The bill provides for the licensure of a third type of dental practitioner, dental therapists. Under the bill, the board must grant a dental therapist license to an individual who satisfies certain criteria, including completion of an approved dental therapy program and passage of required examinations.
Dental therapists may provide dental therapy services only under the supervision of a dentist with whom the dental therapist has a collaborative management agreement that addresses various aspects of the dental therapist’s practice. Dental therapists are, subject to the terms of a collaborative management agreement and what was covered in their dental therapy education program, limited to providing services, treatments, and procedures that are specified in the bill, as well as additional services, treatments, or procedures specified by the board by rule. Dental therapists may initially provide dental therapy services only under the direct or indirect supervision of a qualifying dentist. Once a dental therapist has provided dental therapy services for at least 2,000 hours, the dental therapist may provide services under the general supervision of a qualifying dentist. However, the level of supervision for a dental therapist may be further limited under the terms of a collaborative management agreement. Dental therapists must also, under the bill, either 1) limit their practice to federally defined dental shortage areas or 2) practice in settings where at least 50 percent of their patient base consists of certain specified populations. Dental therapists must complete 12 hours of continuing education each biennium.
The bill subjects dental therapists to, or covers dental therapists under, various other laws, including the health care records law, the volunteer health care provider program, the health care worker protection law, and the emergency volunteer health care practitioner law. The bill also provides for loan forgiveness for dental therapists under the health care provider loan assistance program.
Finally, the bill requires, effective when 50 individuals become licensed as a dental therapist in this state or five years after the bill is enacted, that, to the extent possible, one of the dental hygienist members on the board also be licensed as a dental therapist.
Professional licenses for certain noncitizens
Currently, federal law prohibits all but certain noncitizens from receiving any “state or local public benefit,” which is defined to include any “professional license, or commercial license provided by an agency of a state or local government.” However, federal law allows states to explicitly allow eligibility for certain public benefits. The bill allows certain individuals who are not U.S. citizens to receive any professional license issued in this state if they meet all other requirements or qualifications for the professional license. For purposes of the bill, “professional license” means a license, registration, certification, or other approval to perform certain work tasks, whether issued by the state or a local governmental entity.
DSPS renewal dates; continuing education; nursing workforce survey
Under current law, a two-year renewal period applies to many health and business credentials administered by DSPS or a credentialing board. The renewal date for each two-year period is specified by statute. In addition, the laws governing some professions specify continuing education requirements, either by statute or by rule, as part of credentialing renewal.
The bill eliminates statutory renewal dates for these credentials and instead allows DSPS, in consultation with the credentialing boards, to establish renewal dates. The bill makes various changes to continuing education requirements for various professions to account for the flexible renewal periods allowed in the bill, including allowing DSPS and the credentialing boards to adjust continuing education requirements and to establish interim continuing education or other reporting requirements as needed to align with changes to renewal cycles.
Under current law, in order to renew a registered nurse or licensed practical nurse license, a licensee must complete and submit to DSPS with the application for renewal of the license a nursing workforce survey developed by DWD, completed to the satisfaction of the Board of Nursing, along with a nursing workforce survey fee of $4. The bill modifies this requirement so that it no longer applies specifically as a condition of renewal of a nurse license.
Licensing fee revenue
Current law generally appropriates funding for the licensing, rule-making, and regulatory functions of DSPS for professional credentials and other approvals using 90 percent of revenues from the fees paid for those credentials and other approvals. The remaining 10 percent of these revenues are instead credited as GPR in the general fund.
The bill eliminates the exception whereby 10 percent of these revenues are credited as GPR and instead appropriates 100 percent of these revenues to DSPS for the purposes described above.
Reviews of criminal records
The bill requires DSPS, when conducting an investigation of the arrest or conviction record of a credential applicant, to review and obtain information to determine the circumstances of each case or offense, except that the bill allows DSPS, in its discretion, to complete its investigation of an arrest or conviction record without reviewing the circumstances of certain types of offenses specified in the bill. These offenses include certain first offense operating while intoxicated and related violations; certain underage alcohol violations; and minor, nonviolent ordinance violations, as determined by DSPS.
Rules; license portability
The bill provides that DSPS or a credentialing board in DSPS may promulgate administrative rules to facilitate enhanced license portability to help facilitate streamlined pathways to licensure for internationally trained professionals and increased reciprocity.
Trade exams administered by test service providers
Under the bill, DSPS is authorized to approve a test service provider to prepare, administer, and grade the examinations required for credentials to practice various trades, including for electricians, plumbers, fire sprinkler contractors and fitters, elevator mechanics, and blasters.
Buildings and safety
Use of vapor products in indoor locations
The bill specifies that the general prohibition under current law against smoking in indoor locations includes inhaling or exhaling vapor from a vapor product. Under the bill, a “vapor product” is a noncombustible product that produces vapor or aerosol for inhalation from the application of a heating element to a liquid or other substance. The prohibition applies to vapor products regardless of whether they contain nicotine.
Private on-site wastewater treatment system grants
The bill extends the grant program aiding certain persons and businesses served by failing private on-site wastewater treatment systems (POWTS), which are commonly known as septic tanks. Under current law, the program is repealed effective June 30, 2023. In addition, under the bill, a failing POWTS installed at least 33 years before the submission of a grant application is eligible to receive a grant. Current law authorizes grants only for failing POWTS that were installed before July 1, 1978.
Create appropriation for DSPS contractors
The bill creates an appropriation for payments received by DSPS contractors and vendors for services performed related to the regulation of industry, buildings, and safety.
SHARED REVENUE
Public safety, per capita, and aidable revenues allocations
Under current law, counties and municipalities annually receive county and municipal aid payments, commonly referred to as shared revenue. Generally, each county and municipality receives a payment equal to the payment it received in 2012.
The bill provides additional aid payments by creating a municipal and county shared revenue program and using a percentage of state sales tax revenue to make the payments. The total amount available to make the payments under the bill is an amount equal to 20 percent of the state sales tax revenue collected in each fiscal year, minus the amounts distributed for county and municipal aid, as state aid for exempt personal property, and as payments under the expenditure restraint program.
Beginning in 2024, each county and municipality will receive a public safety payment to be used for law enforcement, fire protection, and ambulance and emergency medical services and to pay the costs of prosecutorial and judicial functions. The amount that DOR will distribute for these payments is equal to 43.4 percent of the total amount allocated for all payments under the bill. The amount of the payments are determined on the basis of the most recent three-year average of the county’s or municipality’s expenditures for law enforcement, fire protection, or ambulance and emergency medical services.
Under the bill, each county and municipality will also receive a payment based on the county’s or municipality’s population. Seventy percent of this per capita distribution is paid to municipalities and 30 percent to counties.
Finally, each county and municipality receives a payment on the basis of its aidable revenues. The bill defines “aidable revenues” as the total of the three-year average of revenues from general property taxes, other taxes, payments in lieu of taxes, special assessments, licenses and permits, fines and forfeitures, public charges, intergovernmental revenues, and shared revenues, not including public utility aid payments. The total amount that DOR distributes for aidable revenues is the amount remaining after determining the amounts distributed as public safety payments or per capita payments. Generally, each county and municipality receives an aidable revenues payment, as adjusted by DOR, in proportion to the amount of its aidable revenues, compared to the aidable revenues for all counties or municipalities.
Nontaxable reservation property
The bill provides an additional county and municipal aid payment for certain towns and counties that will no longer be able to impose property taxes on property located within the boundaries of an American Indian reservation and owned by the tribe or tribal members. A federal court recently held that, pursuant to the 1854 Treaty of La Pointe, the state and its political subdivisions are prohibited from taxing all real property within the Bad River, Lac Courte Oreilles, Lac du Flambeau, and Red Cliff reservations if that property is owned by the tribe or by one or more tribal members, regardless of whether the property was previously owned by a person other than the tribe or a tribal member. See Lac Courte Oreilles Band of Lake Superior Chippewa Indians of Wisconsin v. Evers, 46 F.4th 552 (7th Cir. 2022).
Under the bill, DOA determines the amount of the payments to the affected towns and counties for the payments in 2024. In 2025, and in each year thereafter, the amount of the payment a town or county receives is the amount received in the previous year, less 10 percent. No payments are made under the bill after the distribution in 2033.
Energy storage facility
Under current law, counties and municipalities where power production plants are located receive public utility aid payments on the basis of the value or megawatt capacity of the plant. Generally, the amount of the payment to a county or municipality is determined by applying a mill rate to a specified amount of the license fees paid by the power production plant located in the county and municipality.
The bill provides utility aid payments to counties and municipalities where energy storage facilities are located. The bill defines an “energy storage facility” as property that receives electrical energy, stores the energy in a different form, and converts that other form of energy back to electrical energy for sale or to use to provide reliability or economic benefits to the electrical grid. The bill also defines an “energy storage facility” as property that is owned by a light, heat, and power company, electric cooperative, or municipal electric company and includes hydroelectric pumped storage, compressed air energy storage, regenerative fuel cells, batteries, and similar technologies.
Under the bill, DOA annually distributes to each county and municipality in which an energy storage facility is located an amount calculated by multiplying the facility’s megawatt capacity by $2,000 and then multiplying the product of that calculation by three mills for a county and by six mills for a municipality. However, if the energy storage facility is located in a town, the town receives a payment equal to multiplying the product of that calculation by three mills and the county where the town is located receives a payment equal to multiplying the product of that calculation by six mills.
Electric vehicle charging infrastructure
The bill provides utility aid payments to counties and municipalities where qualified electric vehicle charging infrastructure is located. The bill defines “qualified electric vehicle charging infrastructure” as level three electric vehicle supply equipment that has a minimum charging capacity of 480 volts and that is owned by a light, heat, and power company, electric cooperative, or municipal electric company. Under the bill, DOA annually distributes to each county and municipality in which qualified electric vehicle charging infrastructure is located an amount equal to the value of the qualified electric vehicle charging infrastructure, multiplied by three mills for a county and by six mills for a municipality. However, if the qualified electric vehicle charging infrastructure is located in a town, the town receives a payment equal to the value of the qualified electric vehicle charging infrastructure multiplied by three mills and the county where the town is located receives a payment equal to the value of the qualified electric vehicle charging infrastructure multiplied by six mills.
Expenditure restraint program
Under current law, generally, a municipality is eligible to receive an expenditure restraint payment if its property tax levy is greater than five mills and if the annual increase in its municipal budget is less than the sum of factors based on inflation and the increased value of property in the municipality as a result of new construction. The bill excludes the following from being considered in determining eligibility for an expenditure restraint program payment: 1) money received from the federal government; 2) revenues from a municipal vehicle registration fee that is approved by a majority of voters voting at a referendum; and 3) tax revenues resulting from a tax increase approved by a majority of voters voting at a referendum.
Moving the date of computer aid payments
Beginning in 2024, the bill requires DOA to make computer aid payments to taxing jurisdictions by the first Monday in May. Under current law, computers and certain computer-related equipment are exempt from local personal property taxes, and DOA makes computer aid payments to taxing jurisdictions to compensate them for the corresponding loss of property tax revenue. Current law requires DOA to make computer aid payments by the fourth Monday in July.
STATE GOVERNMENT
General state government
Grant to a professional baseball park district
The bill requires DOA to award a grant in the amount of $290,000,000 to a local professional baseball park district created under state law to assist in the development, construction, improvement, repair, and maintenance of the district’s baseball park facilities. Under the bill, DOA may not award the grant unless the secretary of administration determines that all of the following apply:
1. The district has entered into a lease arrangement for a term that expires not earlier than December 31, 2043, with a professional baseball team that uses the district’s baseball park facilities as its home facilities.
2. The district has entered into a nonrelocation agreement with the professional baseball team, in a form satisfactory to the secretary of administration, that requires the professional baseball team to play substantially all of its home games at the baseball park facilities, and prohibits the professional baseball team from relocating while the lease term specified above is in effect.
3. The district has entered into an agreement with the professional baseball team, in a form satisfactory to the secretary, that requires the professional baseball team, or a third party on the professional baseball team’s behalf, to make expenditures relating to or in connection with the baseball park facilities during the term of the lease specified above in an agreed upon amount satisfactory to the secretary.
4. The district has agreed to provide on an ongoing basis to DOA, the Legislative Fiscal Bureau, and the Legislative Audit Bureau all baseball park facilities project reports and all financial reports of the district.
Grant moneys DOA awards under the bill may not be used to retire the debt of the local professional baseball park district.
Security operations centers
The bill requires DOA to establish one or more security operations centers to provide for the cybersecurity of information technology systems maintained by state agencies, local governmental units, and other eligible entities specified in the bill. The bill requires the Division of Enterprise Technology in DOA to manage the operation of the centers. The bill authorizes DOA to charge fees in connection with the division’s cybersecurity support services provided under the bill.
Project labor agreements
Under current law, the state and local units of government are prohibited from engaging in certain practices in letting bids for state procurement or public works contracts. Among these prohibitions, as established by 2017 Wisconsin Act 3, the state and local governments may not do any of the following in specifications for bids for the contracts: 1) require that a bidder enter into an agreement with a labor organization; 2) consider, when awarding a contract, whether a bidder has or has not entered into an agreement with a labor organization; or 3) require that a bidder enter into an agreement that requires that the bidder or bidder’s employees become or remain members of a labor organization or pay any dues or fees to a labor organization. The bill repeals these limitations related to labor organizations. Vacancies in certain appointive offices
Under current law, vacancies in public office may occur in a number of ways, including when the incumbent resigns, dies, or is removed from office, or, in the case of elected office, when the incumbent’s term expires. However, as the Wisconsin Supreme Court held in State ex rel. Kaul v. Prehn, 2022 WI 50, expiration of an incumbent’s term of office does not create a vacancy if the office is filled by appointment for a fixed term. Absent a vacancy or removal for cause, these incumbents may remain in office until their successors are appointed and qualified.
Under the bill, a vacancy in public office is created if the office is filled by appointment of the governor by and with the advice and consent of the senate for a fixed term and the incumbent’s term expires or the governor submits his or her nomination for the office to the senate, whichever is later.
Director of Native American affairs
The bill requires the secretary of administration to appoint a director of Native American affairs in the unclassified service to manage relations between the state and American Indian tribes or bands in this state.
Grants to each American Indian tribe or band in Wisconsin
The bill requires DOA to award grants of equal amounts to each American Indian tribe or band in this state for the purpose of supporting programs to meet the needs of members of the tribe or band.
The bill also requires DOA to award grants of equal amounts to each American Indian tribe or band in this state to promote tribal language revitalization and cultural preservation.
Under the bill, no grant moneys awarded under the above grant programs may be used to pay gaming-related expenses.
Other tribal grants
The bill requires DOA to do all of the following:
1. Award grants to the Oneida Nation of Wisconsin to support the Healing to Wellness Court program at the Oneida Nation, in an amount not to exceed $259,100 annually.
2. Award grants to the Oneida Nation of Wisconsin to support coordination between the National Estuarine Research Reserve System and Great Lakes tribal nations, in an amount not to exceed $110,100 annually.
