1. Type of Estimate and Analysis | 2. Date |
☐ Original ☐ Updated ☐Corrected | December 19, 2018 |
3. Administrative Rule Chapter, Title and Number (and Clearinghouse Number if applicable) |
Chir 1, 4, 10, and 11 |
4. Subject |
Delegation of services to health care professionals |
5. Fund Sources Affected | 6. Chapter 20, Stats. Appropriations Affected |
☐ GPR ☐ FED ☐ PRO ☐ PRS ☐ SEG ☐ SEG-S |
7. Fiscal Effect of Implementing the Rule |
☐ No Fiscal Effect ☐ Indeterminate | ☐ Increase Existing Revenues ☐ Decrease Existing Revenues | ☐ Increase Costs ☐ Decrease Costs ☐ Could Absorb Within Agency’s Budget |
8. The Rule Will Impact the Following (Check All That Apply) |
☐ State’s Economy ☐ Local Government Units | ☐ Specific Businesses/Sectors ☐ Public Utility Rate Payers ☐ Small Businesses (if checked, complete Attachment A) |
9. Estimate of Implementation and Compliance to Businesses, Local Governmental Units and Individuals, per s. 227.137(3)(b)(1). $0 |
10. Would Implementation and Compliance Costs Businesses, Local Governmental Units and Individuals Be $10 Million or more Over Any 2-year Period, per s. 227.137(3)(b)(2)? ☐ Yes ☐ No |
11. Policy Problem Addressed by the Rule |
The proposed rules make the following changes to reflect the provisions of 2017 Wisconsin Act 180, relating to a chiropractor’s authority to delegate adjunctive services and x-ray services to certain health care professionals: • Adds the definition of “health care professional” under s. 446.01 (1v), Stats., to the definitions in ch. Chir 1. • Revises ss. Chir 4.04 (3) and 10.03 to reflect s. 446.025 (1) (a), Stats., which provides no person may provide x−ray services on behalf of a chiropractor in connection with the practice of chiropractic unless the person is a chiropractic radiological technician and is under the direct supervision of a chiropractor licensed under ch. 446, Stats. • Creates s. Chir 10.023 to, as required under s. 446.02 (7) (c), Stats., establish standards and procedures a chiropractor must use to verify a health care professional has adequate education, training, and experience to perform a delegated adjunctive service safely. • As use of the term “health care professionals” in s. Chir 11.02 (4) is no longer appropriate based on its statutory definition, the proposed rules replace it with the term “healthcare providers.” |
12. Summary of the Businesses, Business Sectors, Associations Representing Business, Local Governmental Units, and Individuals that may be Affected by the Proposed Rule that were Contacted for Comments. |
The proposed rule was posted on the Department of Safety and Professional Services’ website for 14 days in order to solicit comments from businesses, representative associations, local governmental units, and individuals that may be affected by the rule. No comments were received. |
13. Identify the Local Governmental Units that Participated in the Development of this EIA. |
No local governmental units participated in the development of this EIA. |
14. 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) |
This proposed rule will not have a significant impact on specific businesses, business sectors, public utility rate payers, local governmental units, or the state’s economy as a whole. |
15. Benefits of Implementing the Rule and Alternative(s) to Implementing the Rule |
The benefit to implementing the rule is providing clarity and conformity with the Wisconsin Statutes. If the rule is not implemented, it will not reflect the provisions of 2017 Wisconsin Act 180. |
16. Long Range Implications of Implementing the Rule |
The long range implication of implementing the rule is clarity, updated references, and conformity with the Wisconsin Statutes. |
17. Compare With Approaches Being Used by Federal Government |
None |
18. Compare With Approaches Being Used by Neighboring States (Illinois, Iowa, Michigan and Minnesota) |
Illinois: Illinois statutes (Section 54.2, Medical Practice Act) allow physicians, including chiropractic physicians, to delegate authority to certain individuals: • Physicians may delegate patient care tasks to a physician assistant, licensed practical nurse, registered professional nurse, advanced practice nurse, or other licensed person practicing within the scope of their license. • In an office or practice setting and within a physician-patient relationship, a physician may delegate patient care tasks or duties to an unlicensed person who possesses appropriate training and experience provided a health care professional practicing within the scope of their license is on site to provide assistance. • A physician may not delegate any patient care task or duty that is statutorily or by rule mandated to be performed by a physician. Iowa: Rules of the Iowa Board of Chiropractic address the delegation of chiropractic services to a chiropractic assistant (645 IAC 43.12): • A supervising chiropractic physician must ensure at all times that a chiropractic assistant has the necessary training and skills to competently perform a delegated service. • A supervising chiropractic physician may delegate services to a chiropractic assistant that are within the scope of practice of the chiropractic physician. • A chiropractic physician may not delegate any of the following services: Services outside the chiropractic physician’s scope of practice. Initiation, alteration, or termination of chiropractic treatment programs. Chiropractic manipulation and adjustments. Diagnosis of a condition. • A supervising chiropractic physician must ensure a chiropractic assistant is informed of the supervisor and chiropractic assistant relationship and is responsible for all services performed by the chiropractic assistant. Michigan: Michigan statutes allow a chiropractor to delegate to a licensed or unlicensed individual who is otherwise qualified by education, training, or experience the performance of selected acts, tasks, or functions where the acts, tasks, or functions fall within the scope of practice of the chiropractor's profession and will be performed under the chiropractor's supervision. A chiropractor may not delegate an act, task, or function if the act, task, or function, under standards of acceptable and prevailing practice, requires the level of education, skill, and judgment required of the chiropractor (Section 333.16215, Public Health Code). Minnesota: Minnesota statutes specify grounds for the Board of Chiropractic Examiners to refuse to grant or revoke, suspend, condition, limit, restrict, or qualify a license to practice chiropractic. These provisions permit a doctor of chiropractic to employ, supervise, or delegate functions to a qualified person who may or may not be required to obtain a license or registration to provide health services if that person is practicing within the scope of the license or registration or delegated authority (Section 148.10, Subdivision 1, Chiropractic Practice Act). |
19. Contact Name | 20. Contact Phone Number |
Dale Kleven | (608) 261-4472 |
ATTACHMENT A |
1. Summary of Rule’s Economic and Fiscal Impact on Small Businesses (Separately for each Small Business Sector, Include Implementation and Compliance Costs Expected to be Incurred) |
2. Summary of the data sources used to measure the Rule’s impact on Small Businesses |
3. Did the agency consider the following methods to reduce the impact of the Rule on Small Businesses? |
☐ Less Stringent Compliance or Reporting Requirements ☐ Less Stringent Schedules or Deadlines for Compliance or Reporting ☐ Consolidation or Simplification of Reporting Requirements ☐ Establishment of performance standards in lieu of Design or Operational Standards ☐ Exemption of Small Businesses from some or all requirements ☐ Other, describe: |
4. Describe the methods incorporated into the Rule that will reduce its impact on Small Businesses |
5. Describe the Rule’s Enforcement Provisions |
6. Did the Agency prepare a Cost Benefit Analysis (if Yes, attach to form) |
☐ Yes ☐ No |
