CR_12-004 Hearing to consider an order to amend sections N 3.03 (1) (a) 3., N 3.03 (1) (b) 6., N 3.03 (2) (a) 3., and N 3.03 (2) (b) 6., relating to endorsement licensure.

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.

Summary of, and comparison with, existing or proposed federal legislation

There is no comparative existing or proposed federal rule.

Comparison with rules in adjacent states

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

Summary of factual data and analytical methodologies

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.

Analysis and supporting documents used to determine effect on small business or in preparation of economic report

The department finds that this rule will have no effect on small business as small business is defined in 227.114 (1), Stats.

Anticipated Costs Incurred by the Private Sector

The department finds that this rule will incur no additional costs to the private sector.

Fiscal Estimate and Economic Impact Analysis

The proposed rule is not anticipated to have any fiscal impact on businesses, public utility rate payers, local government units or the state's economy as a whole. The proposed rule was posted on the department's website for 14 days. Comments were solicited. The department did not receive any comments regarding an economic impact from local government units, specific business sectors or public utility rate payers. Therefore, the department finds the proposed rule will have no economic impact.

Effect on Small Business

The department finds that this rule will have no effect on small business as small business is defined in s. 227.114 (1) , Stats. The Department's Regulatory Review Coordinator may be contacted at [e-mail] or by calling [phone].

Initial Regulatory Flexibility Analysis

It is anticipated that this rule will have no effect on small business as small business is defined in 227.114 (1), Stats.

Agency Contact Person

Shawn Leatherwood, Paralegal, Department of Safety and Professional Services, 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708; telephone [phone]; email at [e-mail] .

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
Wis. Admin Code Med 8
Subject
Increasing the number of physician assistants a physician may supervise
Fund Sources Affected			Chapter 20 , Stats. Appropriations Affected
GPR FED 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		X 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
The proposed rule addresses the issue of whether to increase the number of physician assistants a physician may concurrently supervise. Currently, a physician may simultaneously supervise two physician assistants at one time. If a physician wishes to supervise more than two physician assistants he or she must submit a written plan to the Medical Examining Board for review and approval. The proposed rule will increase the number of physician assistants a physician may simultaneously supervise from 2 to 4.
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)
The proposed rule is not anticipated to have any fiscal impact on businesses, public utility rate payers, local government units or the state's economy as a whole. The proposed rule was posted on the department's website for 14 days. Comments were solicited. The department did not receive any comments regarding an economic impact from local government units, specific business sectors or public utility rate payers. Therefore, the department finds the proposed rule will have no economic impact.
Benefits of Implementing the Rule and Alternative(s) to Implementing the Rule
The national trend, as recognized by the Federation of State Medical Boards, is to increase the number of physician assistants a physician may supervise as one of the means to address the problem of physician workforce shortages. Implementing this proposed rule will bring Wisconsin in line with the national trend and allow greater flexibility for physicians and physician assistants in providing health care. The alternative to implementing the rule is to allow the current physician to physician assistant ratio to remain the same.
Long Range Implications of Implementing the Rule
The primary long term effect of implementing this rule will be building physician and physician assistant health care teams that are equipped to meet the demands of providing adequate health care in spite of growing physician workforce shortages.
Compare With Approaches Being Used by Federal Government
There are no comparative federal rules.
Compare With Approaches Being Used by Neighboring States (Illinois, Iowa, Michigan and Minnesota )
Similar to the current rule, Illinois and Iowa limit the ration of physician assistants a physician may supervise to 2:1. Illinois allows "alternate supervising physicians" to supervise more than two physician assistants when the supervising physician is unable to perform supervisory duties. Michigan allows a physician assistant to physician ratio of 4:1 when the supervising physician practices within a group of physicians. If the supervising physician has privileges at a health facility, agency or state correctional facility he or she may supervise more than 4. However, if the physician assistant and physician are not in the same location the ratio is limited to 2:1. The proposed rule is most similar to Minnesota which allows a physician to simultaneously supervise five physician assistants at once. In an emergency, a Minnesota physician may supervise more than five physician assistants.
Name and Phone Number of Contact Person
Shawn Leatherwood 608-261-4438

Notice of Hearing

Safety and Professional Services
Board of Nursing

CR 12-004

NOTICE IS HEREBY GIVEN that pursuant to authority vested in the Board of Nursing in sections 15.08 (5) (b), 227.11 (2) and 441.01, Wis. Stats., and interpreting sections 441.06 (1) and 441.10 (3) (d), Wis. Stats., the Board of Nursing will hold a public hearing at the time and place indicated below to consider an order to amend sections N 3.03 (1) (a) 3. , N 3.03 (1) (b) 6. , N 3.03 (2) (a) 3. , and N 3.03 (2) (b) 6. , relating to endorsement licensure.

Hearing Information

Date:   Thursday, February 23, 2012

Time:   8:00 A.M.

Location:   1400 East Washington Avenue
  Room ABC
  3365 W. Brewster St.
  Appleton, WI 54914

Appearances at the Hearing

Interested persons are invited to present information at the hearing. Persons appearing may make an oral presentation but are urged to submit facts, opinions and argument in writing as well. Facts, opinions and argument may also be submitted in writing without a personal appearance by mail addressed to the Department of Safety and Professional Services, Division of Board Services, P.O. Box 8935, Madison, Wisconsin 53708. Written comments must be received at or before the public hearing to be included in the record of rule-making proceedings.

Place Where Comments Are to be Submitted and Deadline For Submission

Comments may be submitted to Sharon Henes, Paralegal, Department of Safety and Professional Services, Division of Board Services, 1400 East Washington Avenue, Room 151, P.O. Box 8935, Madison, WI 53708, or by email to [e-mail] . Comments must be received at or before the public hearing to be held at 8:00 a.m. on February 23, 2012 to be included in the record of rule-making proceedings.

Copies of Rule

Copies of this proposed rule are available upon request to Sharon Henes, 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 [e-mail] .

Analysis Prepared by the Department of Safety and Professional Services

Statutes interpreted

Sections 441.06 (1) and 441.10 (3) (d) , Stats.

Statutory authority

Sections 15.08 (5) (b) , 227.11 (2) ; 441.01 , Stats.

Explanation of statutory authority

An examining board shall promulgate rules for its own guidance and for the guidance of the profession to which it pertains. The Board may establish rules to prevent unauthorized persons from practicing professional nursing.

Related statute or rule

Sections 441.06 (1) and 441.10 (3) (d) , Stats. and N 3.03, Wis. Admin. Code.

Plain language analysis

Currently, a person licensed as a nurse in another state, territory, province or other jurisdiction is prohibited from obtaining licensure as a registered nurse or licensed practical nurse through the endorsement process if there has ever been disciplinary action against their nurse license in any state, territory, province or other jurisdiction.

Section 1-4 are amended to allow the Board to license by endorsement those who have had disciplinary action except in the circumstances that within the Board's discretion the discipline does not warrant licensure in order to protect the public.

Summary of, and comparison with, existing or proposed federal regulations

None.

Comparison with rules in adjacent states

Illinois: The Illinois Board of Nursing permits licensing by endorsement for professional and practical nurses, provided the other state's licensing requirements are similar to Illinois. The Illinois Board of Nursing looks at the disciplinary history from the last five years in making a decision to license by endorsement. While a decision is pending on licensure a temporary endorsement license is issued if the person holds an unencumbered license from another state and will be terminated if it is discovered that within the last five years, the applicant has had a license or permit related to the practice of nursing revoked, suspended or placed on probation by another jurisdiction, if at least one of the grounds is substantially equivalent to grounds in Illinois.

Iowa: The Iowa Board of Nursing permits licensing by endorsement and may consider in the application process a record of prior disciplinary action regardless of jurisdiction.

Michigan: The Michigan Board of Nursing permits licensing by endorsement provided the other state's licensing requirements are substantially the same as Michigan's requirements. The Board's rules do not address the issue of discipline in another state.

Minnesota: The Minnesota Board of Nursing permits licensing by endorsement provided the applicant has the qualifications equivalent to Minnesota's requirements. The rules do not preclude an applicant from licensure solely on the basis of prior discipline and allows for Board discretion.

Summary of factual data and analytical methodologies

The proposed change would facilitate the ability of nurses to obtain licensure to work in our state and increase the available workforce, as well as promote efficiency and fairness. The Wisconsin rule is inconsistent with the rules in the (4) four border states which allow the exercise of discretion when applying for licensure through endorsement. The proposed rule change fosters continued mobility of the nurse workforce and benefits employers by increasing access to qualified nurses.

Analysis and supporting documents used to determine effect on small business or in preparation of economic impact report

This rule creates a change in how licensure decisions are made which does not impact small businesses. This rule was posted for public comment on the economic impact of the proposed rule, including how this proposed rule may affect businesses, local government units and individuals, for a period of 14 days. No comments were received relating to the economic impact of the rule.

Fiscal Estimate and Economic Impact Analysis

The Fiscal Estimate and Economic Impact Analysis are attached.

Initial Regulatory Flexibility Analysis or Summary

There is no effect on small businesses.

Agency Contact Person

Sharon Henes, Paralegal, Department of Safety and Professional Services, Division of Board Services, 1400 East Washington Avenue, Room 151, P.O. Box 8935, Madison, Wisconsin 53708; telephone [phone]; email at [e-mail] .

Text of Rule

SECTION 1. N 3.03 (1) (a) 3. is amended to read:

N 3.03(1)(a)3. Has a license against which no disciplinary action, which the Board deems to warrant a denial, has been taken in any of the states, territories or provinces in which the applicant has held a license.

SECTION 2. N 3.03 (1) (b) 3. is amended to read:

N 3.03(1)(b)3. Has a license against which no disciplinary action, which the Board deems to warrant a denial, has been taken in any of the states, territories or provinces in which the applicant has held a license.

SECTION 3. N 3.03 (2) (a) 3. is amended to read:

N 3.03(2)(a)3. Has a license against which no disciplinary action, which the Board deems to warrant a denial , has been taken in any of the states, territories or provinces in which the applicant has held a license.

SECTION 4 . N 3.03 (2) (b) 6. is amended to read:

N 3.03(2)(b)6. Has a license against which no disciplinary action, which the Board deems to warrant a denial , has been taken in any of the states, territories, provinces or countries in which the applicant has held a license.

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
N 3.03
Subject
Relating to endorsement licensure
Fund Sources Affected			Chapter 20 , Stats. Appropriations Affected
GPR FED PRO PRS SEG SEG-S			None
Fiscal Effect of Implementing the Rule
X No Fiscal Effect Indeterminate	Increase Existing Revenues Decrease Existing Revenues		Increase Costs X 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
Currently, a person licensed as a nurse in another state is prohibited from obtaining licensure as a registered nurse or licensed practical nurse through the endorsement process if there has ever been disciplinary action against their nurse license in any state. This rule will allow the Board of Nursing to evaluate the circumstances of the discipline and determine whether to license the individual.
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)
There is no economic and fiscal impact.
Benefits of Implementing the Rule and Alternative(s) to Implementing the Rule
This rule allows the Board of Nursing to evaluate the circumstances of the discipline, including but not limited to, the nature of the conduct, length of time since the conduct occurred, the discipline imposed, and whether the disciplinary requirements have already been fulfilled. Implementing this rule would benefit the ability to facilitate qualified nurses to obtain licensure to work in our state. In addition, it promotes efficiency and fairness.
Long Range Implications of Implementing the Rule
The long range implication of implementing the rule would be an increase in the available workforce of qualified and competent nurses.
Compare With Approaches Being Used by Federal Government
None
Compare With Approaches Being Used by Neighboring States (Illinois, Iowa, Michigan and Minnesota )
The rule would make Wisconsin's endorsement process consistent with our four neighboring states. All four neighboring states do not preclude an applicant with a disciplinary background from being licensed through endorsement. Each of the neighboring Boards of Nursing evaluate the circumstances surrounding the discipline and use their discretion in licensing decisions.
Name and Phone Number of Contact Person
Sharon Henes, Paralegal [phone]

Notice of Hearing

Safety and Professional Services
Physical Therapy Examining Board

CR 12-002

NOTICE IS HEREBY GIVEN that pursuant to sections 15.08 (5) (b) , 227.11 (2) 448.53 (2) , 448.55 (3) and 448.56 (6) Stats., and interpreting sections 448.53 , 448.535 , 448.54 , 448.55 (3) , 448.56 , Stats., and 2009 Wisconsin Act 149 , the Physical Therapy Examining Board will hold a public hearing at the time and place indicated below to consider an order to repeal section PT 3.01 (7) ; to renumber and amend sections PT1.02 (1) to (6) ; to amend sections PT 1.03 (1) (c) , PT 3.01 (title), PT 3.01 (4) , PT 4.01 (4) , PT 8.05 (intro) , and PT 9.01; to repeal and recreate section PT 1.01 ; and to create sections PT 2.001 , PT2.01 (1) (j) , PT 3.001 , PT 3.002 , PT 3.02 , PT 4.001 , PT 5.001 , Pt 6.001, and PT 9.02 (5) , relating to licensure, examinations, temporary licenses, locum tenens license, referrals, and continuing education.

Hearing Information

Date:   Thursday, February 16, 2012

Time:   9:00 A.M.

Location:   1400 East Washington Avenue (enter at 55       North Dickinson Street)
  Room 121A
  Madison, WI 53703

Appearances at the Hearing

Interested persons are invited to present information at the hearing. You may make a presentation in person, submit a brief statement regarding facts, opinions or 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 up until February 16, 2012 .

Copies of Proposed Rule, Fiscal Estimate, and Economic Impact Analysis

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
[e-mail] .

Place Where Comments are to be Submitted and Deadline For Submission

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 [e-mail] . Comments must be received on or before February 16, 2012 to be included in the record of rule-making proceedings.

Analysis Prepared by the Department of Safety and Professional Services

Statutes interpreted

Sections 448.53 , 448.535 , 448.54 , 448.55 (3) , 448.56 , and 2009 Wisconsin Act 149 .

Statutory authority

Sections 15.08 (5) (b) , 227.11 (2) (a) , 448.53 (2) , 448.55 (3) , and 448.56 (6) , Stats.

Explanation of statutory authority

The legislature via ss. 15.08 (5) (b) , and 227.11 (2) (a) , Stats., confers upon the Physical Therapy Examining Board general powers to promulgate rules for the guidance of the profession and to interpret the provisions of statutes it enforces. Sections 448.53 (2) and 448.55 (3) , Stats., especially concerned with regulating health professions, authorizes the Physical Therapy Examining Board to promulgate rules regarding licensure and maintaining competence to practice in the profession. Section 448.56 (6) provides the Physical Therapy Examining Board may promulgate rules defining direct or general supervision of physical therapist assistants. Therefore, the Physical Therapy Examining Board is authorized both generally and specifically to promulgate these proposed rules.

Related statute or rule

Wis. Admin. Code Chapters PT 1 to PT 9 .

Plain language analysis

Due to the passage of 2009 Wisconsin Act 149 , the administrative rules governing physical therapy professionals required updating. The legislation transformed the Physical Therapists Affiliated Credentialing Board into the Physical Therapy Examining Board. The newly formed board now functions independently without oversight by the Medical Examining Board. These proposed rules effectuate the changes mandated by the legislation by modernizing existing provisions, upgrading the authority sections in Chapters PT 1 - 9 , adding clarifying terms and revising the classes of temporary licensure.

With these proposed rules, the Physical Therapy Examining Board, pursuant to s. 448.53 (2) , Stats., has formed two distinct classes of temporary licensure: the temporary license to practice under supervision, initial licensure and the temporary reentry license. The temporary license to practice under supervision, initial is distinguished from the temporary reentry license in that it is available only to those applicants who have not previously been licensed in Wisconsin. The temporary reentry license is targeted towards returning professional that have not engaged in clinical practice for three years prior to their application. Both classes of temporary licenses are designed to allow entry level professionals and returning professional gain employment opportunities while acquiring clinical experience. Along with revising the classes of temporary licensure, the board further defined the levels of supervision between licensed physical therapist.

SECTION 1 repeals the former authority section and recreates PT 1.01 a new statement of authority.

SECTION 2 renumbers and amends PT 1.02 by adding terms such as, "candidate for reentry", "client", "direct, immediate, on premises supervision", "direct, immediate, one-to-one supervision", "general supervision", "informed consent" and "intimate parts". The terms will aid in clarifying the level of supervision for temporary licensees.

SECTION 3 amends PT 1.03 (1) (c) to distinguish between the documentary evidence required for physical therapist and physical therapist assistants.

SECTION 4 creates PT 2.001 as statement of authority to chapter PT 2.

SECTION 5 creates PT 2.015 (1) (j) by adding a new category for applicants required to complete an oral examination to persons who have voluntarily limited the scope of their practice as a result of being investigated by a credentialing authority.

SECTION 6 creates an authority and definitions sections in chapter PT 3.

SECTION 7 amends PT 3.01 (title) by refining the definition of the temporary license to practice under supervision, initial licensure. This provision extends the class of temporary license holders under supervision to persons who have not previously been licensed in Wisconsin.

SECTION 8 amends PT 3.02 (4) by deleting duplicative language regarding the supervision of physical therapist assistants.

SECTION 9 repeals the renewal provision in PT 3.01 (7) for physical therapist and physical therapist assistants under supervision.

SECTION 10 creates PT 3.02 regarding the temporary reentry license. Physical therapist and physical therapist assistants who have not engaged in the clinical practice of physical therapy for three years are eligible for the temporary reentry license. The temporary reentry license is valid for one year and is nonrenewable.

SECTION 11 creates authority provisions for Chapters PT 4 to PT 6 .

SECTION 12 amends PT 4.01 (4) by adding language that allows the Physical Therapy Examining Board greater discretion in extending the expiration date of a locum tenens license. Currently, a locum tenens license expires within 90 days of being issued.

SECTION 13 amends PT 8.05 (intro) by adding a renewal exception for the newly created class of temporary reentry applicants.

SECTION 14 amends the authority and purpose provision in PT 9.01 to reflect the change in status from affiliated credentialing board to examining board.

SECTION 15 creates PT 9.02 (5) adding the term "remedial education". This term applies to continuing education for disciplinary purposes.

Summary of, and comparison with, existing or proposed federal regulation

There is no comparative existing or proposed federal rule.

Comparison with rules in adjacent states

Illinois: Illinois does not issue a temporary license, Illinois allows applicants to apply for restoration of licenses that have expired or have been placed on inactive status for a period of 5 to 10 years. Ill. Admin. Code tit.68 §1340.60 (4) (A) Individuals that have allowed their license to lapse must obtain 160 contact hours under the supervision of a licensed physical therapist, or twenty hours of continuing education on the clinical aspects of physical therapy or a combination of both.

Iowa: The state of Iowa does not issue a temporary license. Iowa allows individuals whose license have been inactive for five years or less and those individuals whose license have been inactive for more than five years to apply for reactivation of an inactive license. Iowa Admin. Code r. 645-200.15 (17A, 147, 272C) However, Iowa does have provisions enumerating the supervision requirements for physical therapy assistants. Iowa Admin. Code r. 645-200.6 (272C)

Michigan: Michigan issues a nonrenewable temporary license for physical therapist and physical therapist assistants who are applying for re-licensure and whose license has lapsed less than three years of their expiration date provided they have completed all other requirements other than examination. Mich. Admin. code R 338.7149 Michigan also issues a limited license for physical therapist assistants who graduated from a board approved program but still must complete a physical therapist assistant examination. Mich. Admin. code R 338.7143 Temporary license holders must practice under the supervision of license holders and may not be supervised by limited license holders or temporary license holders. Mich. Comp. Laws § 333.16181

Minnesota: By statute, Minnesota issues temporary permits to practice physical therapy. M inn. Stat. § 148.71 The permit, once issued, expires 90 days after the next examination for licensure given by the Board. The temporary permit cannot be renewed. Temporary license holders may be supervised by applicants for physical therapist, physical therapist assistants and licensed physical therapist. The level of supervision must be direct immediate and on premises.

Summary of factual data and analytical methodologies

The Physical Therapy Examining Board conducted an extensive review of its rules along with legal counsel. The Federation of State Boards of Physical Therapy Model Practice Act was also reviewed. The board and its legal counsel identified key areas that required updating pursuant to the passage of 2009 Wisconsin Act 149 .

Analysis and supporting documents used to determine effect on small business or in preparation of economic impact report

It is anticipated that this rule will have no effect on small business as it is defined in s. 227.114 (1) , Stats.

Anticipated costs incurred by the private sector

The proposed rules will not incur additional costs to the private sector.

Fiscal Estimate and Economic Impact Analysis

With regard to the fiscal impact there would be additional IT costs of approximately $2130 related to coding in the licensing system and additional costs of approximately $340 for updating forms and the website. These costs would be absorbed within the DSPS budget. With regard to the economic impact, the proposed rule language was made available on the department's website for 14 days. Comments were solicited. The department did not receive any comments regarding an economic impact from local government units, specific business sectors or public utility rate payers. The department finds the proposed rule will have no economic impact.

Effect on Small Business

This rule will have no effect on small business as small business is defined in 227.114 (1), Stats.

The department's Regulatory Review Coordinator may be contacted by email at [e-mail] or by calling [phone].

Initial Regulatory Flexibility Analysis

It is anticipated that this rule will have no effect on small business as small business is defined in 227.114 (1), Stats.

Agency Contact Person

Shawn Leatherwood, Paralegal, Department of Safety and Professional Services, 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708; telephone [phone]; email a
[e-mail] .

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
Wis. Admin. Code ss. PT 1- PT 9
Subject
Licensure, applications and credentials, examinations, temporary licenses, locum tenens license and continuing education of physical therapists and physical therapist assistants
Fund Sources Affected			Chapter 20 , Stats. Appropriations Affected
GPR FED PRO X PRS SEG SEG-S			20.165 (1) (g)
Fiscal Effect of Implementing the Rule
No Fiscal Effect Indeterminate	Increase Existing Revenues Decrease Existing Revenues		X 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
The proposed rule effectuates the recent passage of 2009 Wisconsin Act 149. The act changed the Physical Therapists Affiliated Credentialing Board to the Physical Therapy Examining Board. The board now functions independently without oversight by the Medical Examining Board. In order to implement the legislation, the proposed rule modernizes existing provisions, revises the classes of temporary licensure and further defines the level of supervision within the profession. The proposed rule forms to distinct classes of temporary licensure, the temporary license to practice under supervision, initial licensure and the temporary reentry license. The temporary license to practice under supervision, initial licensure is distinguished from temporary reentry license in that it is available only to those applicants who have not previously been licensed in Wisconsin. The temporary reentry license is targeted towards individuals that are returning to practice after having not engaged in clinical practice for a period of three years prior to applying for licensure. Both classes of temporary licensure are designed to allow entry level professionals and returning professionals gain employment opportunities while acquiring clinical experience.
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)
With regard to the fiscal impact there would be additional IT costs of approximately $2130 related to coding in the licensing system and additional costs of approximately $340 for updating forms and the website. These costs would be absorbed within the DSPS budget. With regard to the economic impact, the proposed rule language was made available on the department's website for 14 days. Comments were solicited. The department did not receive any comments regarding an economic impact from local government units, specific business sectors or public utility rate payers. The department finds the proposed rule will have no economic impact.
Benefits of Implementing the Rule and Alternative(s) to Implementing the Rule
The benefit of implementing the proposed rule will be creating opportunities for persons seeking to enter the practice of physical therapy valuable clinical experience and bringing the current regulations that govern the practice of physical therapy in conformity with 2009 WI Act 149. By distinguishing the classes of temporary licensure and defining the multiple levels of supervision, the proposed rule will provide greater protection for the public. An alternative to implementing the rule is to allow the current regulations to remain outdated and out of compliance with 2009 WI Act 149.
Long Range Implications of Implementing the Rule
The anticipated long-term result of the proposed rules will be a more consistent scope of practice for licensed physical therapist and physical therapist assistants, as well as consistency in training for those entering the profession.
Compare With Approaches Being Used by Federal Government
There is no comparative existing or proposed federal rule.
Compare With Approaches Being Used by Neighboring States (Illinois, Iowa, Michigan and Minnesota )
Of the neighboring states only Minnesota and Michigan issue temporary licenses. The Minnesota temporary license cannot be renewed and expires 90 days after the next examination for licensure by the board. Michigan also issues a non-renewable temporary license for applicants waiting for exam results. Illinois and Iowa do not issue temporary licensure.
Name and Phone Number of Contact Person
Shawn Leatherwood [phone]