CR_13-061 Amends sections DE 11.05 (1), 11.06 (1), and 11.07 (1) and creates section DE 11.02 (9m), relating to sedation permits and classes of permits.

Plain language analysis

The objective of the proposed rule is to eliminate the requirement that a written authorization for dental laboratory work shall be on a form approved by the board. The proposed rule will also allow for the continued use of current technologies, such as the request may be made electronically and work orders detailed digitally.

SECTIONS 1. and 2. These sections are proposed to separate the subjects of authority and definitions from the current section, s. DE 9.01 whereby creating two renumbered sections, ss. DE 9.01 and 9.015. The definitions for both dental laboratory and work authorization now clearly remove any reference to a written request or the use of a board-approved form.

SECTION 3. This section deals primarily with the changes to no longer requiring written lab work authorizations, in so far as amending s. DE 9.02 (intro.) , (1) , (2) , and (4) to remove references to out-dated methods of work order requests.

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

No rules or laws were found in an Internet-based search of the U.S. Code or the Code of Federal Register (CFR) for dental lab work authorizations, written or electronic, made by dentists.

Comparison with rules in adjacent states

An Internet-based searched resulted in the following findings:

Illinois: The Illinois statutes and codes were researched via the Internet and no specifications were found for dental work authorizations, either written or electronic. [PART 1220 ILLINOIS DENTAL PRACTICE ACT]

Iowa: In searching Iowa codes, ch. 153 , Dentistry, no specifications were found for dental work authorizations, either written or electronic. [ http://www.state.ia.us/dentalboard/board/rules-policy/docs/IowaCode153_2013.pdf ]

Michigan: Board of Dentistry 2012-111 LR , No specifications were found for dental work authorizations, either written or electronic.

[ http://www7.dleg.state.mi.us/orr/Files/AdminCode/1118_2012-111LR_AdminCode.pdf ]

Minnesota: Minnesota board of dentistry rules for dentists, hygienists, and assistants are contained in ch. 3100 [ https://www.revisor.mn.gov/rules/?id=3100 ]. No specifications were found for dental work authorizations, either written or electronic.

Summary of factual data and analytical methodologies

The Board, in reviewing their rules in response to Executive Order 61, recognized these out-dated methods for making lab work order requests and authorizations. These methods are costly and time consuming to small business.

The proposed provisions are expected to make such requests more efficient, more accurate and less costly for small business.

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

The Dentistry Examining Board in reviewing their rules in response to Executive Order 61 found that the industry has replaced an outdated process with technological advances.

Fiscal Estimate and Economic Impact Analysis

The Fiscal Estimate and Economic Impact Analysis is attached.

Effect on Small Business

These proposed rules do not have an economic impact on small businesses, as defined in s. 227.114 (1) , Stats. The Department's Regulatory Review Coordinator may be contacted by email at [e-mail] , or by calling [phone].

Environmental Assessment/Statement [if required]

A copy of the preliminary assessment/statement is available upon request and will be available at the public hearing.

Agency Contact Person

Jean MacCubbin, Program Manager, Department of Safety and Professional Services, Division of Policy Development, 1400 East Washington Avenue, Room 151, P.O. Box 8935, Madison, Wisconsin 53708; telephone [phone] or telecommunications relay services via 711; email at [e-mail] .

STATE OF WISCONSIN DEPARTMENT OF ADMINISTRATION DOA-2049 (R03/2012)	Division of Executive Budget and Finance 101 East Wilson Street, 10th Floor P.O. Box 7864 Madison, WI 53707-7864 FAX: [phone]
ADMINISTRATIVE RULES Fiscal Estimate & Economic Impact Analysis

1. Type of Estimate and Analysis
X Original   ⍽ Updated   ⍽ Corrected
2. Administrative Rule Chapter, Title and Number
DE 9 Laboratories and Work Authorizations
3. Subject
Lab Work Authorizations
4. Fund Sources Affected			5. Chapter 20, Stats. Appropriations Affected
⍽ GPR   ⍽ FED   X PRO   ⍽ PRS   ⍽ SEG   ⍽ SEG-S			20.165 (1) (g)
6. 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 Cost
7. 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)
8. Would Implementation and Compliance Costs Be Greater Than $20 million? ⍽ Yes   X No
9. Policy Problem Addressed by the Rule
The current rule relies on out-dated methods to request dental lab work; modern technology is used in the industry.
10. 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.
Licensees and commercial dental laboratories
11. Identify the local governmental units that participated in the development of this EIA.
None
12. 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 provisions are expected to make such requests more efficient, more accurate and less costly for small business.
13. Benefits of Implementing the Rule and Alternative(s) to Implementing the Rule
The proposed provisions are expected to make such lab requests more efficient, more accurate and less costly for small business. To do nothing relies on an outdated and possibly cumbersome process.
14. Long Range Implications of Implementing the Rule
The proposed provisions are expected to make such lab requests more efficient, more accurate and less costly for small business.
15. Compare With Approaches Being Used by Federal Government
None
16. Compare With Approaches Being Used by Neighboring States (Illinois, Iowa, Michigan and Minnesota )
For the four neighboring states, no specifications were found for dental work authorizations, either written or electronic.
17. Contact Name				18. Contact Phone Number
Jean MacCubbin				608.266.0955

This document can be made available in alternate formats to individuals with disabilities upon request.

Notice of Hearing

Safety and Professional Services —
Dentistry Examining Board

CR 13-061

NOTICE IS HEREBY GIVEN that pursuant to authority vested in the Dentistry Examining Board in sections 15.08 (5) (b) and 447.02 (2) (b) , Stats., and interpreting section 447.02 (2) (b) , Stats., the Dentistry Examining Board will hold a public hearing at the time and place indicated below to consider an order to amend sections DE 11.05 (1) , 11.06 (1) , and 11.07 (1) and create section DE 11.02 (9m) , relating to sedation permits and classes of permits.

Hearing Information

Date:   Wednesday, November 6, 2013
Time:   9:30 a.m.
Location:   1400 East Washington Avenue (enter at
  55 North Dickenson Street)
  Room 121A
  Madison, Wisconsin

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 Policy Development, P.O. Box 8935, Madison, Wisconsin 53708-8935. 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 Jean MacCubbin, Program Manager, Department of Safety and Professional Services, Division of Policy Development, 1400 East Washington Avenue, Room 151, P.O. Box 8935, Madison, WI 53708-8935, or by email to Jean.MacCubbin@ wisconsin.gov . Comments must be received before the public hearing to be held on November 6, 2013, to be included in the record of rule-making proceedings.

Copies of rule

Copies of this proposed rule are available upon request to Jean MacCubbin, Department of Safety and Professional Services, Division of Policy Development, 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708-8935, by email at [e-mail] or on our website at http://dsps.wi.gov/ Default.aspx?Page=44e541e8-abdd-49da-8fde-046713617e9e .

Analysis Prepared by the Department of Safety and Professional Services

Statutes interpreted

Section 447.02 (2) (b) , Stats.

Statutory authority

Sections 15.08 (5) (b) and 447.02 (2) (b) , Stats.

Explanation of agency authority

Section 15.08 (5) (b) , Stats. The examining board shall promulgate rules for the guidance of the profession to which it pertains and define and enforce professional conduct and unethical practices not inconsistent with the law relating to the particular trade or profession.

Section 447.02 (2) (b) , Stats. The examining board shall promulgate rules specifying the " … standards, conditions and any educational requirements that are in addition to the requirements specified in s. 447.04 (1) , Stats., that must be met by a dentist to be permitted to induce general anesthesia or conscious sedation in connection with the practice of dentistry."

Related statute or rule

Section 447.01 (8) (d) , Stats.

Plain language analysis

The intent of the rule is to allow the Dentistry Examining Board discretion in approving sedation permits for licensees who have received discipline action against their permit(s) or are currently under investigation regarding their permit(s). Therefore, the granting of permits shall be permissive. In addition, the definitions of classes of sedation permits are added as no such reference occurs in the rule or the rule series, chs. DE 1 to 13 .

SECTION 1 provides a definition of sedation permit classes which correspond to the permit application process.

SECTIONS 2 to 4 modify the current text making the approval of permits permissive and update the permit classes as now defined in s. DE 11.02 (9m) .

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

No existing or proposed rules or laws were found in an Internet-based search of the U.S. Code or the Code of Federal Register (CFR) regarding classes of sedation, sedation permits for licensed dentists or how discipline may affect dentists applying for or maintaining such permits.

Comparison with rules in adjacent states

Illinois: The State of Illinois has an application process for dental sedation permits, which includes conscious sedation - Permit A and deep sedation and general anesthesia — Permit B. A permit application includes a request for information on fines, reprimands, probations, censures, revocations, suspensions, license surrenders, restrictions or limitations, but does not specifically list a prohibition of permit approval as a consequence of any discipline. [Title 68, subch. VIIb, sec. 1220.510]

Iowa: Iowa rules, IAC 650—Chapter 29 , much like Illinois, have permits for sedation and their application forms request the following information: " … have your clinical activities ever been limited, suspended, revoked, not renewed, voluntarily relinquished, or subject to other disciplinary or probationary conditions?" In order to obtain a permit for deep sedation/general anesthesia, a dentist must hold current certification in Advanced Cardiac Life Support (ACLS) 650 IAC 29.3(4) — procedures by a dentist with a permit for deep sedation/general anesthesia can only be done with the assistance of at least two auxiliary personnel that have current basic life support certification [IAC 29.3(5)]. In this search, no rule or law was found to specifically prohibit applying for or maintaining such a permit while a licensee has been disciplined.

Michigan: In a search of ch. 33 Michigan health code, no provisions for application for sedation classes or permits were found.

Minnesota: In Minnesota, dentists must obtain a certificate from the Board to administer general anesthesia or conscious sedation per Ch. 3100.3600 Subp 9. Requirements for both general anesthesia and conscious sedation stipulate for the dentist to have current ACLS certification (Subp 2, 3).

Dentists, dental hygienists and registered dental assistants may administer nitrous oxide inhalation analgesia with current CPR certification (Subp 4D). The required continuing education includes both advanced cardiac life support (ACLS) and pediatric advanced life support (PALS). There is no mention of the ability to apply for or termination of such certification based on discipline or a licensee.

Summary of factual data and analytical methodologies

No factual data and analytical methodologies were used to draft these rules.

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

The information comparing the states listed in this analysis was obtained directly from an Internet-based search and a review of the applicable regulations and rules, when found.

Fiscal Estimate and Economic Impact Analysis

The Fiscal Estimate and Economic Impact Analysis is attached.

Effect on Small Business

These proposed rules do not have an economic impact on small businesses, as defined in s. 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 or Summary

This rule change will not have an effect on small business.

Environmental Assessment/Statement [if required]

N/A

Agency Contact Person

Jean MacCubbin, Program Manager, Department of Safety and Professional Services, Division of Policy Development, 1400 East Washington Avenue, Room 151, P.O. Box 8935, Madison, Wisconsin 53708; telephone [phone] or telecommunications relay services via 711; email at [e-mail] .

STATE OF WISCONSIN DEPARTMENT OF ADMINISTRATION DOA-2049 (R03/2012)	Division of Executive Budget and Finance 101 East Wilson Street, 10th Floor P.O. Box 7864 Madison, WI 53707-7864 FAX: [phone]
ADMINISTRATIVE RULES Fiscal Estimate & Economic Impact Analysis

1. Type of Estimate and Analysis
X Original   ⍽ Updated   ⍽ Corrected
2. Administrative Rule Chapter, Title and Number
Ch. DE 11 Anesthesia
3. Subject
Sedation Permits
4. Fund Sources Affected			5. Chapter 20, Stats. Appropriations Affected
⍽ GPR   ⍽ FED   X PRO   ⍽ PRS   ⍽ SEG   ⍽ SEG-S			20.165 (1) (g)
6. 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 Cost
7. 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)
8. Would Implementation and Compliance Costs Be Greater Than $20 million? ⍽ Yes   X No
9. Policy Problem Addressed by the Rule
The objective of the proposed rule is to allow the Board to use discretion in granting sedation permits to a dentist who is currently being investigated or has had disciplinary action relating to general anesthesia or conscious sedation.
10. 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.
Licensees
11. Identify the local governmental units that participated in the development of this EIA.
None
12. 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)
None.
13. Benefits of Implementing the Rule and Alternative(s) to Implementing the Rule
Providing the Board to use discretion in granting sedation permits based on investigation or disciplinary actions of licensees.
14. Long Range Implications of Implementing the Rule
None known.
15. Compare With Approaches Being Used by Federal Government
None found.
16. Compare With Approaches Being Used by Neighboring States (Illinois, Iowa, Michigan and Minnesota )
Illinois and Iowa request information pertaining to arrests, convictions, etc. Neither Minnesota or Michigan appears to request such information at time of permit application.
17. Contact Name				18. Contact Phone Number
Jean MacCubbin				608.266.0955

This document can be made available in alternate formats to individuals with disabilities upon request.