This order creates rules relating to how a new program called BadgerCare, established under s. 49.665, Stats., will work. Under BadgerCare, families with incomes up to 185% of the federal poverty level, but not low enough to be eligible for regular Medical Assistance (MA) coverage of their health care costs, and that lack access to group health insurance, are eligible to have BadgerCare pay for their health care costs. This order incorporates the rules for operation of BadgerCare into chs. HFS 101 to 108, the Department's rules for operation of the MA Program.
Benefits under BadgerCare will be identical to the comprehensive package of benefits provided by MA. The existing Wisconsin MA HMO managed care system, including mechanisms for assuring the quality of services, improving health outcomes and settling grievances, will be used also for BadgerCare.
The rules included in this order modify chs. HFS 101 to 108 to accommodate BadgerCare and in the process provide more specificity than s. 49.665, Stats., about the nonfinancial and financial conditions of eligibility for BadgerCare; state who is included in a BadgerCare group and whose income is taken into consideration when determining the eligibility of a BadgerCare group; expand on statutory conditions for continuing to be eligible for BadgerCare; require a BadgerCare group with monthly income above 150% of the federal poverty level to contribute toward the cost of the health care coverage; and set forth how the Department, as an alternative to providing MA coverage, will go about purchasing family coverage offered by the employer of a member of a family eligible for BadgerCare if the Department determines that purchasing that coverage would not cost more than providing MA coverage.
The Department obtained approval for BadgerCare from the federal Health Care Financing Administration (HCFA) on January 22, 1999, effective July 1, 1999, and on July 1, 1999, published emergency rules for the operation of BadgerCare. These are the identical permanent rules to replace the emergency rules.
Contact Person
To find out more about the hearings or to request a copy of the proposed rules, write, phone or E-mail:
Alfred Matano
Division of Health Care Financing
P.O. Box 309, Room 350
Madison, WI 53701-0309
(608) 267-6848 or,
if you are hearing impaired,
(608) 266-1511 (TTY)
If you are hearing or visually impaired, do not speak English, or have other personal circumstances which might make communication at a hearing difficult and if you, therefore, require an interpreter or a non-English, large-print or taped version of the hearing document, contact the person at the address or phone number above. A person requesting a non-English or sign language interpreter should make that request at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.
Written comments on the proposed rules received by U.S. mail at the above address no later than September 3, 1999 will be given the same consideration as testimony presented at the hearing.
Fiscal Estimate
This order creates rules that specify how the BadgerCare Program established under s. 49.665, Stats., will work. Under BadgerCare, families with incomes below 185% of the federal poverty level, but not low enough to be eligible for regular Medical Assistance coverage of their health care costs, and that lack access to group health insurance, are eligible to have BadgerCare pay for their health care costs.
The order incorporates the rules for operation of BadgerCare into the Department's current rules for operation of the Medical Assistance (MA) program since BadgerCare benefits will be the same as Medical Assistance benefits and provider certification requirements and provider rights and responsibilities will also be the same.
The order modifies four chapters of the Medical Assistance rules to accommodate BadgerCare and in the process provides more specificity than the program statute about nonfinancial and financial conditions of eligibility for BadgerCare; states who is included in a BadgerCare group and whose income is taken into consideration when determining the eligibility of a BadgerCare group; expands on statutory conditions for continuing eligible for BadgerCare; exempts a BadgerCare group with monthly income at or below 150% of the federal poverty level from being obliged to contribute toward the cost of the health care coverage; and sets forth how the Department will go about purchasing family coverage offered by the employer of a member of a family eligible for BadgerCare if the Department determines that purchasing that coverage would not cost more than providing BadgerCare coverage.
These rules will not affect the expenditures or revenues of state government or local governments. Costs of implementing BadgerCare were taken into consideration by the Legislature during development of the 1999-01 biennial budget.
Initial Regulatory Flexibility Analysis
The rules for the BadgerCare program apply to the Department, to families that are applicants or recipients of the health care coverage provided by BadgerCare and to county social service or human service departments that take applications and determine eligibility for BadgerCare. The rules will not directly affect small businesses as “small business" is defined in s. 227.114 (1) (a), Stats.
Notice of Hearing
Health & Family Services
(Health, Chs. HFS 110-)
Notice is hereby given that, pursuant to s. 149.143(2)(a)2.,3., and 4. and (3), Stats., the Department of Health and Family Services will hold a public hearing to consider the amendment of ss. HFS 119.07(6)(b)(intro.) and Medicare Plan tables and (c) 2. (intro.) and tables and 119.15, Wis. Adm. Code, relating to operation of the Health Insurance Risk-Sharing Plan (HIRSP), and the emergency rules now in effect on the same subject.
Hearing Information
September 9, 1999 Conf. Rm. inside Rm. 218
Thursday State Office Building
Beginning at 1:00 p.m. 1 West Wilson Street
MADISON, WI
The hearing site is fully accessible to people with disabilities. Parking for people with disabilities is available in the parking lot behind the building, in the Monona Terrace Convention Center Parking Ramp or in the Doty Street Parking Ramp. People with disabilities may enter the building directly from the parking lot at the west end of the building or from Wilson Street through the side entrance at the east end of the building.
Analysis Prepared by the Department of Health and Family Services
The State of Wisconsin in 1981 established a Health Insurance Risk-Sharing Plan (HIRSP) for the purpose of making health insurance coverage available to medically uninsured residents of the state. One type of coverage provided by HIRSP is supplemental coverage for persons eligible for Medicare. This coverage is called Plan 2. Medicare (Plan 2) has a $500 deductible. Approximately 17% of the 7,291 policies in effect on March 31, 1999 were of the Plan 2 type.
The Department through this order is amending two sections of the HIRSP program administrative rules:
1. It is updating HIRSP Plan 2 premium rates in accordance with the authority and requirements set out in s. 149.143 (3) (a), Stats. The Department is required to set premium rates by rule and the rates must be calculated in accordance with generally accepted actuarial principles. Policyholders are to pay 60% of the costs of HIRSP. There are separate sets of tables in ch. HFS 119 that show unsubsidized and subsidized Plan 2 premium rates. Both sets of tables are being updated. The Plan 2 premium rates need to be increased to cover increased costs of treatment for individuals enrolled under Plan 2. Premium rates for Plan 2 increase by about 18%.
2. It is also adjusting the total HIRSP insurer assessments and provider payment rates in accordance with the authority and requirements set out in s. 149.143 (2)(a)3. and 4., Stats. With the approval of the HIRSP Board of Governors and as required by statute, the Department approved a methodology that reconciles the most recent calendar year actual HIRSP program costs, policyholder premiums, insurance assessments and collected health care provider contributions with the statutorily required funding formula. The result of the reconciliation process for calendar year 1998 indicated that insurance assessments collected were greater than 20% of costs (net of the GPR contribution from appropriation s. 20.435(5)(af), Stats.) required of insurers. As a result, the insurer assessments for the time period beginning July 1, 1999 are reduced in order to offset the overpayment for 1998. The reconciliation process also showed that an insufficient amount was collected from health care providers for 1998. Therefore, the adjustments to the provider payment rates for the time period beginning July 1, 1999 are increased in order to recoup the provider contributions that were not collected for 1998.
Identical emergency rules were published to take effect on July 1, 1999.
Contact Person
To find out more about the hearing or to request a copy of the proposed rules, write or phone:
Randy McElhose
Division of Health Care Financing
P.O. Box 309, Room 265
Madison, WI 53701-0309
(608) 267-7127 or,
if you are hearing impaired,
(608) 266-1511 (TTY)
If you are hearing or visually impaired, do not speak English, or have other personal circumstances which might make communication at the hearing difficult and if you, therefore, require an interpreter, or a non-English, large-print or taped version of the hearing document, contact the person at the address or phone number above. A person requesting a non-English or sign language interpreter should make that request at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.
Written comments on the proposed rule received at the above address no later than September 16, 1999 will be given the same consideration as testimony presented at the hearing.
Fiscal Estimate
This order updates the Health Insurance Risk-Sharing Plan (HIRSP) premium rates effective July 1, 1999 for HIRSP policies that provide supplemental health insurance coverage for persons eligible under Medicare, and adjusts total HIRSP insurer assessments and provider payment rates for the 12-month period beginning July 1, 1999. This is being done in order to cover Plan costs.
The rule changes will not, by themselves, affect the expenditures or revenues of state government or local governments. They adjust premiums as permitted under the program statute to help offset increased program costs. The rule changes also adjust the insurer assessments and provider payment rates, in accordance with a statute-specified methodology, to offset program costs. There is no local government involvement in the administration of HIRSP.
Initial Regulatory Flexibility Analysis
The rule changes will affect Plan 2 policyholders, the Department and the Department's fiscal agent. They will not affect small businesses as “small business" is defined in s. 227.114(1)(a), Stats. Although the program statutes and rules provide for assessment of insurers to help finance the Health Insurance Risk-Sharing Plan (HIRSP), no assessed insurer is a small business as defined in s. 227.114(1)(a), Stats. Moreover, s. 149.143, Stats., prescribes how the amount of an insurer's assessment to help finance HIRSP is to be determined and, similarly, how the health care provider payment rate is to be calculated.
Notice of Hearing
Public Instruction
Notice is hereby given that pursuant to ss. 121.14 (1) and 227.11 (2) (a), Stats., and interpreting ss. 118.04, 121.004 (8), and 121.14, Stats., the department of public instruction will hold a public hearing as follows to consider the creation of Chapter PI 17, relating to summer school programs. The hearing will be held as follows:
Hearing Information
September 9, 1999 Conference Room
Thursday CESA 6
6:00 - 8:00 p.m. 2300 State Road 44
Oshkosh
The hearing site is fully accessible to people with disabilities. If you require reasonable accommodation to access the hearing site, please call Larry Allen, Director, Education Options Team, at (608) 267-2402 or leave a message with the Teletypewriter (TTY) at (608) 267-2427 at least 10 days prior to the hearing date. Reasonable accommodation includes materials prepared in an alternative format, as provided under the Americans with Disabilities Act.
Copies of Rule and Contact Person
A copy of the proposed rule and the fiscal estimate may be obtained by writing to:
Lori Slauson
Administrative Rules & Federal Grants Coordinator
Department of Public Instruction
125 South Webster Street
P.O. Box 7841
Madison, WI 53707
Written comments on the proposed rules received by Ms. Slauson at the above address no later than September 15, 1999, will be given the same consideration as testimony presented at the hearing.
Analysis by the Department of Public Instruction
1997 Wis. Act 240 specifies that state aid shall be paid to each district or county handicapped children's education board only for those academic summer classes or laboratory periods that are for necessary academic purposes, as defined by the state superintendent by rule.
