Mail: PO Box 7873, Madison, WI 53707-7873
Analysis Prepared by the Office of the Commissioner of Insurance
Statutes interpreted
Statutory authority
Explanation of agency authority
The commissioner of insurance, with the approval of the board of governors (board) of the injured patients and families compensation fund (fund), is required to establish by administrative rule the annual fees which participating health care providers must pay to the fund and the annual fee due for the operation of the medical mediation panel.
Related statutes or rules
None.
Plain language analysis and summary of proposed rule
This rule establishes the fees that participating health care providers must pay to the fund for the fiscal year beginning July 1, 2010. These fees represent an 8.6% increase from fees paid for the 2009-10 fiscal year. The board approved these fees at its meeting on May 18, 2010.
The board is also required to promulgate by rule the annual fees for the operation of the injured patients and families compensation mediation system, based on the recommendation of the director of state courts. The recommendation of the director of state courts was reviewed by the board's actuarial and underwriting committee. This rule implements the funding level approved by the board by establishing mediation panel fees for the next fiscal year at $28.00 for physicians and $6.00 per occupied bed for hospitals, representing an increase of $3.00 per physician and $1.00 per occupied bed for hospitals from 2009-10 fiscal year mediation panel fees.
Comparison with federal regulations
To the fund board's and OCI's knowledge there is no existing or proposed federal regulation that is intended to address patient compensation fund rates, administration or activities.
Comparison of similar rules in adjacent states
To the fund board's and OCI's knowledge there are no similar rules in the adjacent states to compare this rule to as none of these states have a patients compensation fund created by statute where rates are directed to be established yearly by rule as is true in Wisconsin.
Summary of factual data and analytical methodologies
None. This rule establishes annual fund fees pursuant to the requirements of the above-noted Wisconsin statutes.
Analysis and documentation used to determine rule's effect on small businesses
This increase in fund fees and mediation panel fees will have an affect on some small businesses in Wisconsin; particularly those that employ physicians and other health care professionals. The mediation panel fee is assessed only on physicians and hospitals, not on corporations or other health care entities. These increases will affect only those small businesses that pay the fund fees and mediation panel fees on behalf of their employed physicians. However, these increases will not have a significant effect nor should it negatively affect the small business's ability to compete with other providers.
Private Sector Fiscal Impact
The increase in fees promulgated by this rule does not result in a significant fiscal effect on the private sector. Although a health care provider may pass this increase on to its patients, there will not be a significant fiscal effect on the private sector as a result of this proposed rule.
Small Business Fiscal Impact
This rule will have little or no effect on small businesses. The increase contained in the proposed rule will require providers to pay an increased fund fee and mediation panel fee which will increase the operational expenses for the providers. However, this increase is not considered to be significant and will have no effect on the provider's competitive abilities.
Small business regulatory coordinator
The OCI small business coordinator is Eileen Mallow and may be reached at phone number (608) 266-7843 or at email address:
eileen.mallow@wisconsin.gov.
Fiscal Estimate
Assumptions used in arriving at fiscal estimate
The Injured Patients and Families Compensation Fund (IPFCF or Fund) is a segregated fund. Annual Fund fees are established to become effective each July 1 based the Fund's needs for payment of medical malpractice claims. The proposed fees were approved by the Fund's Board of Governors at its May 18, 2010, meeting and represent an increase of 8.6% over fiscal year 2010 fund fees.
The Fund is a unique fund; there are no other funds like it in the country. The Fund provides unlimited liability coverage and participation is mandatory. These two features make this Fund unique compared to funds in other states. The only persons who will be affected by this rule change are the Fund participants themselves as the IPFCF is fully funded through assessments paid by Fund participants.
There is no effect on GPR.
State fiscal effect
None.
Local government fiscal effect
None.
Long-range fiscal implications
None.
Agency Contact Person
Inger Williams, OCI
Phone: (608) 264-8110
Address: 125 South Webster St – 2nd Floor
Madison WI 53703-3474
Mail: PO Box 7873
Madison, WI 53707-7873
Notice of Hearing
Insurance
NOTICE IS HEREBY GIVEN That pursuant to the authority granted under s.
601.41 (3), Stats., and the procedures set forth under s.
227.18, Stats., the Office of the Commissioner of Insurance (OCI) will hold a public hearing to consider the adoption of the proposed rulemaking order affecting section
Ins 8.49 Appendix
1, Wis. Adm. Code, relating to uniform small employer application for health care and affecting small business.
Hearing Information
Date: July 21, 2010
Time: 1:30 p.m., or as soon thereafter as the
matter may be reached
Location: OCI, Room 227
125 South Webster Street, 2nd Floor
Madison, WI
Submittal of Written Comments
Written comments can be mailed to:
Julie E. Walsh
Legal Unit - OCI Rule Comment for Rule Ins 849
Office of the Commissioner of Insurance
PO Box 7873
Madison WI 53707-7873
Written comments can be hand delivered to:
Julie E. Walsh
Legal Unit - OCI Rule Comment for Rule Ins 849
Office of the Commissioner of Insurance
125 South Webster St – 2nd Floor
Madison WI 53703-3474
Comments can be emailed to:
Julie E. Walsh
The deadline for submitting comments is 4:00 p.m. on the 14th day after the date for the hearing stated in this Notice of Hearing.
Copies of Proposed Rule and Fiscal Estimate
A copy of the full text of the proposed rule changes, analysis and fiscal estimate may be obtained from the OCI internet Web site at
http://oci.wi.gov/ocirules.htm or by contacting:
Inger Williams, OCI
Phone: (608) 264-8110
Address: 125 South Webster St – 2nd Floor
Madison WI 53703-3474
Mail: PO Box 7873
Madison, WI 53707-7873
Analysis Prepared by the Office of the Commissioner of Insurance
Statutes interpreted
Statutory authority
Explanation of agency authority
In accordance with s.
601.41 (8), Stats., the office of the commissioner of insurance is required to revise the uniform small employer application form at least once every two years in consultation with the health advisory council. The rule was initially promulgated in 2003, and due to federal changes and a request of the health advisory council the office of the commissioner of insurance proposes this rule.
Related statutes or rules
Section
635.10, Stats., requires use of the small employer uniform employee application for group health insurance.
Plain language analysis and summary of proposed rule
Additionally the federal government has also modified the Health Insurance Portability and Accountability Act (HIPAA) to include the requirement of additional descriptive information for persons who after a qualifying event are permitted the option of a special enrollment period to understand how to obtain and apply for coverage. The proposed rule contains the modifications to the waiver and health underwriting questions to comply with the Genetic Information Nondiscrimination Act of 2008 (GINA) and the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) as well mandated coverage for dependents.
Specifically, the modifications include several to the small employer uniform application for group health insurance. In section V of the application a sentence has been added in accordance with an amendment to CHIPRA that informs an employee how to obtain information on electing health insurance coverage through a special election period due to a qualifying event including Medicaid premium assistance. This information is to be provided at the time the employee waives the right to obtain health insurance through the small employer. Information is updated regarding the treatment of genetic information in the medical information section of the application. Additionally, modification were made to delete reference to a dependent needing to be a full-time student or financially dependent as both state and federal law mandate inclusion of dependents.
