No existing or proposed federal regulation addresses the contemplated rule changes.
Entities Affected by the Rule
The new rules will affect members, subscribers, their beneficiaries and dependents who have granted power of attorney to one or more individuals or entities.
Estimate of Time Needed to Develop the Rule
State employees will spend an estimated 30 hours to develop these rules.
Employee Trust Funds
Subject
Revises Chapter
ETF 52, relating to the administration of the Duty Disability Program under s.
40.65, Stats.
Objective of the Rule
The Department of Employee Trust Funds seeks to clarify the existing rule regarding the administration of the Duty Disability Program and streamline the process of applying for and making determinations regarding the Duty Disability benefit.
Policy Analysis
ETF is responsible for ensuring that the Duty Disability benefit authorized by s.
40.65, Stats., is appropriately administered for participants in the Wisconsin Retirement System. Chapter
ETF 52 was promulgated, in its entirety, in 1998. Since that time, the Department has further developed policies and procedures for administering the benefit, and finds that the rules should be amended to incorporate many of these policies and procedures and to clarify how the Duty Disability benefit is administered under the rules.
The proposed rule would amend definitions in s.
ETF 50.02 to clarify how the terms are used by the Disability Bureau of ETF. Other provisions that could be amended include, without limitation, ss.
ETF 52.04,
52.06,
52.07,
52.08,
52.12,
52.16 and
52.22.
ETF also contemplates creating new rules regarding the Duty Disability benefit to conform with existing policies and procedures of the Disability Bureau of ETF in administering the benefit.
Statutory Authority
Comparison with Federal Regulations
No existing or proposed federal regulation addresses the contemplated rule changes.
Entities Affected by the Rule
The new rules will affect members in the Duty Disability program as well as those who apply for the program.
Estimate of Time Needed to Develop the Rule
State employees will spend an estimated 75 hours to develop these rules.
Financial Institutions — Banking
Subject
Objective of the Rule
The purpose of the rule is to provide a definition of “health care billing companies."
Statutory Authority
Comparison with Federal Regulations
None.
Entities Affected by the Rule
Health care billing companies.
Estimate of Time Needed to Develop the Rule
50 hours.
Contact Information
Mark Schlei, Deputy General Counsel
Dept. of Financial Institutions, Office of the Secretary
P.O. Box 8861, Madison, WI 53708-8861
Phone: (608) 267-1705
Financial Institutions — Banking
Subject
Creates Chapter
DFI-Bkg 75, relating to payday lending.
Objective of the Rule
The purpose of this rule is to set forth certain procedures and requirements for payday lenders. Matters affected may include the conduct of payday lenders, definitions, licensure, applications, fees, bonds, relocation, conducting other business, records, reports, revocations, suspensions, disclosure requirements, informational materials, interest, penalties, prepayment, repayment, rescission, prohibitions, database and customer information.
Statutory Authority
Comparison with Federal Regulations
None.
Entities Affected by the Rule
Payday lenders.
Estimate of Time Needed to Develop the Rule
150 hours.
Contact Information
Mark Schlei, Deputy General Counsel
Dept. of Financial Institutions, Office of the Secretary
P.O. Box 8861, Madison, WI 53708-8861
Phone: (608) 267-1705
Insurance
Subject
Creates section
Ins 3.35, relating to colorectal cancer screening coverage and affecting small business.
Objective of the Rule
The commissioner is required to promulgate rules to implement
2009 Wis. Act 346 requiring health insurance coverage of colorectal cancer screenings. The rule will specify guidelines for the colorectal cancer screening that are to be covered by disability insurance policies and self-insured health plans of the state, county, city, town, village or school district that provide coverage of any colorectal cancer examinations and lab tests. The rule will also specify the factors for determining whether an individual is at high risk for colorectal cancer. The commissioner will consult with the secretary of health services and consider nationally validated guidelines in the development of the rule.
Policy Analysis
There are no directly relevant policies, however s.
632.895 (8), Stats., mandates coverage for mammograms and s.
Ins 3.47, Wis. Adm. Code regulates the solicitation of cancer insurance products. The prevention of cancer including routine screening may currently be found in the coverage offered by many insurers. As the commissioner enforces other health coverage mandates and will be consistent in developing rules for colorectal cancer screening.
Statutory Authority
Sections 601.41 (3) and 632.895 (16), Stats., as created by
2009 Wis. Act 346 and renumbered to 632.895 (16m), under s. 13.92 (1) (bm) 2., Stats.
Comparison with Federal Regulations
There are no existing or proposed federal regulations that address the newly enacted law or proposed rule.
Entities Affected by the Rule
Insurers offering group health insurance, self-funded governmental plans and licensed intermediaries authorized to solicit group health insurance.
Estimate of Time Needed to Develop the Rule
200 hours and no other resources are necessary.
Insurance
Subject
Creates section
Ins 3.375, relating to health insurance coverage of nervous and mental disorders, alcoholism and other drug abuse problems and affecting small business.
Objective of the Rule
The commissioner is required to promulgate rules to implement
2009 Wis. Act 218 requiring health insurance coverage of nervous and mental disorders, alcoholism and other drug abuse problems. The rules will guide implementation of the Act in light of the federal mental health parity law. The rules will also reflect the ability for employers and small employers to qualify for an exemption from the requirements of the Act for specified periods of time. Further if an employer including a small employer qualifies for an exemption the commissioner is required to specify by rule and the content and manner in which the notices must be provided to enrollees. Finally the commissioner is to promulgate rules regarding the actuarial study necessary to qualify for an exemption.
The Act authorizes the commissioner to promulgate rules on an emergency basis under s.
227.24, Stats., without providing evidence that an emergency rule is necessary to preserve the public peace, health, safety or welfare and is not required to make a finding of emergency. It is anticipated since the Act is effective December 1, 2010 that an emergency rule will need to be promulgated.
Policy Analysis
Section
632.89, Stats., and s.
Ins 3.37, Wis. Adm. Code, are existing policies relevant to the new rule.
Statutory Authority
Comparison with Federal Regulations
Recently guidance in the form of interim final rules was published implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). MHPAEA is a federal law that provides participants who already have benefits under mental health and substance use disorder (MH/SUD) coverage parity with benefits limitations under their medical/surgical coverage. MHPAEA may apply to two different types of coverage: large group self-funded group health plans and large group fully insured group health plans.
The guidance includes amendments to the internal revenue code, HIPAA regulations and the Department of Health and Human Services requirements for the group health insurance market. Each respective set of rules contains the same definition of mental health benefits. Mental health benefits means benefits with respect to services for mental health conditions, as defined under the terms of the plan and in accordance with applicable Federal and State law. Any condition defined by the plan as being or as not being a mental health condition must be defined to be consistent with generally recognized independent standards of current medical practice (for example, the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the most current version of the ICD, or State guidelines).
The federal regulations and MHPAEA apply when the health plan offers coverage for mental health and addiction services but does not mandate such coverage be contained in health plans. In contrast, Wisconsin requires group health benefit plans to cover nervous and mental disorders, alcoholism and other drug abuse problems and now requires parity in coverage.
