Scope statements
Health and Family Services
Subject
The Department proposes to develop a rulemaking order that modifies ch.
HFS 119 regarding the Wisconsin Health Insurance Risk-Sharing Plan (HIRSP). Modifications to ch.
HFS 119 are needed to reflect an actuarially driven update of HIRSP policyholder health insurance premiums and insurer and provider assessments for the time period beginning July 1, 2005.
Policy analysis
HIRSP is a longstanding state program for Wisconsin citizens who are at high medical risk. The Department has amended ch.
HFS 119 each year since 1998. The amended rule will address HIRSP policyholder premiums, and insurance and provider assessments. Updated rules are necessary per increased HIRSP costs and funding requirements, generally accepted accounting principles, statutory requirements, Wisconsin's biennial budget, and actions taken by the HIRSP Board of Governors at its April 13, 2005 meeting. By law, the HIRSP Board has a diverse membership that includes consumers, insurers, health care providers, small business representatives and other affected parties.
Health insurers and providers of medical services subsidize the premium rates offered by HIRSP. Wisconsin citizens who are at high medical risk are thereby better able to obtain insurance coverage and good health. Health care providers are better able to serve more customers. Absent HIRSP, the health care marketplace is such that insurers would find it difficult to serve people who routinely experience high medical risk. HIRSP increases the number of people with high medical needs with health insurance.
Statutory authority
Staff time required
The estimated DHCF staff time and other resources needed to develop and promulgate these rules is about 130 hours. This estimate includes the time required to make the actuarial calculations, rule drafting and promulgation.
Entities affected by the rule
The entities affected by this rule are HIRSP policyholders, health insurers who are required by law to fund a portion of HIRSP costs, and health care providers who serve HIRSP policyholders, who are also required to fund a portion of HIRSP costs.
Comparison with federal requirements
There are no existing or proposed federal regulations that address HIRSP premium rates and insurer and provider assessments.
Health and Family Services
Subject
The Department proposes to amend ch.
HFS 132, rules relating to nursing homes.
Policy analysis
The Department proposes to update ch.
HFS 132 to reflect current standards of care and practice; enhance the Department's authority relating to the initial licensing of nursing homes; and remove provisions that duplicate applicable federal requirements. The proposed changes do not compromise the care and safety to nursing home residents.
Section
50.02 (2) (a), Stats., gives the Department the authority to establish and enforce regulations and standards for the care, treatment, health, safety, rights, welfare and comfort of residents in nursing homes. It also authorizes the Department to promulgate and enforce administrative rules that provide the conditions of licensure for nursing homes.
Effective November 1, 2004, revisions were made to ch.
HFS 132 to reflect changes that have occurred in service delivery (e.g. pain management and quality assurance) and technology (e.g. electronic records and physical environment), to remove overly prescriptive rules and to make the rules more reflective of and compatible with the comparable federal regulations.
Through this rulemaking initiative, the Department is continuing the rule revision process by further updating the rule to recognize changes in service delivery and technology and by eliminating or modifying state regulations that are already addressed in ch.
50, Stats.; chs.
Comm 61 to
65, also known as the Wisconsin Commercial Building Code; and
42 CFR 483, the federal regulatory requirements for nursing homes. The Department's intent is to streamline ch.
HFS 132, while ensuring a nursing home's responsibility to provide quality care and meet the needs of its residents. In addition, eliminating rules that duplicate federal regulations would reduce the number of citations issued for the same violation.
The Department is also proposing to enhance its authority relating to approving licenses under s.
HFS 132.14. These changes are intended to ensure that new operators applying for a Wisconsin nursing home license are qualified professionals and have demonstrated fiscal responsibility in the operation of health care facilities.
Statutory authority
Staff time required
The Department estimates that it will take approximately 640 hours of staff time to to promulgate the proposed changes to ch.
HFS 132.
Entities affected by rule
The entities affected by the proposed rules are all licensed nursing homes in Wisconsin.
Comparison with federal requirements
Federal conditions of participation for nursing homes are in the Code of Federal Regulations,
42 CFR 483. The federal regulations and existing ch.
HFS 132 address largely similar regulatory areas. Generally, ch.
HFS 132 provides more specificity than the comparable federal regulations for nursing homes.
Health and Family Services
Subject
The Department proposes to amend ch.
HFS 149, rules relating to the selection and monitoring of vendors for the special supplemental food program for women, infants and children (WIC).
Policy analysis
Under the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the federal government provides supplemental foods and nutrition education through payment of cash grants to states that administer the program through local agencies at no cost to eligible persons. The WIC program serves as an adjunct to good health care during critical times of growth and development, in order to prevent the occurrence of health problems. In Wisconsin, the WIC program has 112,000 certified participants, comprised of low-income pregnant and breastfeeding women, infants and children under 5 years of age. Seventy local WIC projects (located in city and county public health departments, private non-profit organizations, and one hospital) administer WIC in designated project service areas. These services include health screening, nutrition assessment and counseling, referrals to other health and social services, and vouchers to purchase nutritious foods at authorized grocery stores and pharmacies (vendors).
The Wisconsin WIC program is responsible for the authorization of some 1,000 vendors to provide food to WIC participants. Applications are screened for basic store and management information, business integrity, and the selection of WIC authorized foods at competitive prices, as determined by prices charged by all stores in a project service area.
Currently applicants for WIC vendor authorization are required under s.
HFS 149.03 (2) (c) to charge a price that is no more than 115% of the average price charged for a standardized combination of foods by other applicants in the project service area in which the grocery store or pharmacy is located. The average price is determined by the Department and based on reported prices of large and small stores statewide for the standardized combination of foods during the previous 6-month period. The Department believes that this method of computing average price may impede the ability of smaller stores to obtain or maintain WIC vendor authorization, due to the smaller stores' inability to offer prices that are competitive with that of larger stores.
The Department proposes to amend s. HFS 149. 03 (2) (c) to remove the requirement that store prices be competitive with all other stores within a project service area to require that prices be competitive with stores within its vendor peer group of similar stores located throughout the state. This change would result in the Department being able to compute average price based on reported prices of the vendor peer group and, therefore, a more equitable process for small store applicants. Prices of these stores will no longer be compared to the prices of larger stores, who can offer lower prices than their smaller counterparts due to economies of scale.
The Department also proposes to amend s.
HFS 149.03 (7) to change the duration of authorization from every two years to every three years. Instead of ending on October 31 of even-numbered years regardless of when authorization was granted, the authorization would end on October 31 of every third year. This is now allowed per federal regulation and would lessen the burden of reauthorization for both the vendors and the state WIC office. In addition, the Department proposes to eliminate the one-year initial certification period, allowing new vendors' authorization period to extend to October 31 of every third year. The one-year certification has not proven to be effective in addressing fraud, and is burdensome for both the vendor and the state WIC office.
Statutory authority
Staff time required
The Department estimates it will take 40 hours of staff time to develop the proposed amendments.
Entities affected by the rule
The entities that will be directly affected by the proposed amendments are Wisconsin grocery stores and pharmacies.
Comparison with federal requirements
The Wisconsin WIC program operates under a State Plan pursuant to
7 CFR 246. The Department does not know of any proposed regulations that address the subject of the proposed rules.
Natural Resources
Subject
Objective of the rule. The Bureau of Fisheries Management and Habitat Protection is requesting authorization to draft rules for implementing
2003 WI Act 275 that allows the Department to use up to 10% of the annual lake protection grant appropriation to fund a citizen lake monitoring network through contracts to groups and individuals. Rules are needed to specify the eligible activities and qualifications for participation in the network and other details for administering the contracts.
Policy analysis
In 1986 the Department created the Self Help Lake Monitoring Program to enlist citizens in the monitoring of lake ecosystems. The program was funded through a portion of the operational budget (lake segregated account) for lake management. By 1995 participation in the program had reached its funding capacity though the need for, and interest in, the program continued to grow. In 2000, ch.
NR 190 was amended to allow individual small-scale grants to fund expanded participation in the program. However, the administration and tracking of hundreds of individual grants in addition to managing the existing program-funded network became problematic. Rule promulgation will reduce workload and stream line an expanded citizen lake monitoring network.
Statutory authority
Authority for the rule comes from s.
281.68 (3) Stats. and general Department rule making authority under s.
227.11 (2) (a), Stats.
Staff time required
