(608) 266-9314
Notice of Hearing
Health and Family Services
NOTICE IS HEREBY GIVEN that pursuant to ss.
149.143 (2) (a) 2.,
3., and
4., and
(3), Stats., and
227.11 (2) Stats., interpreting ss.
149.14 (5m),
149.142,
149.143,
149.146, and
149.165, Stats., the Department of Health and Family Services will hold a public hearing to consider the proposed permanent rules and emergency rules amending ss.
HFS 119.07 (6) (b) to
(d) and
119.15 (2) and
(3), relating to operation of the health insurance risk-sharing plan (HIRSP).
The Department anticipates that the emergency rules will take effect on July 1, 2004.
Hearing Information
Date and Time
|
Location
|
July 13, 2004
Tuesday
Beginning at 1:00 p.m.
|
Conference Room 372
(3rd Floor)
State Office Building
1 West Wilson Street
Madison, WI
|
The hearing site is fully accessible to people with disabilities. If you are hearing or visually impaired, do not speak English, or have circumstances that 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 given above at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.
Written comments may be submitted at the public hearing, or in lieu of attending a public hearing written comments can be submitted by regular mail or email to the contact person listed below. Written comments may also be submitted to the Department using the Wisconsin Administrative Rules Internet website at the web address listed below. The deadline for submitting comments is 4:30 p.m., on July, 19, 2004.
Analysis Prepared by the Department of Health and Family Services
The State of Wisconsin in 1981 established a Health Insurance Risk-Sharing Plan (HIRSP). HIRSP provides major medical health insurance for persons who are covered under Medicare because they are disabled, persons who have tested positive for HIV, and persons who have been refused coverage or who cannot get coverage at an affordable price in the private health insurance market because of their mental or physical health conditions. Also eligible for coverage are persons who do not currently have health insurance coverage, but who were covered under certain types of health insurance coverage (called creditable coverage) for at least 18 months in the past. According to state law, HIRSP policyholder premium rates must fund sixty percent of plan costs. The remaining funding for HIRSP is to be provided by insurer assessments and adjustments to provider payment rates, in co-equal twenty percent amounts.
HIRSP Plan 1 is for policyholders that do not have Medicare. Ninety percent of the 17,669 HIRSP policies in effect in February 2004 were of the Plan 1 type. Plan 1 has Option A ($1,000 deductible) or Option B ($2,500 deductible). The rates for Plan 1 contained in this rulemaking order increase an average of 12.2% for policyholders not receiving a premium reduction. The average rate increase for policyholders receiving a premium reduction is also 12.2%. Rate increases for individual policyholders within Plan 1 range from 9.6% to 13.5%, depending on a policyholder's age, gender, household income, deductible and zone of residence within Wisconsin. Plan 1 rate increases reflect general and industry-wide premium increases and take into account the increase in costs associated with Plan 1 claims.
HIRSP Plan 2 is for persons eligible for Medicare because of a disability or because they become age-eligible for Medicare while enrolled in HIRSP. Plan 2 has a $500 deductible. Ten percent of the 17,669 HIRSP policies in effect in February 2004 were of the Plan 2 type. The rate increases for Plan 2 contained in this rulemaking order increase an average of 18.4% for policyholders not receiving a premium reduction. The average rate increase for policyholders receiving a premium reduction is also 18.4%. Rate increases for individual policyholders within Plan 2 range from 15.7% to 20.0%, depending on a policyholder's age, gender, household income and zone of residence within Wisconsin. Plan 2 rate increases reflect general and industry-wide cost increases and take into account the increase in costs associated with Plan 2 claims. Plan 2 premiums are also set in accordance with the authority and requirements set out in s.
149.14 (5m), Stats.
Initial Regulatory Flexibility Analysis
HIRSP program statutes require an assessment of insurers and providers in order to help finance HIRSP. The rule changes do not affect health insurers who are small businesses as “small business" is defined in s.
227.114 (1) (a), Stats. The rules changes may affect some health care providers that are small businesses. The net fiscal impact of HIRSP on these small health care providers is unknown.
Fiscal Estimate
The Health Insurance Risk-Sharing Plan (HIRSP) has the purpose of making health insurance coverage available to medically uninsured residents of the state. This order updates HIRSP premiums for policyholders effective July 1, 2004. It also adjusts total HIRSP insurer assessments and provider payment rates for the 12-month period beginning July 1, 2004. This adjustment process is being done in order to reflect changing HIRSP costs and a statute-specified calculation methodology, in order to fund total HIRSP costs.
The fiscal adjustments contained in this order were developed by an independent actuarial firm on behalf of HIRSP. The projected adjustments have been reviewed by DHFS staff and approved by the HIRSP Board of Governors. By law, the Board is a diverse body composed of consumers, insurers, health care providers, small business and other affected parties. By statute, these adjustments include estimates for the annual reconciliation process, which is based on the previous calendar year and implemented in the subsequent plan year. The fiscal adjustments are based upon a combination of a retrospective reconciliation process, current HIRSP expenses, inflation trends in medical care and statutory requirements. The resulting adjustments are then applied to the time-period beginning July 1, 2004. Similar annual fiscal adjustments to the HIRSP rules have occurred in each state fiscal year since 1998.
The amount of $152,283,191 will be required to be collected from insurers, providers and policyholder in order to fund HIRSP in SFY 2005. The total cost to fund HIRSP in SFY 2005 is estimated to be $168,006,117. The total required contribution for insurers is $35,216,294, but due to a prior year surplus of $2,770,012, the insurers' assessment amount for SFY 2005 is $32,446,282, a decrease of $2,997,827 from SFY 2004. The total required contribution for providers is $35,216,294, but due to a prior year surplus of $1,0936,317, the providers' contribution amount for SFY 2005 is $34,122,977, a decrease of $5,047,376 from SFY 2004. The total required contribution for policyholders is $97,573,530, but due to a prior year surplus of $11,859,597, policyholders' necessary premium contribution amount for SFY 2005 is $85,713,933, a decrease of $9,366,073 from SFY 2004. Although the total policyholder required amount decreases, this rule increases policyholder premiums in order to comply with the statutory requirements. Plan 1 premiums will increase an average of 12.2% to keep rates at the statutorily-established minimum rate, i.e., 140% of the industry standard rate. Premiums for Plan 2 (the plan for HIRSP policyholders who are also on Medicare) will increase an average of 18.4% based on the criteria established in statute. Therefore, policyholders will actually pay $102,812,878 in premiums, which is $5,239,348 above the required policyholder contribution.
HIRSP has an impact on policyholders, insurers and health providers. Under HIRSP, policyholders are required by law to fund 60% of its costs, while Wisconsin's health insurers and health care providers are each required to fund 20%. HIRSP offers health insurance to high medically at-risk citizens, at rates subsidized by healthcare insurers and providers of service. HIRSP has approximately 17,700 policyholders, out of a Wisconsin population of about 5.5 million. HIRSP increases the number of Wisconsin citizens with health insurance. Wisconsin citizens are helped because they can obtain otherwise unavailable health insurance coverage. This allows them to improve their health status. Health care insurers find themselves unable to serve this marketplace niche and health care providers receive additional customers.
Copies of Rule and Contact Person
A copy of the full text of the rules and the full text of the fiscal estimate, and other documents associated with this rulemaking may be obtained, at no charge, from the Wisconsin Administrative Rules website at
http://adminrules.wisconsin.gov. At this website you can also register to receive email notification whenever the Department posts new information about this rulemaking and, during the public comment period, you can submit comments on the rulemaking order electronically and view comments that others have submitted about the rule.
A copy of the full text of the rule and the fiscal estimate may also be obtained by contacting the Department's representative listed below:
Randy McElhose
Division of Health Care Financing
P.O. Box 309, Room B274
1 W. Wilson St.
Madison, WI 53701-0309
Phone: (608) 267-7127 or if you are hearing impaired, (608) 266-1511 (TTY)
Fax: (608) 264-7720
Mcelhrf@dhfs.state.wi.us
Notice of Hearings
Health and Family Services
NOTICE IS HEREBY GIVEN that pursuant to ss.
227.16 (1),
227.17 and
227.18, Stats., and interpreting ss.
49.45 (30e),
49.46 (2) (b) 6. Lm,
51.04,
51.42 (7) (b), and
51.61, Stats., the Department of Health and Family Services will hold public hearings to consider the proposed creation of chapter HFS 118, relating to Wisconsin's Statewide Trauma Care System.
Hearing Information
The public hearings will be held:
Date & Time Location
July 15, 2004 Room B139
Thursday State Office Building
10:00am - 2:00pm 1 West Wilson Street
Madison, WI
July 15, 2004 Room B139
Thursday State Office Building
4:30pm - 6:30pm 1 West Wilson Street
Madison, WI
July 16, 2004 Room 45
Friday Milwaukee State Office Bldg.
10:00am - 2:00pm 819 North 6th St.
Milwaukee, WI
July 22, 2004 Room 152A
Thursday Northeastern Regional Public Health Office
10:00am - 3pm 200 North Jefferson Street
Green Bay, WI
July 23, 2004 Conference Room
Friday Northern Regional Public Health Off.
9:00am - 1:00pm 1853 North Stevens Street
Rhinelander, WI
July 27, 2004 Room 123
Tuesday DHFS State Office Building
11:00am - 3:00pm 610 Gibson Street
Eau Claire, WI
The hearing sites are fully accessible to people with disabilities. If you are hearing or visually impaired, do not speak English, or have circumstances that 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 given at the end of this notice at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.
Written comments may be submitted at the public hearing or in lieu of attending a public hearing, written comments can be submitted by regular mail or email to the contact person listed below. Written comments may also be submitted to the Department using the Wisconsin Administrative Rules Internet website at the web address listed below.
Deadline for Comment Submission
The deadline for submitting comments is 4:30 p.m., August 6, 2004.
Analysis Prepared by the Department of Health and Family Services
The Department proposes to create ch.
HFS 118, rules governing the development and operation of Wisconsin's Statewide Trauma Care System. The system's objective is to reduce death and disability resulting from traumatic injury by:
-- Decreasing the incidence of trauma;
-- Providing optimal care of trauma victims and their families; and
-- Collecting and assessing trauma-related data.
Trauma is a sudden physical injury caused by the application of an external force or violence, such as a motor vehicle crash, a fall or a blow from a blunt or penetrating instrument. Trauma is the leading cause of death in Wisconsin among people under age 35 and is the fourth leading cause of death among the general Wisconsin population. Traumatic injury and its resultant care may, directly or indirectly, affect all Wisconsin residents and visitors. Section
146.56, Stats., directs the Department of Health and Family Services to develop and implement a statewide trauma care system. Through a statewide trauma system, health care and public safety participants will best be able to respond to and address the needs of trauma victims and their families. The Statewide Trauma Advisory Council, established under s.
15.197 (25), Stats., and appointed by the Secretary of the Department of Health and Family Services, has been collaborating with the Department for the past three years towards the development and implementation of Wisconsin's Statewide Trauma Care System. Wisconsin's Statewide Trauma Care System, when fully implemented, will enhance community health through an organized system of injury prevention, acute care and rehabilitation that is fully integrated with the public health care system in a community.
The Department is proposing the following through its creation of chapter HFS 118:
-- A method by which to classify the emergency care capabilities of all Wisconsin hospitals;
-- Use of the American College of Surgeons publication, Resources for Optimal Care of the Injured Patient: 1999, to evaluate the adequacy of hospitals' trauma care capabilities;
-- Policies guiding the development and use of Regional Trauma Advisory Councils for the purpose of developing, implementing and monitoring the trauma care system; and
-- Policies governing the establishment and operation of a statewide trauma registry; triage and transfer protocols among trauma care providers; and the promotion of improved trauma care provider performance.
Data collected from the state trauma registry on injury incidence, patient care and outcomes, specified in section
HFS 118.09, will help identify problems and evaluate the performance of the existing trauma care system. Through this information, communities will be able to assess the nature of traumatic injuries in Wisconsin and establish appropriate injury prevention programs to reduce the occurrence of injuries, expedite patients' recovery and minimize the lasting effects of injuries.
Effect on Small Business
This chapter will primarily affect Wisconsin hospitals, rural medical centers and ambulance service providers. Based on fiscal year 2002 data, three hospitals had annual revenues under $5 million. There are currently 456 ambulance service providers in Wisconsin. The Department does not have annual revenue data for ambulance service providers. However, the Department presumes that most, if not all, ambulance service providers have annual revenues under $5 million.
Under these proposed HFS 118 rules, the Department would require all ambulance service providers to affiliate and participate with a Regional Trauma Advisory Council (RTAC). The purpose of such affiliation is to participate in their region's trauma care system. The proposed rules require ambulance service providers to state their RTAC affiliation choice in the ambulance service provider's operational plan. Under chapter HFS 110, ambulance service providers already must submit operational plans to the Department. The Department collects operational plans to ensure the appropriate operation of ambulance services. There will be no additional cost to fulfill this obligation.
Fiscal Estimate
Section
146.56 of the statutes mandates a statewide trauma care system and requires the Department to promulgate rules to develop and implement the system. The statutes also require the Department to develop Regional Trauma Advisory Councils (RTACs). The rule requires hospitals to become affiliated with a Regional Trauma Advisory Council by December 31, 2004. There will be no fiscal effect as a result of this requirement.
Under this statute, hospitals are required to certify to the Department the classification level of trauma care services they provide. Trauma facilities are classified as Level I, II, III, or IV, depending on the comprehensiveness of the trauma care provided. Each hospital determines the level of trauma facility care for which it qualifies. If a hospital wishes to become a Level I or Level II trauma care facility, it must receive verification from the American College of Surgeons (ACS). Hospitals not seeking to obtain Level I or II trauma status need only do a self-report survey.
This rule requires hospitals to report the level of their trauma facilities to the Department. The rule does not require that hospitals attain a certain level of facility. Any costs that hospitals incur in becoming Level I or II facilities would be the result of the verification process, not the reporting requirement of the rule. There will, therefore, be no cost to hospitals as the result of this requirement.
The rule requires Emergency Medical Services (EMS) to become affiliated with an RTAC. There will be no cost to EMS providers for this affiliation.
The rule establishes policies governing the operation of a statewide trauma registry and the promotion of improved trauma provider performance. When the registry is operational, hospitals and EMS providers will be required to submit trauma data on a quarterly basis to the registry. The Department will use this data to improve trauma care.
