Statutes interpreted
Statutory authority
Explanation of agency authority
The OCI, in order to comply and implement the requirements of
2007 Wis. Act 20, creating the Wisconsin Long-Term Care Insurance Partnership Program (Partnership Program) including the requirements for intermediary training and the process by which insurers submit policies that are intended to qualify for the Partnership Program must adopt the 2000 and 2006 National Association of Insurance Commissioners (NAIC) Long-Term Care Insurance Model Act and Model Laws, pursuant to the Deficit Reduction Act of 2005 (Pub.L. 109-171) (DRA). These amendments are needed to expand consumer protection and comply with the requirements of the Center for Medicare and Medicaid Services (CMS) as delegated to the NAIC the function of regulating the insurers offering long-term care insurance products.
Related statutes or rules
The Partnership Program is described at s.
49.45 (31), Stats., and requires coordination between the OCI and the Department of Health and Family Services.
Plain language analysis
The current administrative rule was last revised in 2001 and is not fully compliant with the NAIC Long-Term Care Model Act and NAIC Long-Term Care Model Law (NAIC Model Act and Model Law). When
2007 Wis. Act 20 created the Partnership Program, the OCI is required to implement the NAIC Model Act and Model Law in order for insurers to offer policies compliant with the DRA. Significant portions of the proposed rule update and expand definitions and require disclosure of these definitions to insureds so that they understand how the long-term care, home health care or nursing home insurance policy is able to be used and the limitations or exclusions that may be applied by insurers.
In section 3.455, the modifications primarily address the conversion from a group long-term care insurance policy to an individual long-term care insurance policy. The expanded information is intended to both comply with the NAIC Model Act and Model Law and Wisconsin conversion and continuation law. The section also includes expanded definition related to conversion of long-term care insurance policies.
Section
3.46 modifications begin with updated and revised definitions that are intended to provide consumers with greater specificity regarding terms used within long-term care, home health care and nursing home care insurance policies. Of note the current NAIC Model Act and Model Law do not exempt group long-term care insurers and as such the exemption in s.
3.46 (2) has been struck. Consumer protection elements are introduced or existing protections expanded throughout this section. One tool to both provide a check on the industry and its intermediaries and better assist consumers with the purchase of long-term care, home health care or nursing home care insurance is through the consolidation and expansion of the marketing requirements. Intermediaries and insurers are required to report on their prior dealings with consumers and state that the policy being sold is an appropriate product for that person. Although similar tools are currently required, the expansion requires additional data reporting to the OCI so that as the regulator we are provided a clearer picture of what sales are occurring and trends in the marketplace. The information will also highlight for both OCI and the insurers contracting with intermediaries information that may reveal unacceptable practices including high pressure sales tactics or interactions with persons resulting in a higher rate of complaints than other intermediaries. Appropriateness of each sale is to be reviewed and must meet the insurer's guidelines.
Additionally, some of the modifications reflect changes in our society, for instance the recognition and use of the internet or on-line completion of applications. Also, nonforfeiture of benefits provisions reflect the increasing cost of long-term care and the affect those increases have on the insureds. Some seniors, at a time near to when the policy may be most useful are least able to afford premium increases. Nonforfeiture of benefits or contingent nonforfeiture provisions allow those who have paid premiums for many years benefits even after they are no longer able to keep their policy enforce.
New paragraphs are also added regarding upgrade and down-grades of policies, and expanded disclosure requirements are included for various benefits including nonforfeiture benefits. These modifications reflect the marketplace and include oversight provisions. These types of benefits potentially give consumers greater control and options when faced with increasing premiums rather than just lapsing the policy due in part to financial constraints. Expanded notification to insureds of new benefits or changing access to providers is also contained in this proposed rule, a modification that allows insureds options that they may not previously been informed of or had access to from within the same carrier. Requirements monitoring replacement of policies is also expanded to enhance oversight of actions by intermediaries and insurers.
Finally, s.
3.46 includes a new section related to initial and on-going intermediary training for long-term care insurance products. In part, this provision delineates training requirements related to the Wisconsin Partnership Program, but is required for all intermediaries offering, selling or negotiating long-term care contracts. Insurers are required to verify compliance to the OCI and OCI assure the Department of Health and Family Services that the intermediaries dealing with Wisconsin consumers are aware of the unique programs available in Wisconsin.
Section
3.465 is newly created to implement the requirements of the Wisconsin Long-Term Care Insurance Partnership Program. This section contains minimum inflation protection percentage increases by age as outlined by the federal government in order for the policies offered by insurers both meet the requirements of the Deficit Reduction Act of 2005 (Pub.L. 109-171). The section also delineates when and how insurers exchange existing long-term care insurance policies for policies that are intended to qualify for the Partnership Program in both the individual and group market. Appendices outline various notices that are to be provided to consumers at the time of solicitation and again at the point of sale. These are intended to educate the consumer so that the may be better able to make informed decisions.
Comparison with federal regulations
It is understood that CMS is anticipating promulgating rules related to the reciprocity of the Partnership Program. Those rules are not anticipated to affect OCI.
Comparison of rules in adjacent states
Illinois: Illinois adopted NAIC Model Act and Law in January 2003 with no substantive deviations. Illinois noticed proposed regulations in compliance with the 2006 NAIC Model Act and Law on August 3, 2007, without substantive deviations. Illinois HB 517 authorizing the Medicaid Office to file the review State Partnership Application for participation in the Partnership Program on August 16, 2007.
Iowa: Iowa adopted the 2000 version of the NAIC Model Act and Model Law in July 2003. With the exception of the intermediary training that Iowa promulgated effective January 1, 2009, the state has notice proposals to adopt the 2006 NAIC Model Act and Law. The requirement for intermediary training requires 4 hours of initial training and 3 hour on-going training every 3 years thereafter. Iowa has not implemented the Partnership Program in accordance with the DRA as yet.
Michigan: Michigan adopted the 200 version of the NAIC Model Act and Law in June 2007. Michigan regulates long-term care insurance by statute and as such did not adopt exact language as the NAIC Model but did incorporate each area covered by the Model. Michigan did enact authorizing legislation to implement the Partnership Program in 2007 and filed its State Partnership Application retroactive to October, 2007. Michigan has not implemented the intermediary training for all intermediaries and is currently formalizing the process.
Minnesota: Minnesota adopted the 2000 NAIC Model Act and Law in January 2002, without substantial deviation. The DRA, Partnership Program became effective July 1, 2006. However there has been delays it was not operational until October 2007. Minnesota adopted the intermediary training and additionally requires non-resident intermediaries demonstrate knowledge of unique aspects of the Minnesota medial assistance program.
Summary of factual data and analytical methodologies
The OCI was required to implement portions of the Partnership Program in compliance with
2007 Wis. Act 20, and utilized a subcommittee comprised of consumer, industry, intermediary and regulatory members to achieve its duty. The group met, in open meetings, two times in the past two months to review and discuss Partnership drafts proposed by the OCI.
For the provisions updating and incorporating the NAIC models, the OCI reviewed each NAIC provision against existing Wisconsin law and rule to ensure consumer protections were not lost in the process and to expand consumer information.
Analysis and supporting documentation used to determine effect on small business
The key provision that may have an effect on small businesses is the requirement for long-term care intermediary initial and on-going training. The OCI included a provision to permit the training to qualify as continuing education credits and to recognize courses non-resident intermediaries may take in states other than Wisconsin. With the exception of two-credit hours that must include the training information developed and maintained by the Department of Health and Family Services, the training requirements allow for the greatest flexibility to not unduly burden intermediaries or unnecessarily increase expenses related to receiving the required training. It is expected, in light of these considerations that if there is any effect, the effect on small businesses will not be significant.
Description of the effect on small business
This rule will have little or no effect on small businesses.
Initial Regulatory Flexibility Analysis
This rule does not impose any additional requirements on small businesses.
Notice is hereby further given that pursuant to s.
227.114, Stats., the proposed rule may have an effect on small businesses. The initial regulatory flexibility analysis is as follows:
Types of small businesses affected
Insurance agents.
Description of reporting and bookkeeping procedures required
None beyond those currently required.
Description of professional skills required
None beyond those currently required.
Fiscal Estimate
State fiscal effect
None
Local fiscal effect
None
Long-range fiscal implications
None
Notice of Hearing
Natural Resources
Fish, Game, etc., Chs.
NR 1—
NOTICE IS HEREBY GIVEN that pursuant to ss.
23.09 (2) (intro.),
23.091,
23.11 (1),
23.22 (2) (a) and
(b) 6.,
27.01 (2) (j),
29.014 (1),
29.041,
29.039 (1),
29.509 (4) and
(5),
227.11 (2) (a) and
227.24 (1) (a), Stats., interpreting ss.
23.09 (2) (intro.),
23.22 (2) (a),
29.014 (1),
29.039 (1),
29.041 and
227.11 (2) (a), Stats., the Department of Natural Resources will hold a public hearing on Natural Resources Board Emergency Order No. FH-40-07A(E) which took effect on April 4, 2008.
Hearing Information
NOTICE IS HEREBY FURTHER GIVEN that the hearing will be held on:
May 12, 2008
Monday
11:00 a.m.
|
Room 405
GEF #2 State Office Building
101 South Webster Street
Madison
|
NOTICE IS HEREBY FURTHER GIVEN that pursuant to the Americans with Disabilities Act, reasonable accommodations, including the provision of informational material in an alternative format, will be provided for qualified individuals with disabilities upon request. Please call Bill Horns at (608) 266-8782 with specific information on your request at least 10 days before the date of the hearing.
Submission of Comments and Copies of Rule
The emergency rule and fiscal estimate may be reviewed and comments electronically submitted at the following Internet site:
http://adminrules.wisconsin.gov.
Written comments on the proposed rule may be submitted via U.S. mail to Mr. Bill Horns, Bureau of Fisheries Management and Habitat Protection, P.O. Box 7921, Madison, WI 53707. Comments may be submitted until May 16, 2008. Written comments whether submitted electronically or by U.S. mail will have the same weight and effect as oral statements presented at the public hearings. A personal copy of the proposed rule and fiscal estimate may be obtained from Mr. Horns.
Analysis Prepared by the Dept. of Natural Resources
FH-40-07A(E) revises chs.
NR 19 and
20, Wis. Adm. Code, pertaining to control of fish diseases and invasive species, as affected by Natural Resources Board Emergency Order No. FH-40-07(E), which took effect on November 2, 2007. FH-40-07A(E) deals with viral hemorrhagic septicemia (VHS) virus, which is present in Wisconsin waters.
FH-40-07A(E) will:
1. Allow anglers to retain minnows after a fishing trip if the minnows were obtained from a Wisconsin bait dealer and have not been exposed to the water or fish of the lake or stream, or the minnows were obtained from a Wisconsin bait dealer and will subsequently be used for bait only on that same water body.
2. Allow up to 2 gallons of water in a container holding those minnows to be transported away from the water body.
3. Prohibit the harvest of minnows (except suckers) from any water body where the Department has reason to believe that the VHS virus may be present (as identified by the Department).
4. Allow suckers to be harvested from those waters, but not be transported alive away from those waters.
Notice of Hearing
Transportation
NOTICE IS HEREBY GIVEN that pursuant to ss.
85.15 (1),
218.0152 and
227.11, Stats., interpreting Subchapter 1 of Chapter
218, Stats., the Department of Transportation will hold a public hearing to consider the amendment of chs.
Trans 137,
138 and
139, Wis. Adm. Code, relating to motor vehicle dealer franchise operations, record keeping and trade practices.
Hearing Information
May 13, 2008
10:00 a.m.
|
Hill Farms State Transportation Bldg.
Room 254
4802 Sheboygan Avenue
Madison, WI
|
An interpreter for the hearing impaired will be available on request for this hearing. Please make reservations for a hearing interpreter at least 10 days prior to the hearing.
Parking for persons with disabilities and an accessible entrance are available.
Agency Contact Person, Submission of Written Comments, Copies of Proposed Rule
The public record on this proposed rule making will be held open until close of business the day of the hearing to permit the submission of comments in lieu of public hearing testimony or comments supplementing testimony offered at the hearing. Any such comments should be submitted to Carson Frazier, Department of Transportation, Bureau of Vehicle Services, Room 255, P. O. Box 7911, Madison, WI 53707-7911. You may also contact Ms. Frazier by phone at (608) 266-7857 or via e-mail at:
carson.frazier@dot.state. wi.us.
Analysis Prepared by the Department of Transportation
Statutes interpreted
Subchapter 1 of Chapter
218, Stats.
Statutory authority
Explanation of agency authority
The Wisconsin Department of Transportation is authorized to license and regulate motor vehicle dealers and their trade practices. This rule making controls motor vehicle dealer trade practices, record keeping, and relevant definitions.
Related statute or rule
Plain language analysis
This rule amendment makes several additions to chs.
Trans 137,
138 and
139, regarding motor vehicle dealer requirements under Chapter
218, Wis. Stats. The rule additions clarify several authorized and prohibited actions by dealers, most of which the Department has previously clarified in policy.
1. Explicitly define in chs.
Trans 137,
138 and
139 a “title" as a title in s.
342.10, Stats. While common understanding of the term has long prevailed, this will make the meaning clear.
2. Create a definition in ch.
Trans 139 of “bird dogging," i.e., referral selling, and explicitly prohibit this practice. While this practice is prohibited in statute, which governs dealer behavior, DOT believes it would be appropriate to repeat the statutory prohibition in rule and elaborate on statutory definition.
3. In ch.
Trans 138, clearly allow multi-location dealership records to be kept at a single location, with proper availability for inspection. This is implicit in rule reference to a dealership, and is currently allowed by DMV policy, but it would appropriate to state explicitly, and to clarify what constitutes a single dealership with multiple locations as opposed to separate dealerships.
4. Amend the ch.
Trans 137 definition of “used motor vehicle" to include rental or leased vehicles with 4,000 or fewer miles that have been damaged. The current definition effectively treats these vehicles as “new" for the purpose of needing a franchise to sell the vehicles.
