Julie E. Walsh
The deadline for submitting comments is 4:00 p.m. on the 10th 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, Public Information and Communications, OCI, at:
inger.williams@wisconsin.gov, (608) 264-8110, 125 South Webster Street — 2
nd Floor, Madison WI or 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 statutes all relate to the commissioner's authority to promulgate rules regulating the business of insurance as it relates to disability insurance products. Specifically, s.
632.895 (12m) (f), Wis. Stats., requires the commissioner to define “intensive-level services," “nonintensive-level services," “paraprofessional," and “qualified" for purposes of providing services under this subsection. The statute further authorizes that the commissioner may promulgate rules governing the interpretation or administration of this subsection.
Related statutes or rules
There are no other statutes or rules that mandate services for autism spectrum disorders. This rule creates a new section to implement the newly created mandate pursuant to
2009 Wis. Act 28.
Plain language analysis and summary of the proposed rule
Under
2009 Wisconsin Act 28, the Commissioner is required pursuant to s.
632.895 (12m), Stats., to define four terms: intensive level services, non-intensive level services, qualified, and paraprofessionals; and may draft rules that relate to the interpretation or administration of section.
To ensure clear understanding of current provider qualifications and treatment options for autism spectrum disorders, the Commissioner established the Autism Working Group. The work group was charged with advising the Commissioner on definitions for the four required terms and making recommendations on how the statute should be implemented. The group was composed of parents, providers, insurers, legislators and advocates. Administrators of the Waiver program at the Department of Health Services also participated. The group met every other week beginning June 23rd, 2009 until September 10th, 2009 and continues meeting on a quarterly basis.
The Waiver program was used as a baseline to discuss the implementation of the new mandate. Current literature on autism spectrum disorders and information from other states was presented to the working for review and consideration. Because the research and literature in the realm of autism treatments is rapidly evolving, the working group recommended defining “evidence-based" and “behavioral" rather than creating a list of approved therapies that could readily become outdated.
The proposed rule includes definitions of intensive level evidence-based behavioral therapy and non-intensive level evidence-based therapy. Based upon current research, the rule limits intensive level services to children aged 2 to 9 as this period of time has shown to be the optimum time for gains for individuals diagnosed with autism spectrum disorders. Building from the Waiver program, the working group developed a comprehensive regulation.
The proposed rule contains criteria necessary for one to be considered a qualified provider, qualified professional, qualified therapist and qualified paraprofessional. The criteria include a combination of educational, professional and specific training with individuals diagnosed with autism spectrum disorders and, for qualified paraprofessionals, specific requirements for supervised implementation of a treatment plan for the insured. The rule includes provisions to permit individuals who are currently providing services through the department's Waiver program to be deemed qualified for up to two years and to permit insurers and self-funded plans to contract with these individuals who are experienced but may not meet the “qualified" requirements. The proposed rule differentiates between treatment providers for intensive versus nonintensive-level services. For a psychiatrist, psychologist, social worker certified or licensed to practice psychotherapy or a professional working under the supervision of an outpatient mental health clinic to be considered qualified to provide intensive-level services, the rule delineates a combination of education, training and experience with individuals diagnosed with autism spectrum disorders.
A current, valid state-issued license or certificate is necessary in order for a psychiatrist, psychologist, social worker certified or licensed to practice psychotherapy, speech pathologist, or occupational therapist to be qualified to provide nonintensive-level services or to implement an intensive-level treatment plan. For a person who is a qualified professional working under the supervision of an outpatient mental health clinic, the clinic must be certified under s.
51.038, Stats., in order for the professional to provide nonintensive-level services or to implement an intensive-level treatment plan.
The proposed rule also establishes requirements for paraprofessionals, individuals who may only provide services while working under the supervision of a psychiatrist, psychologist or social worker certified or licensed to practice psychotherapy.
The rule also handles several administrative concerns. It allows insurers to deny claims they believe to be fraudulent, exclude travel time from the required hours of treatment and allocated dollars for treatment and permits dispute resolution through independent review organizations.
Comparison with federal regulations
Autism Treatment Acceleration Act of 2009 (S. 819, H.R. 2413) was proposed in May. If passed, Section 12 will require all insurance companies to provide coverage for evidence-based, medically-necessary autism treatments and therapies. A comparison of final federal requirements and state law and regulation will be reviewed if this act is passed.
Additionally, the ``Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008'' (
29 U.S.C. 1185a), requires group health plans that offer both medical and surgical benefits and mental health or substance use disorder benefits to ensure financial and treatment limitations are no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan. Further, the federal law does not permit separate cost-sharing requirements that are applicable only with respect to mental health or substance-use disorder benefits.
The federal government issued interim final rules implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) on February 5, 2010. Although the interim rules do not specifically define what constitutes a mental health condition, the newly issued rules provide some guidance to states and insurers. The MHPAEA rules are first effective July 1, 2010 to newly-issued plans or upon the renewal, extension or modification on or after July 1, 2010. The MHPAEA rules require mental health benefits to be defined within the plan by the issuer in accordance with federal and state law and consistent with generally recognized independent standards of current medical practice including the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM, most current version IV, contains diagnostic criteria for “autistic disorder." Although there is no direct federal guidance that autism spectrum disorders are subject to federal parity requirements, it is the position of the Commissioner that parity for autism services does apply to group health plans with more than 50 employees based upon preliminary review of the regulations.
Wisconsin's law is broader than the federal law, as it mandates inclusion of mental health, alcohol and other substance abuse benefits. Further, Wisconsin's autism treatment mandate applies to individual, small employer and governmental self-funded health plans in addition to group health plans with more 50 employees. The individual, small employer and governmental self-funded plans will remain subject to these mandates as they are not regulated by the federal government.
Comparison of similar rules in adjacent states
Illinois:
Public Act 95-1005 requires private insurers cover autism benefits for children under 21 years of age. No rule-making accompanied this law, however, the statute does include Applied Behavioral Analysis, intervention, and modification as a part of the covered behavioral treatments. The law is subject to pre-existing condition limitations. It is also subject to denials based on medical necessity.
Iowa:
A Bill, SF 1, was introduced in the Iowa legislature this year but did not pass. There are no other similar laws or rules in Iowa.
Michigan:
Two bills, HB 4183 and 4176, requiring autism coverage, have passed the Michigan House; however, they are not expected to reach a vote this year. There are no other similar laws or rules in Michigan.
Minnesota:
Section 62A.3094 was enacted and became effective August 1, 2009. The mandate requires coverage for the diagnosis, evaluation, assessment and medically necessary care for autism spectrum disorders including intensive evidence-based behavior therapy, behavior services, speech therapy, occupational therapy, physical therapy and medications.
Summary of factual data and analytical methodologies
The Commissioner created an advisory Autism Working Group to assist in the development of workable definitions of “intensive" and “nonintensive" level services; “qualified" providers and “paraprofessionals." The advisory working group was comprised of providers, insurers, advocates, parents of autistic children and representatives from the Department of Health Services familiar with the Medicaid Waiver program for autism services. The working group met seven times between June 23 and September 10, 2009, and continues to meet quarterly. This proposed rule reflects the advisory working group's recommendations.
Analysis and supporting documentation used to determine rule's effect on small businesses
There are no insurers offering disability insurance or state or local governmental self-funded entities that meet the definition of a small business.
Small Business Impact
This rule will have little or no effect on small businesses and does not impose any additional requirements on small businesses.
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
This rule change will have no significant effect on the private sector regulated by OCI.
There will be no state or local government fiscal effect
Agency Contact Person
Inger Williams, OCI Services Section
Address: 125 South Webster Street, 2nd Floor
Madison WI 53703-3474
Mail: PO Box 7873
Madison, WI 53707-7873
Phone: (608) 264-8110
Notice of Hearing
Natural Resources
Fish, Game, etc., Chs.
NR 1—
(DNR # WM-02-10)
NOTICE IS HEREBY GIVEN that pursuant to ss.
29.011,
29.014,
29.024,
29.03,
29.053(3),
29.192,
29.193,
29.885,
169.21,
169.39 and
227.11, Stats., the Department of Natural Resources will hold a public hearing to consider revisions to Chapters
NR 8,
10,
12 and
17, Wis. Adm. Code relating to license and permit procedures, game and hunting, wildlife damage and nuisance control and dog trials and training.
Hearing Information
Date and Time: Location:
June 7, 2010 Natural Resources State Office Bldg.
Monday Room 613
at 2:00 PM 101 S. Webster Street
Madison, WI
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 Scott Loomans at (608) 267-2452 with specific information on your request at least 10 days before the date of the scheduled hearing.
Copies of Proposed Rule and Submittal of Written Comments
The proposed 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. Scott Loomans, Bureau of Wildlife Management, P.O. Box 7921, Madison, WI 53707. Comments may be submitted until
June 8, 2010. 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. Loomans.
Analysis Prepared by Department of Natural Resources
Statutory authority
Sections
29.011,
29.014,
29.024,
29.03,
29.053(3),
29.192,
29.193,
29.885,
169.21,
169.39 and
227.11, Stats.
Statutes interpreted
Sections
29.011,
29.014,
29.024,
29.03,
29.053(3),
29.192,
29.193,
29.324,
29.592,
29.885,
169.21,
169.39 and
227.11, Stats.
Plain language rule analysis
The intent of these rule changes is to correct drafting errors, provide clarification to existing rules, simplify regulations, and update administrative code language and references. Policy issues affected by this rule are ones which have already been addressed by previous rulemaking. The proposed rules will:
1. Allow customers to request free hard copies of turkey, pheasant, trout, waterfowl or salmon stamps through the phone, a designated county clerk's office, or any department office that provides counter service.
2. Update agency contact information and requirements for administration of the Wildlife Violator Compact Program.
3. Clarify that a person who may only hunt with a mentor, and the mentor with whom they are hunting, can group hunt for deer even though they are only allowed to possess or control one firearm jointly. The season must be open for both hunters, they must be hunting within arms reach of one another, and both must possess the proper licenses and permits. This is consistent with s.
29.324, Stats., related to group hunting and simplifies the explanation of how this law applies during a mentored hunt.
4. Eliminate extraneous deer hunting season language and add a cross reference to update language following the 2006 sunset of a two-year experiment with seasons that did not include October antlerless only deer hunts.
5. Eliminate the description of where hunting is allowed at Big Bay state park because it is unnecessary and the only state park for which such language is established in code.
6. Update a cross reference related to the hours when hunting is allowed.
7. Clarify that in addition to .410 shotguns, it is also illegal to hunt deer, bear or elk with handguns which fire .410 shotgun slugs.
8. Update cross references related to deer registration and deer carcass tags in the CWD zone.
9. Clarify that enforcement action can be taken against a person who fails to report bobcat harvest as required.
10. Repeal a redundant, unnecessary prohibition on hunting from a roadway specifically for wild turkeys.
11. Clarify that when the assistant to a disabled hunter uses a firearm to aid in retrieval of a deer or turkey that has been shot by the disabled hunter, the assistant needs to possess a deer hunting license or any license that authorizes hunting when retrieving a turkey.
12. Clarify that disabled hunters participating in special hunts may tag a deer of either sex with their gun buck carcass tag and additional antlerless deer if they possess valid tags for that unit.
13. Move a provision to a more proper location in order to simplify code language about the removal of nuisance animals.
14. Clarify that a federal permit for the removal of certain nuisance animals can serve as the state permit in order to reduce paperwork. The state could still review permits.
15. Clarify that deer may be shot under the authority of nuisance permits on the day before the opening of nine day gun season in the CWD Management Zone where other firearm hunting is also allowed on that day. Outside the CWD Management Zone, hunting with firearms for species other than waterfowl would continue to be prohibited.
