STATE OF WISCONSIN
DEPARTMENT OF ADMINISTRATION
DOA-2049 (R03/2012)
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Division of Executive Budget and Finance
101 East Wilson Street, 10th Floor
P.O. Box 7864
Madison, WI 53707-7864
FAX: (608) 267-0372
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ADMINISTRATIVE RULES
Fiscal Estimate & Economic Impact Analysis
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1. Type of Estimate and Analysis
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X Original
⍽ Updated
⍽ Corrected
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2. Administrative Rule Chapter, Title and Number
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DHS 115, Screening of Newborns for Congenital and Metabolic Disorders
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3. Subject
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Newborn screening for congenital and metabolic disorders (to add Critical Congenital Heart Disease (CCHD) and Organic Acidemia (OA) as conditions for which newborns must be tested)
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4. Fund Sources Affected
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5. Chapter 20, Stats. Appropriations Affected
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⍽ GPR
⍽ FED
⍽ PRO
⍽ PRS
⍽ SEG
⍽ SEG-S
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6. Fiscal Effect of Implementing the Rule
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X No Fiscal Effect
⍽ Indeterminate
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⍽ Increase Existing Revenues
⍽ Decrease Existing Revenues
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⍽ Increase Costs
⍽ Could Absorb Within Agency's Budget
⍽ Decrease Cost
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7. The Rule Will Impact the Following (Check All That Apply)
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⍽ State's Economy
⍽ Local Government Units
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⍽ Specific Businesses/Sectors
⍽ Public Utility Rate Payers
⍽ Small Businesses (if checked, complete Attachment A)
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8. Would Implementation and Compliance Costs Be Greater Than $20 million?
⍽ Yes X No
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9. Policy Problem Addressed by the Rule
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As provided in s. 253.13 (1), Stats. (2011-12), ch. DHS 115 specifies the congenital and metabolic orders for which newborns must be screened by means of a blood sample shortly after birth and tested by the Wisconsin State Laboratory of Hygiene (WSLH). 2013 Wisconsin Act 135 modified s. 253.13 (1) Stats., relating to infant blood tests to provide that the required screening may be performed by methods in addition to blood testing. Under the emergency order, the department revises ch. DHS 115 to conform the rules to s. 253.13, Stats., and adds CCHD and OA as conditions for which newborns must be tested.
CCHD is usually described as those congenital cardiac malformations in which surgical or catheter-based therapy is necessary within the first months of life, and is screened for by use of pulse oximetry. In September 2010, the federal Department of Health and Human Services' Discretionary Advisory Committee on Heritable Disorders in Newborns and Children added CCHD to its Recommended Uniform Screening Panel Core Conditions. To date, 35 states have added CCHD screening to their newborn screening panel.
Adding OA as a condition for testing corrects an inadvertent omission from the list of congenital and metabolic disorders. OA is a group of inherited disorders that lead to an abnormal buildup of particular acids known as organic acids in the body for which the WSLH currently tests newborns. Though OA met the criteria under s. DHS 115.06 for being added to the list of congenital and metabolic disorders for which WSLH must test blood samples, the disorders were not included in subsequent revisions of s. DHS 115.04.
The department does not anticipate that the revisions to ch. DHS 115 will have a fiscal impact on the department or local government.
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10. Summary of the businesses, business sectors, associations representing business, local governmental units, and individuals that may be affected by the proposed rule that were contacted for comments.
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Pursuant to s. 227.137 (5), Stats., the information required under this section does not apply to emergency rules.
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11. Identify the local governmental units that participated in the development of this EIA.
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Pursuant to s. 227.137 (5), Stats., the information required under this section does not apply to emergency rules.
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12. Summary of Rule's Economic and Fiscal Impact on Specific Businesses, Business Sectors, Public Utility Rate Payers, Local Governmental Units and the State's Economy as a Whole (Include Implementation and Compliance Costs Expected to be Incurred)
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Pursuant to s. 227.137 (5), Stats., the information required under this section does not apply to emergency rules.
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13. Benefits of Implementing the Rule and Alternative(s) to Implementing the Rule
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Section 253.13 (1), Stats., requires that every infant born in each hospital or maternity home, prior to its discharge, be tested for congenital and metabolic disorders, as specified in rules promulgated by the department. Therefore, there are no reasonable alternatives to the proposed rulemaking.
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14. Long Range Implications of Implementing the Rule
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Indeterminate
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15. Compare With Approaches Being Used by Federal Government
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Pursuant to s. 227.137 (5), Stats., the information required under this section does not apply to emergency rules.
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16. Compare With Approaches Being Used by Neighboring States (Illinois, Iowa, Michigan and Minnesota)
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Pursuant to s. 227.137 (5), Stats., the information required under this section does not apply to emergency rules.
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17. Contact Name
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18. Contact Phone Number
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Susan Uttech
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608-267-3561
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STATE OF WISCONSIN
DEPARTMENT OF ADMINISTRATION
DOA-2049 (C04/2011)
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Division of Executive Budget and Finance
101 East Wilson Street, 10th Floor
P.O. Box 7864
Madison, WI 53707-7864
FAX: (608) 267-0372
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ADMINISTRATIVE RULES – FISCAL ESTIMATE
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1. Fiscal Estimate Version
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X Original ⍽ Updated ⍽ Corrected
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2. Administrative Rule Chapter Title and Number
INS 1728
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3. Subject
Injured Patients and Families Compensation Fund Annual fund and Mediation Panel Fees for the fiscal year beginning July 1, 2014 and affecting small business
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4. State Fiscal Effect:
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X No Fiscal Effect
⍽ Indeterminate
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⍽ Increase Existing Revenues
⍽ Decrease Existing Revenues
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⍽ Increase Costs
⍽ Yes ⍽ No May be possible to absorb
within agency's budget.
X Decrease Costs
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5. Fund Sources Affected:
⍽ GPR ⍽ FED ⍽ PRO ⍽ PRS X
SEG ⍽ SEG-S
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6. Affected Ch. 20, Stats. Appropriations:
None
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7. Local Government Fiscal Effect:
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X No Fiscal Effect
⍽ Indeterminate
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⍽ Increase Revenues
⍽ Decrease Revenues
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⍽ Increase Costs
⍽ Decrease Costs
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8. Local Government Units Affected:
⍽ Towns
⍽ Villages ⍽ Cities
⍽ Counties ⍽ School Districts ⍽ WTCS Districts ⍽Others: None
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9. Private Sector Fiscal Effect (small businesses only):
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X No Fiscal Effect
⍽ Indeterminate
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⍽ Increase Revenues
⍽ Decrease Revenues
⍽ Yes X No May have significant
economic impact on a
substantial number of
small businesses
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⍽ Increase Costs
⍽ Yes ⍽ No May have significant
economic impact on a
substantial number of
small businesses
X Decrease Costs
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10. Types of Small Businesses Affected:
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Small businesses that employ physicians or other health care professionals participating in the Fund.
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11. Fiscal Analysis Summary
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No significant impact. For Fund fees a 10% decrease and although the rule proposes an increase from zero for mediation panel fees, the proposed fees are less than the 2011-2012 fees.
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12. Long-Range Fiscal Implications
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None
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13. Name — Prepared by
Julie E. Walsh
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Telephone Number
(608) 264-8101
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Date
May 9, 2014
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14. Name – Analyst Reviewer
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Telephone Number
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Date
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Signature—Secretary or Designee
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Telephone Number
(608) 267-3782
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Date
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STATE OF WISCONSIN
DEPARTMENT OF ADMINISTRATION
DOA-2049 (R03/2012)
|
Division of Executive Budget and Finance
101 East Wilson Street, 10th Floor
P.O. Box 7864
Madison, WI 53707-7864
FAX: (608) 267-0372
|
ADMINISTRATIVE RULES
Fiscal Estimate & Economic Impact Analysis
|
1. Type of Estimate and Analysis
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X Original
⍽ Updated
⍽ Corrected
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2. Administrative Rule Chapter, Title and Number
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Agency 145 Ch Ins 17.01 (3), and 17.28 (6)
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3. Subject
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Injured Patients and Families Compensation Fund Annual Fund fees and Mediation Panel Fees for the fiscal year beginning July 1, 2014.
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4. Fund Sources Affected
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5. Chapter 20, Stats. Appropriations Affected
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⍽ GPR
⍽ FED ⍽ PRO ⍽ PRS
X SEG ⍽ SEG-S
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None
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6. Fiscal Effect of Implementing the Rule
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X No Fiscal Effect
⍽ Indeterminate
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⍽ Increase Existing Revenues
⍽ Decrease Existing Revenues
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⍽ Increase Costs
⍽ Could Absorb Within Agency's Budget
⍽ Decrease Cost
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7. The Rule Will Impact the Following (Check All That Apply)
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⍽ State's Economy
⍽ Local Government Units
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X Specific Businesses/Sectors
⍽ Public Utility Rate Payers
X Small Businesses (if checked, complete Attachment A)
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8. Would Implementation and Compliance Costs Be Greater Than $20 million?
⍽ Yes
X No
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9. Policy Problem Addressed by the Rule
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To establish the annual fees that participating health care providers must pay to the Injured Patients and Families Compensation Fund ("Fund") as required by s. 655.27 (3), Wis. Stats., for fiscal year beginning July 1, 2014. The proposed rule will also establish the mediation panel fees for fiscal year 2015 commencing on July 1, 2014. This rule provides the Fund with appropriate and adequate funding and solvency for future years. This is the main vehicle for achieving and maintaining the Fund's solvency.
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10. Summary of the businesses, business sectors, associations representing business, local governmental units, and individuals that may be affected by the proposed rule that were contacted for comments.
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OCI solicited comments generally through publication requesting comments from the public utilizing the OCI website. Additionally OCI solicited comments from businesses, individuals, and local government units related to the implementation and compliance costs. Solicitations were sent to health insurance members of OCI's Health and Life Insurance Advisory Council and interested parties. Members included health insurance companies, health insurance agent representatives, consumer representatives, provider representatives and representatives of small business. Additional solicitations were made to associations representing various affected parties and local government representatives including:
• Wisconsin Association of Health Plans
• Wisconsin Association of Health Underwriters
• Independent Insurance Agents Association of Wisconsin
• National Federation of Independent Business-Wisconsin
• Wisconsin Association of Nurse Anesthetists
• Wisconsin Manufacturers and Commerce
• Wisconsin Dental Association
• Wisconsin Medical Society
• Professional Insurance Agents of Wisconsin
• National Association of Insurance and Financial Advisors-Wisconsin
• Wisconsin Hospital Association
• Wisconsin Association for Justice
• The League of Wisconsin Municipalities
• Wisconsin Counties Association
• Wisconsin Towns Association
• Wisconsin Association of School Boards
• Wisconsin Association of School District Administrators
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11. Identify the local governmental units that participated in the development of this EIA.
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None beyond solicitation for comments.
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12. Summary of Rule's Economic and Fiscal Impact on Specific Businesses, Business Sectors, Public Utility Rate Payers, Local Governmental Units and the State's Economy as a Whole (Include Implementation and Compliance Costs Expected to be Incurred)
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All health care provider participants in the Fund as set forth in s. 655.002 (1), Wis. Stat., will be required to pay a 10% reduced assessment for their medical malpractice coverage under Ch.655, Wis. Stat. The impact is considered to be minimal and in fact positive to the participants. In addition there is a fee this fiscal year for mediation panel fees so while greater than fiscal year 2013-2014 fees of zero, the fees are lower than the fees for fiscal year 2011-2012.
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13. Benefits of Implementing the Rule and Alternative(s) to Implementing the Rule
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The proposed rule will benefit Fund participants by ensuring that fee revenue is adequate to cover anticipated administrative, operating and claims payments costs. The alternatives to this rule would be to establish a Fund fee increase, to maintain current fee amounts or to assess fees lower than the proposed 10% reduction in Fund fees. A greater reduction in fees would leave the Fund with inadequate funding to cover actuarially-based projected costs, while a fee increase or static fee level would present an unnecessary cost to Fund participants. The proposed rule does not significantly impact Wisconsin's economy, productivity, jobs or the overall economic competitiveness of Wisconsin. Wisconsin's health care marketplace is strengthened with an affordable layer of medical malpractice coverage. The Fund has existed in Wisconsin since 1975. Fund participants will benefit from a stable and solvent fund. Additionally, Fund participants should not experience increased compliance costs with the reduction of fund fees even with inclusion this year of mediation panel fees.
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14. Long Range Implications of Implementing the Rule
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The long-range implication of the rule as proposed will be an adequately funded and solvent Fund.
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15. Compare With Approaches Being Used by Federal Government
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Federal government does not address this subject matter.
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16. Compare With Approaches Being Used by Neighboring States (Illinois, Iowa, Michigan and Minnesota)
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None of the neighboring states have a patient compensation fund or a general program of state-sponsored liability insurance for physicians.
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17. Contact Name
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18. Contact Phone Number
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Louie Cornelius
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608-264-8113
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ATTACHMENT A
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1. Summary of Rule's Economic and Fiscal Impact on Small Businesses (Separately for each Small Business Sector, Include Implementation and Compliance Costs Expected to be Incurred)
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The agency does not anticipate any implementation costs or additional compliance costs for fund participants. All health care provider participants in the Fund as set forth in s. 655.002 (1), Wis. Stat., will be required to pay the reduced assessment for their medical malpractice coverage under Ch. 655, Wis. Stat. In addition there is a fee this fiscal year for mediation panel fees however, while the fees are greater than fiscal year 2013-2014 fees of zero, the fees are lower than the fees for fiscal year 2011-2012.
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2. Summary of the data sources used to measure the Rule's impact on Small Businesses
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The Fund contracts for actuarial services to develop the documentation and analysis necessary for the Actuarial and Underwriting Committee of the Fund. The documentation includes an actuarially indicated rate level for break even financial projections against expected claims reflective of all physician classifications. Since some physicians are small employer practices this information does relay information to the Committee and Board for the impact on small businesses directly impacted by the proposal. The actuarial firm presents its analysis to the Actuarial and Underwriting Committee of the Fund Board of Governors. The Committee reviews all documentation and projections and makes a recommendation to the full Board of Governors for consideration. The Fund Board of Governors reviewed the Committee's recommendation at its December 18, 2013 meeting as well as the underlying analysis by the actuarial firm. Following deliberation, the Board of Governors affirmed the Committee's recommendation of a decrease of 10% for Fund fees and at the March 19, 2014 meeting affirmed the change to the mediation panel fees from last year's fees of zero to $7.75 for physicians and $1.50 per occupied bed for hospitals.
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3. Did the agency consider the following methods to reduce the impact of the Rule on Small Businesses?
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⍽ Less Stringent Compliance or Reporting Requirements
⍽ Less Stringent Schedules or Deadlines for Compliance or Reporting
⍽ Consolidation or Simplification of Reporting Requirements
⍽ Establishment of performance standards in lieu of Design or Operational Standards
⍽ Exemption of Small Businesses from some or all requirements
X Other, describe:
The Board of Governors discussed maintaining fees at 2014 levels but determined that such action was unnecessary in light of the Fund's present financial condition and the reduced fees would adequately fund the Fund for claims incurred during fiscal year 2015 without shifting the burden of funding to future years and providers.
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4. Describe the methods incorporated into the Rule that will reduce its impact on Small Businesses
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The proposed increase is below breakeven financing for the Fund but sufficient to cover anticipated claims, administrative and operating expenses.
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5. Describe the Rule's Enforcement Provisions
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This rule proposes fees. Failure to pay Fund fees is governed by s. Ins 17.01, Wis. Adm. Code, which requires the Fund to notify the medical examining board of each physician who has not paid the fee and notify the Department of Health Services of each hospital that has not paid the fee as required.
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6. Did the Agency prepare a Cost Benefit Analysis (if Yes, attach to form)
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⍽ Yes X No
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