Summary of Final Regulatory Flexibility Analysis:
This proposed rule is not expected to affect small businesses, except those engaged in the provision of interlock services to the public.
In accordance with the requirements of s. 227.19 (3) (e), Stats., the Department provides the following analysis of the administrative rule:
1. The methods suggested in s. 227.114 (2), Stats., for reducing the impact of a regulation upon a small business will not be useful in this situation. The small businesses affected require the government to supply them with clientele, and this proposed regulation may decrease the number of drivers who are required to obtain ignition interlock devices (IID's) as a condition of obtaining an occupational license. The potential impact on these businesses results not from cost of compliance with government regulations, but from potential change in demand for their product.
2. Representatives of National Interlock Service suggested at hearing that the Department require all drivers convicted of second or greater offense OWI to obtain IID's as a condition of occupational licensing. The Department believes s. 343.10 (5) (a) 3., Stats., grants the Department discretionary authority to impose the requirement on some, but not all such drivers. No other alternatives were suggested. The Department did, however, expand the scope of situations where it would order the use of ignition interlocks by repeat drunk drivers to include all situations in which a court recommends or orders imposition of the requirement.
3. No reports are required of small businesses under this rule.
4. No measures or investments are required of small businesses to comply with this rule.
5. The methods suggested by s. 227.114 (2), Stats., are inapplicable in this instance and therefore providing a cost analysis of using those methods is not possible.
6. The methods suggested by s. 227.114 (2), Stats., are inapplicable in this instance and therefore providing a public health, safety and welfare impact analysis is not possible.
Summary of Comments:
No comments were reported.
S. VE 4.01 (3) - Evidence that would be required in order to obtain a veterinary license of a candidate who is not a graduate of a school that has been approved by the Board.
Summary of Final Regulatory Flexibility Analysis:
These proposed rules will have no significant economic impact on small businesses, as defined in s. 227.114 (1) (a), Stats.
Summary of Comments:
No comments were reported.
Ch. DWD 58 - Child care quality standards and grants.
Summary of Final Regulatory Flexibility Analysis:
No effect on small business.
Summary of Comments of Legislative Standing Committees:
No comments were reported.
16.
Workforce Development
(CR 96-7)
SS. ILHR 100.02 and 132.001 and ch. ILHR 140 - Unemployment insurance appeals.
Summary of Final Regulatory Flexibility Analysis:
Rule changes have no new compliance requirements on small business. Small business did not raise any issues or submit any comments. No additional costs, new measures, or investments are required of small business.
Summary of Comments of Legislative Standing Committees:
No comments received.
E x e c u t i v e O r d e r s
The following is a listing of recent Executive Orders issued by the Governor.
Executive Order 312. Relating to a Proclamation that the Flag of the United States and the Flag of the State of Wisconsin be Flown at Half-Staff on Memorial Day.
Public Notices
Public Notice
Health and Family Services
(Medical Assistance Reimbursement of Hospitals)
The State of Wisconsin reimburses hospitals for medical services provided to low-income persons under the authority of Title XIX of the Federal Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. Medicaid or Medical Assistance (MA) is administered by the State's Department of Health and Family Services. Federal statutes and regulations require state plans, one for outpatient services and one for inpatient services, which provide the methods and standards for paying for hospital outpatient and inpatient services.
State plans are now in effect for the reimbursement of outpatient hospital services and inpatient hospital services. The Department is proposing to make several changes in these plans effective July 1, 1997. Many of these changes are included in the proposed 1997-1999 state budget. After enactment of the state budget for 1997-1999, certain of these proposed changes will be modified if necessary to effectuate the mandates included in the budget act.
Proposed changes in the state plan for reimbursement for outpatient hospital services are the following:
1. Adjustment of the percentages by which base year outpatient costs are increased for the July 1997 through June 1999 biennium to implement the payment adjustments included in the 1997-1999 budget act.
2. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds.
3. Modification of supplemental payments to essential access city hospitals (EACH) to maintain compliance with federal payments limits.
4. For the indigent care allowance, adjustment of the maximum available funding, modification of the criteria for a hospital to qualify for an allowance, and modification of the methodology for distributing the available funding to qualifying hospitals in order to carry out mandates of s. 49.45 (6y), Wisconsin Statutes, and to maintain compliance with federal payment limits.
Proposed changes in the state plan for reimbursement for inpatient hospital services are the following:
1. For the payment system which is based on diagnosis-related groups (DRGs), adjustment of DRG weighting factors, standard DRG-base rates, area wage indices, and capital and medical education payments to implement the average rate adjustment provided by the 1997-1999 budget act.
2. Adjustment of payment rates and payment maximums for AIDS treatment, ventilator care and brain injury treatment to implement the average rate adjustment included in the 1997-1999 budget act.
3. If mandated under the 1997-1999 budget act, establishment of a supplemental payment to only those hospitals which provide a significant amount of inpatient pediatric services.
4. Adjusting capital payment which is currently paid at 85% of capital costs to 95% of capital costs, or some other percentage, as may be mandated under the 1997-1999 budget act.
5. Modification of the methodology for establishing payment rates for mental health hospitals owned and operated by the State to implement mandates that may be provided under the 1997-1999 budget act.
6. For hospitals paid under the DRG-based payment system, conversion of the monthly payment rate for capital costs and direct medical education costs to a rate of payment per hospital stay. Such a rate per stay will more specifically pay for the current volume of hospital stays for which the Department directly pays a fee to hospitals for the services provided. With increasing numbers of hospital stays expected to be paid by managed care organizations (HMOs) under contract with the Department, the Department will be paying hospitals directly for significantly fewer stays. The monthly payment rate cannot be reliably adjusted to reflect the decrease in the number of stays for which the Department will directly pay a specific hospital. This change is necessary to ensure a more reliable level of payment for capital and direct medical education and to ensure that the Department's direct fee for service payments to hospitals does not exceed available funding included in the 1997-1999 budget act.
7. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds.
8. Updating the disproportionate share adjustment parameters to recognize the more current proportion of services provided by hospitals to Medicaid recipients.
9. Modification of the funding limit, the qualifying criteria and the methodology for determining supplemental payments to essential access city hospitals (EACH) to maintain compliance with federal payments limits and as may be mandated under the 1997-1999 budget act.
10. For rehabilitation hospitals which change ownership, modification of provisions identifying which fiscal year cost reports are to be used for setting rates to ensure that sufficient updated payment rates can be established for such hospitals.
11. Modification of criteria defining combined hospitals to clarify the intent of the Department.
12. Modification of the methodology for establishing the outlier cost-to-charge ratio for major border-status hospitals so that the methodology is more like that used for payment of outlier cases at instate hospitals.
13. For the indigent care allowance, adjustment of the maximum available funding, modification of the criteria for a hospital to qualify for an allowance, and modification of the methodology for distributing the available funding to qualifying hospitals in order to carry out mandates of s. 49.45 (6y), Wisconsin Statutes, and to maintain compliance with federal payment limits.
14. For the general assistance disproportionate share supplement, adjustment of the maximum available funding, modification of the criteria for a hospital to qualify for the supplement, and modification of the methodology for distributing the available funding to qualifying hospitals in order to carry out mandates of s. 49.45 (6z), Wisconsin Statutes, and to maintain compliance with federal payment limits.
Implementation of the above changes to the state plans for inpatient hospital services and outpatient hospital services is expected to increase MA annual expenditures by $5.4 million all funds for state fiscal year 1997-1998 ($3.2 million federal financial participation and $2.2 million general purpose revenue). This amount is the combination of $13.5 million all funds of expected increases and a decrease of $8.1 million all funds in the general assistance disproportionate share supplement and the indigent care allowance (outpatient item 4 and inpatient items 13 and 14).
Copies of State Plan with Detail of Proposed Changes
The Department is incorporating the implementing details of these proposed changes into the state plan documents which describe the methods and standards for paying hospitals. Copies of the detailed proposed changes will be sent to every county social services or human services department main office where they will be available for public review on or before Friday, August 15, 1997. For copies of the detailed proposed changes or more information, interested people may telephone, fax or write:
David Bodoh
Telephone (608) 267-9589
FAX (608) 266-1096
Hospital Reimbursement Unit
Bureau of Health Care Financing
Division of Health
P.O. Box 309
Madison, WI 53701-0309
Written Comments
Written comments on the proposed changes are welcome and should be sent to David Bodoh at the above address. Comments should be submitted by Monday, September 8. Later comments may be considered. Before finalizing any state plan changes, the Department may modify its proposed changes after considering the comments. A copy of the changes will be available from the above address. The comments received on the changes will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily at:
Bureau of Health Care Financing
Room 265, State Office Building
One West Wilson Street
Madison, WI
Public Notice
Health and Family Services
