The United States Department of the Treasury, Internal Revenue Service published an interpretation of the American Recovery and Reinvestment Act of 2009 that provided a continuation election opportunity for covered employees including former employees when an employer discontinues a group health plan. The proposed rule will consider continuation coverage election options for employees that meet the requirements of s.
632.897, Stat., or s.
9126 of
2009 Wisconsin Act 11 whose employer or former employer discontinues the group health insurance policy. The proposed rule will consider election and eligibility criteria for continuation of coverage through a group policy.
Comparison with federal regulations
The United States Department of the Treasury, Internal Revenue Service published in a frequently asked question and answer format the question of continuation rights for employees and their dependents when employers discontinue a group policy and determined that eligible employees would be able to elect continuation coverage that may be eligible for premium subsidy under the American Recovery and Reinvestment Act of 2009. There is no current state rule or policy on this specific issue.
Comparison of similar rules in adjacent states
Illinois:
None.
Iowa:
None.
Michigan:
None.
Minnesota:
None.
Summary of factual data and analytical methodologies
This proposed rule would enact for Wisconsin insureds the ability to elect continuation of coverage when an employer discontinues group health insurance consistent with the Internal Revenue Service's interpretation of the American Recovery and Reinvestment Act of 2009.
Analysis and supporting documentation used to determine effect on small businesses
The rule imposes no substantial requirements on small employers but would allow discontinued employees of small employer who have group insurance the ability to elect continuation of health insurance coverage.
Small Business Impact
This rule does not impose any additional requirements on small businesses and will have little or no negative effect on them.
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
Private sector fiscal impact
This rule change will have no significant negative effect on the private sector regulated by OCI but will allow numerous people to continue group health insurance that would not be able to without this change.
State or local government fiscal impact
There will be no state or local government fiscal effect.
Long-range fiscal implications
None.
Notice of Hearing
Insurance
NOTICE IS HEREBY GIVEN that pursuant to the authority granted under s.
601.41 (3), Stats., and the procedures set forth under s.
227.18, Stats., the Office of the Commissioner of Insurance (OCI) will hold a public hearing to consider emergency rules and the adoption of proposed permanent rules creating Chapter
Ins 57, Wis. Adm. Code, relating to care management organizations and affecting small business.
Hearing Information
Date: December 3, 2009
Time: 10:00 a.m., or as soon thereafter as the
matter may be reached
Place: OCI, Room 227
125 South Webster Street, 2nd Floor
Madison, WI
Submission of Written Comments
Written comments can be mailed to:
Julie E. Walsh
Legal Unit - OCI Rule Comment for Rule Ins 57
Office of the Commissioner of Insurance
PO Box 7873
Madison WI 53707-7873
Written comments can be hand delivered to:
Julie E. Walsh
Legal Unit - OCI Rule Comment for Rule Ins 57
Office of the Commissioner of Insurance
125 South Webster St – 2nd Floor
Madison WI 53703-3474
Comments can be emailed to:
Julie E. Walsh
The deadline for submitting comments is 4:00 p.m. on the 14th day after the date for the hearing stated in this Notice of Hearing.
Copy of Proposed Rule and Contact Person
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, OCI Services Section, at:
Phone: (608) 264-8110
Address: 125 South Webster St – 2nd Floor,
Madison WI 53703-3474
Mail: PO Box 7873, Madison, WI 53707-7873
Analysis Prepared by the Office of the Commissioner of Insurance (OCI)
Statutes interpreted
Statutory authority
Explanation of agency authority
2009 Wisconsin Act 28 created chapter 648, Wis. Stat., establishing the regulation of care management organizations. The statute specifically authorizes the commissioner to promulgate rules that are necessary to carry out the intent of the statute with consultation with the department. These proposed rules are the result of numerous discussions with the department and incorporate effective regulatory tools modified appropriately for care management organizations.
Related statutes or rules
The proposed rule is consistent with and related to existing financial regulations including, chs.
Ins 9,
40 and
50, Wis. Adm. Code.
Plain language analysis and summary of the proposed rule
Ch.
648, Wis. Stats., was created to establishes financial regulation of care management organizations that provide and coordinate services for the Family Care program. Family Care is a Wisconsin Medicaid program that was designed to provide cost-effective, comprehensive and flexible long-term care that fosters consumers' independence and quality of life, while recognizing the need for interdependence and support. Family Care improves the cost-effective coordination of long-term care services by creating a single flexible benefit that includes a large number of health and long-term care services that are typically only available separately. Enrollees have access to specific health care services offered by Medicaid as well as long-term care services in the Home and Community-Based Waivers and the state-funded Community Options Program.
Family Care is a public program operated by the Wisconsin Department of Health Services (“Department"), that contracts with both private and public plans to provide consumers an option for coverage of long-term care services beyond fee-for-service and the self-directed supports waiver. The care management organizations receive a fixed capitated amount per enrollee from the Department through the waiver programs. However, due to the nature of the organizations and the structure of the plan, care management organizations, unlike insurers, may be less able to build and draw upon reserves both during the expansion periods and due to the potential for unforeseen expenditures.
The proposed rule implements ch.
648, Stats., financial regulatory oversight of the care management organizations in coordination with the Department to ensure the organizations use sound financial tools when commencing operations and ongoing oversight of the financial condition of the organizations. Specifically the proposed rule establishes minimum financial standards, financial reporting requirements, regulatory examinations and restricted reserves for care management organizations in the event of an insolvency.
Comparison with federal regulations
There is no existing or proposed federal regulation related to oversight of care management organizations.
Comparison of similar rules in adjacent states
Illinois:
None.
Iowa:
None.
Michigan:
None.
Minnesota:
None.
Summary of factual data and analytical methodologies
The Office engaged along with the Department of Health Services engaged PricewaterhouseCoopers to analyze the necessary reserves and regulatory structure for the Family Care program. In addition the office reviewed care management organizations' financial information, coordinated the proposed regulatory scheme with current oversight provided by the Department and reviewed accounting principles best suited for care management organizations
Analysis and supporting documentation used to determine effect on small businesses
The Office worked with the Department of Health Services to determine the rule's effect on small businesses that are care management organizations.
Small Business Impact
