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 across the country to provide coverage for evidence-based, medically-necessary autism treatments and therapies. If passed a comparison of final federal requirements and state law and regulation will need to be reviewed.
Additionally, the ``Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008'' (
29 U.S.C. 1185a), requires for 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. Federal guidance is due early 2010 on the Mental Health Equity Act of 2008. Wisconsin's law is broader than the federal act but will need to be reviewed when the federal regulations are finally promulgated and effective.
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 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. This proposed rule reflects the advisory working group's recommendations.
Analysis and supporting documentation used to determine 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
The rule will have little or no effect 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
Private sector fiscal impact
This rule change will have no significant effect on the private sector regulated by OCI.
State or local government fiscal impact
None.
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 section
Ins 3.75, Wis. Adm. Code, relating to continuation of group insurance policies.
Hearing Information
Date: December 8, 2009
Time: 10:30 a.m., or as soon thereafter as the
matter may be reached
Place: OCI, Room 227
125 South Webster Street, 2nd Floor
Madison, WI
Written comments can be mailed to:
Robert Luck
Legal Unit - OCI Rule Comment for Rule Ins 375
Office of the Commissioner of Insurance
PO Box 7873
Madison WI 53707-7873
Written comments can be hand delivered to:
Robert Luck
Legal Unit - OCI Rule Comment for Rule Ins 375
Office of the Commissioner of Insurance
125 South Webster St – 2nd Floor
Madison WI 53703-3474
Comments can be emailed to:
Robert Luck
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 Act 11 specifically permits the commissioner to enact this rule.
Related statutes or rules
Plain language analysis and summary of the proposed rule
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
