Ins 57.04(4)(a)(a) Types of contingencies. The commissioner shall consider the risks of: Ins 57.04(4)(a)1.1. Increases in the frequency or severity of losses beyond the levels contemplated by the capitation payments received; Ins 57.04(4)(a)2.2. Increases in expenses beyond those contemplated by the capitation payments received; and Ins 57.04(4)(a)3.3. Any other contingencies the commissioner can identify which may affect the care management organization’s operations. Ins 57.04(4)(b)(b) Controlling factors. In making the determination under this subsection, the commissioner shall take into account the following factors: Ins 57.04(4)(b)1.1. The most reliable information available as to the magnitude of the various risks under par. (a); Ins 57.04(4)(b)2.2. The extent to which the risks in par. (a) are independent of each other or are related, and whether any dependency is direct or inverse; Ins 57.04(4)(b)3.3. The care management organization’s recent history of profits or losses; Ins 57.04(4)(b)4.4. The extent to which the care management organization has provided protection against the contingencies in ways other than the establishment of restricted reserves, including the use of conservative actuarial assumptions to provide a margin of security; and Ins 57.04(5)(5) Corrective action plan. A care management organization that does not meet the requirements in sub. (1) or (2) shall file a corrective action plan with the commissioner. The corrective action plan shall include all of the following: Ins 57.04(5)(a)(a) Identification of the conditions which contribute to the deficiency. Ins 57.04(5)(b)(b) Proposals of corrective actions which the care management organization intends to take and would be expected to result in compliance with subs. (1) and (2). Ins 57.04(5)(c)(c) Projections of the care management organization’s financial results in the current year and at least the first succeeding year. Ins 57.04(5)(d)(d) Identification of the key assumptions impacting the care management organization’s projections and the sensitivity of the projections to the assumptions. Ins 57.04(5)(e)(e) Such other information as is requested by the commissioner, after consultation with the department. Ins 57.04 HistoryHistory: EmR0927: emerg. cr. eff. 10-10-09; CR 09-093: cr. Register May 2010 No. 653, eff. 6-1-10. Ins 57.05Ins 57.05 Business plan. All applications for permits of a care management organization shall include a proposed business plan. In addition to the items listed in s. 648.05 (2), Stats., the following information shall be contained in the business plan: Ins 57.05(1)(1) Organizational information. All care management organization business plans shall include: Ins 57.05(1)(a)(a) A narrative that discusses the business environment, the strategies and tactics that will be employed to manage the business including a plan to utilize mandated care principles and targets associated with that plan, and other areas of focus, stress, change, efficiency or any other information that supports or affects the financial projections. Ins 57.05(1)(b)(b) A description of the general business model to be employed by the care management organization. Ins 57.05(1)(c)(c) A brief organizational history, providing and describing major milestones in the development of the care management organization including organizational strengths and deficits, as they relate to the ongoing delivery of the Family Care program. Ins 57.05(1)(d)(d) A description of the care management organization’s governance structure, including organizing documents (e.g., articles, by-laws, mission statement, etc.), and an organizational chart that clearly demonstrates reporting lines and domains of management authority, with names of current incumbents for management positions. Ins 57.05(1)(e)(e) Information for all persons or entities who are in direct control of the care management organization, including the names, addresses and occupations of all controlling persons, directors and principal officers of the care management organization currently and for the preceding 10 years. The care management organization information shall also include the position held and target group representation, if applicable, for each member of the board of directors. Ins 57.05(2)(2) Geographical service area. The geographical service area by county including a chart showing the number of providers with locations and service areas by county. A description and the method of handling out–of–area services shall also be included. Ins 57.05(3)(3) Enrollment. A description of the target populations being served by the care management organization, in what proportions these target groups are currently being served, what the long range expectations of the care management organization are in serving each target group (i.e., anticipated program growth), and how historical trends or projections are similar to, or different, from program averages. Ins 57.05(4)(4) Provider agreements. The extent to which any of the following are included in provider agreements and the form of any provisions that do any of the following: Ins 57.05(4)(a)(a) Permit or require the provider to assume a financial risk in the care management organization, including any provisions for assessing the provider, adjusting capitation or fee–for–service rates, or sharing in the earnings or losses. Ins 57.05(4)(b)(b) Govern amending or terminating agreements with providers.