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The rules would not directly impose any new reporting, bookkeeping or other procedures on small businesses.
Types of professional skills necessary for compliance with the rules.
No new professional skills are necessary for compliance with the rules.
Rules have a significant economic impact on small businesses?
No.
Small business regulatory coordinator
Any inquiries for the small business regulatory coordinator for the Department of Commerce can be directed to Sam Rockweiler, as listed above.
Environmental Impact
The Department has considered the environmental impact of the proposed rules. In accordance with chapter Comm 1, the proposed rules are a Type III action. A Type III action normally does not have the potential to cause significant environmental effects and normally does not involve unresolved conflicts in the use of available resources. The Department has reviewed these rules and finds no reason to believe that any unusual conditions exist. At this time, the Department has issued this notice to serve as a finding of no significant impact.
Fiscal Estimate
Assumptions used in arriving at fiscal estimate
Although the rules will newly result in review of documentation relating to applications and reports for grants under this chapter, the time needed for these reviews is expected to be spent by current employees. Therefore, the proposed rules are not expected to have any significant fiscal effect on the Department.
The proposed rules are not expected to impose any significant costs on the private sector because the rules address submittal of documentation, and other activities, only by entities that choose to pursue obtaining grants under this chapter.
State fiscal effect
None.
Local government fiscal effect
None.
Long-range fiscal implications
None known.
Agency Contact Person
Shelly Harkins
Wisconsin Department of Commerce
Bureau of Business Finance and Compliance
P.O. Box 7970, Madison, WI 53707-7970
Phone: (608) 266-0346
Notice of Proposed Rulemaking
Without Public Hearing
Health Services
Health, Chs. DHS 110—
NOTICE IS HEREBY GIVEN that pursuant to s. 227.11 (2) (a), Stats., and according to the procedure set forth in s. 227.16 (2) (e), Stats., the Department of Health Services will adopt the following rule as proposed in this Notice, without public hearing unless within 30 days after publication of this Notice in the Wisconsin Administrative Register on July 14, 2010, the Department of Health Services is petitioned for a public hearing by 25 natural persons who will be affected by the rule; a municipality which will be affected by the rule; or an association which is representative of a farm, labor, business or professional group which will be affected by the rule. The rule revises Chapter DHS 138, relating to subsidy of health insurance premiums for persons with HIV infection.
Submittal of Written Comments
General questions may be submitted to:
Kathy Rogers
Department of Public Health
Wisconsin Department of Health Services
Phone: (608) 267-6875
Analysis Prepared by Department of Health Services
In this proposed order, the Department is making technical modifications to ch. DHS 138 to conform with the technical changes to ss. 252.16 and 252.17, Stats., made under 1999 Act 103, 2007 Act 20, and 2009 Act 28. The Department is operating in accordance with the modifications made to ss. 252.16 and 252.17, Stats., under each Act.
Sections 252.16 and 252.17, Stats., require the Department to operate a program that provides subsidies to cover the cost of health insurance premiums for persons with human immunodeficiency virus (HIV) infection who, because of a medical condition resulting from that infection, are unable to continue working or must reduce their hours of work or take an unpaid leave from their jobs. Under the program, the Department pays premiums for health insurance coverage of eligible individuals to employers, insurers, or employees, as applicable. The Department has been operating this program since November 1990 under ch. DHS 138.
1999 Wisconsin Act 103 modified s. 252.17, Stats., in several respects. First, it increased the family income eligibility limits under s. 252.17 (3) (b), Stats., from 200% to a maximum of 300% of the FPL. Second, it created s. 252.17 (4) (d), Stats., which specifies that the Department will pay a portion of the health insurance premium for individuals whose family income is between 200% and 300% of the FPL. It further specifies that the Department will establish the schedule for payment in administrative rule. Act 103 also created s. 252.17 (6) (c), Stats., which requires the Department to establish, in rule, the premium contribution schedule for individuals who have a family income that exceeds 200% but does not exceed 300% of the FPL. In establishing the schedule, the Department is required to take into consideration both income level and family size.
2007 Wisconsin Act 20 modified s. 252.16 (1) (d) and (4) (a), Stats., to permit the Department to pay Part D Medicare premiums.
2009 Wisconsin Act 28 modifies ss. 252.16 (1) (ar) and 252.17 (3) (d), Stats., to include domestic partner in the definition of “dependent" and to allow an eligible individual's premium contribution to include the cost of coverage of a domestic partner.
The Department's modification of ch. DHS 138 will address the changes made to ss. 252.16 and 252.17, Stats., by the above mentioned legislation.
Comparison with federal regulations
Not applicable.
Comparison with rules in adjacent states
Illinois:
Illinois has a similar program to pay health insurance premiums for persons with HIV and has established administrative rules for the program under 89 ILL Admin. Code 118.150. Eligibility is similar to eligibility under Wisconsin's program in that the applicant must have physician-documented HIV infection. The Illinois income guideline is at 200% of the FPL whereas Wisconsin's income limit is at 300% of FPL. Illinois considers assets but Wisconsin does not. Illinois also caps its monthly premium payment at $300. The Illinois rules do not address payment of premiums during an unpaid medical leave or require a cost share.
Iowa:
Iowa has a similar program operating under 441 IAC 75.22 (249A). Iowa's eligibility requirements are similar to Wisconsin's in that they require a physician to state that the applicant is HIV infected and that the applicant must reduce work hours or terminate employment due to HIV related illness. Iowa considers income and assets where Wisconsin only considers income. Both Wisconsin's and Iowa's income limit is at 300% of FPL. Iowa's rules do not address payment of premiums during an unpaid medical leave nor do they require a cost share.
Michigan:
Michigan has a similar program to pay health insurance premiums but does not have administrative rules that govern the program.
Minnesota:
Minnesota has a similar program to pay health insurance premiums under Minn. Stat. s. 256.9365 but does not have administrative rules for the program.
Summary of factual data and analytical methodologies
The Department reviewed 1999 Act 103, 2007 Act 20, 2009 Act 28, and ss. 252.16 (6) (c) and 252.17 (6) (c), Stats., for this rulemaking. In addition, the Department reviewed program utilization data for SFY 2008 to determine the number of program participants who were on unpaid medical leave with an income greater than 200% FPL and less than or greater than 300% FPL. During SFY 2008, of eight program applicants or participants who were on unpaid medical leave, only two had income greater than 200% FPL.
Analysis and supporting documents used to determine effect on small business
Any business that offers employer based health insurance that is the employer or former employer of a program participant will be affected by the rule.
Small Business Impact
The proposed rules will not directly affect small businesses.
Fiscal Estimate
Summary
The rules are amended to establish a 3% annual premium contribution schedule for individuals on unpaid medical leave who have a family income that exceeds 200% but does not exceed 300% of the federal poverty level (FPL). The rules are also amended to include “domestic partner" in the definition of “dependent" and to allow for payment of a participant's health insurance premiums even if a domestic partner is also covered on the health insurance policy. These changes will impact only a small number of insurance program participants and will result in minimal cost increases to the Department that can be absorbed in the program budget.
During 2009 only 56 of 683 insurance program participants indicated on their application that they were living with a partner. Among these 56 individuals, only 2 (<1% of total program clients) had health insurance policies with family coverage. The increased cost to the Department for these individuals is the difference between the cost of an individual premium and the cost of a family premium. Also during 2009 only 4 of 683 (<1%) insurance program participants received program assistance while they were on an unpaid medical leave. None of them had income greater than 200% of FPL. These unpaid leaves are short-term, usually lasting 3 to 6 months and the cost associated with them is minimal compared to overall program costs.
State fiscal effect
Indeterminate. Increase costs — may be possible to absorb within agency's budget.
Fund sources affected
GPR; FED.
Affected Ch. 20, Stats., appropriations
Section 20.435 (1) (am), Stats.
Local government fiscal effect
None.
Private sector fiscal effect
None.
Long-range fiscal implications
None known.
Text of Proposed Rule
SECTION 1. DHS 138.03 (2), (3) and (14) are amended to read:
DHS 138.03 (2) “Department" means the Wisconsin department of health and family services.
(3) “Dependent" means a spouse, domestic partner under ch. 770, Stats., or an unmarried child under the age of 19 years, an unmarried child who is a full-time student under the age of 21 years and who is financially dependent upon the parent, or an unmarried child of any age who is medically certified as disabled and who is dependent upon the parent.
(14) “Medicare" means coverage under part A or, part B or part D of Title XVIII of the federal social security actSocial Security Act, 42 USC 1395 to 1395zz1395hhh.
SECTION 2. DHS 138.04 (1) (b) 2. and (d), (2) (a) (intro.) and 7. Note and (b) are amended to read:
DHS 138.04 Participation in the health insurance premium subsidy program. (1) (b) 2. For a subsidy under s. 252.17, Stats., have a family income that does not exceed 200 300% of the federal poverty line for a family the size of the individual's family;
(d) Have health insurance coverage under a group health plan or, an individual health policy or Medicare part D, or is eligible for health insurance coverage under a group health plan or, an individual health policy or Medicare part D;
(2) APPLICATION PROCESS. (a) Any individual who satisfies the eligibility conditions under sub. (1) and wants to participate in the health insurance premium subsidy program shall complete and submit to the department an application form, DOH 4614F-44614, which shall provide the following information:
7. Note: To obtain a copy of DOH 4614F - 44614, write or phone the Wisconsin Division of Public Health, AIDS/HIV Program, P.O. Box 2659, Madison, WI 53701-2659, (608) 267-5287. The completed form should be returned to the same office.
(b) Any individual who does not satisfy sub. (1) (b), (d) or (e), may submit an application form, DOH 4614F - 44614, that the department will hold until the individual satisfies all the applicable requirements under sub. (1). The department may not contact the individual's employer, former employer or health insurer until the individual satisfies all the applicable requirements under sub. (1) unless the individual authorizes the department, in writing, to make that contact and to make any necessary disclosure regarding the individual's HIV infection.
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