EmR1516 Injured Patients and Families Compensation Fund Annual Fund and mediation panel fees for the fiscal year beginning July 1, 2015, and affecting small business.

EMERGENCY ORDER AMENDING, REPEALING AND CREATING A RULE .

Office of the Commissioner of Insurance

Agency 145 Rule No . 029-15 : To amend s. Ins 17.01 (3) , and to repeal and recreate s. Ins 17.28 (6) , Wis. Admin. Code .

Relating to : Injured Patients and Families Compensation Fund Annual Fund and Mediation Panel Fees for the fiscal year beginning July 1, 201 5 , and affecting small business .

The statement of scope for this rule SS 029-15 , was approved by the Governor on January 15 , 201 5 , published in Register No. 711A4 , on March 23 , 201 5 , and approved by the Commissioner on April 6, 2015 . This emergency rule was approved by the Governor on May 29, 2015.

__________________________ _ _________________________________________________
FINDING OF EMERGENCY

The Commissioner of Insurance finds that an emergency exists and that the attached rule is necessary for the immediate preservation of the public peace, health, safety, or welfare. Facts constituting the emergency are as follows:

These changes must be in place with an effective date prior to July 1, 201 5 in order for the new fiscal year assessments to be issued in accordance with s. 655.27 (3) , Wis. Stats. The permanent rule - making process cannot be complete d prior to the effective date of the new fee schedule. The fiscal year fund fees were established by the Board of Governors at the meeting held on December 1 7 , 201 4 and the mediation panel fees established by the Board of Governors at the meeting held on March 18, 2015 .

ANALYSIS PREPARED BY THE OFFICE OF THE COMMISSIONER OF INSURANCE (OCI)

  1.   Statutes interpreted:

ss. 655.27 (3) , and 655.61 , Wis. Stats.

  2.   Statutory authority:

ss. 601.41 (3) , 655.004 , 655.27 (3) (b) , and 655.61 , Wis. Stats.

3.   Explanation of OCI’s authority to promulgate the proposed rule:

The injured patients and families compensation fund (“fund”), was established by and operated under Ch. 655 , Wis. Stats. The commissioner of insurance with approval of the board of governors (“board”) is required to annually set the fees for the fund and the medical mediation panel by administrative rule. The proposed fees comply with the limitation delineated in s. 655.27 (3) (br) , Stats. Section 655.04 , Stats., provides that the director of state courts and the commissioner may promulgate rules necessary to enable them to perform their responsibilities under this chapter. Pursuant to s. 655.27 (3) (b) , Stats., the commissioner, after approval by the board, shall by rule set the fees to the fund and s. 655.61 , Stats., requires the board, by rule, to set the fees charged to health care providers at a level sufficient to provide the necessary revenue to fund the medical mediation panels. Further, s. 601.41 (3) , Stats., provides that the commissioner shall have rule-making authority pursuant to s. 227.11 (2) , Stats.

  4.   Related statutes or rules:

None.

  5.   Plain language analysis:

This proposed rule establishes the fees that participating health care providers must pay to the fund for the fiscal year beginning July 1, 201 5 . These fees represent a 34 % de crease from fees paid for the 201 4 - 20 1 5 fiscal year. The board approved these fees at its meeting on December 17 , 201 4 , based on the recommendation of the board's actuarial and underwriting committee and reports of the fund’s actuaries.

The board is also required to promulgate by rule the annual fees for the operation of the injured patients and families compensation medical mediation system, based on the recommendation of the director of state courts. The recommendation of the director of state courts was reviewed by the board’s actuarial and underwriting committee. This rule implements the funding level approved by the board on March 18 , 201 5 by establishing mediation panel fees for the next fiscal year at $ 13.50 for physicians and $ 2.75 per occupied bed for hospitals, representing a n increase of $ 5.75 per physician and a n in crease of $ 1.25 per occupied bed for hospitals from 201 4 - 20 1 5 fiscal year mediation panel fees.

  6.   Summary of and comparison with any existing or proposed federal statutes and regulations:

To the fund board’s and OCI’s knowledge there is no existing or proposed federal regulation that is intended to address fund rates, administration or to fund medical mediation panel activities.

  7.   Comparison with rules in adjacent states:

To the fund board’s and OCI’s knowledge there are no similar rules in the adjacent states to compare this rule to as none of adjacent states have a fund created by statute where rates are directed to be established yearly by rule as is true in Wisconsin.

  8.   A summary of the factual data and analytical methodologies that OCI used in support of the proposed rule:

None. This rule establishes annual fund fees pursuant to the requirements of the above-noted Wisconsin statutes. The recommendation to the board regarding the fund fee and the medical mediation panel assessment is developed and reviewed annually by the fund’s actuaries and the board’s actuarial and underwriting committee. The actuarial and underwriting committee after review and discussion with the fund’s actuaries present the information and the actuaries report to the board for consideration. This proposed rule reflects the rates approved by the board at the December 17, 2014 , and March 18 , 201 5 , board meeting s .

  9.   Analysis and supporting documentation that OCI used in support of OCI’s determination of the rule’s effect on small business or in preparation of an economic impact analysis:

This de crease in fund fees will have a positive effect on s mall businesses in Wisconsin, particularly those that employ physicians and other health care professionals. The mediation panel fee is assessed only on physicians and hospitals, not on corporations or other health care entities that will incur the slight increase for fiscal year 201 6 . The proposed rule will affect only those small businesses that pay the fund fees and mediation panel fees on behalf of their employed physicians. The fund fee de crease and mediation panel fee increase will not have a significant effect nor should it negatively affect the small business’s ability to compete with other providers.

  10.   Effect on small business:

This rule will have little or no effect on small businesses. The de crease of fund fees and slight increase in mediation panel contained in the proposed rule will require providers to pay reduced fund fee s which will de crease the operational expenses for the providers which will greatly outweigh the slight increase in mediation panel fees . The increase in mediation panel fees contained in this proposed rule should not result in a significant fiscal effect on the private sector.

  11.   A copy of any comments and opinion prepared by the Board of Veterans Affairs under s. 45.03 (2m) , Stats., for rules proposed by the Department of Veterans Affairs.

      None.

  12.   Agency contact person:

A copy of the full text of the proposed rule changes, analysis and fiscal estimate may be obtained from the Web site at: http://oci.wi.gov/ocirules.htm

or by contacting Inger Williams, OCI Services Section, at:

Phone:   [phone]

Email:   [e-mail]

Address:   125 South Webster St – 2 nd Floor, Madison WI 53703-3474

Mail:   PO Box 7873, Madison, WI 53707-7873

  13.   Place where comments are to be submitted and deadline for submission:

The deadline for submitting comments is 4:00 p.m. on June 23 , 2015 .

Mailing address:

Julie E. Walsh

Legal Unit - OCI Rule Comment for Rule Ins 1701

Office of the Commissioner of Insurance

PO Box 7873

Madison WI 53707-7873

Street address:

Julie E. Walsh

Legal Unit - OCI Rule Comment for Rule Ins 1701

Office of the Commissioner of Insurance

125 South Webster St – 2 nd Floor

Madison WI 53703-3474

Email address:

Julie E. Walsh

[e-mail]

Web site: http://oci.wi.gov/ocirules.htm

 

The proposed rule changes are:

SECTION 1. Ins 17.01 (3) is amended to read :

Ins 17.01 (3) FEE SCHEDULE. The following fee schedule shall be effective July 1, 2013 201 5 :

(a)

For physicians-- $ 0 $ 13.50 .

(b)

For hospitals, per occupied bed-- $0 $ 2.75 .

SECTION 2. Ins 17.28 (6) is repealed and recreated to read:

(6)   Fee schedule. The following fee schedule is in effect from July 1, 201 5 to June 30, 201 6 :

(a)

Except as provided in pars. (b) to (f) and sub. (6e), for a physician for

whom this state is a principal place of practice:

    Class 1…. $ 865       Class 3….$ 3,461

    Class 2…. $ 1,558   Class 4….$ 5,711

  (b) For a resident acting within the scope of a residency or fellowship program:

    Class 1…..   $ 433       Class 3….$ 1,732

    Class 2…..   $ 779       Class 4….$ 2,858

  (c) For a resident practicing part-time outside the scope of a residency or fellowship program:

    All classes……………………………… $ 519

 

  (d) For a Medical College of Wisconsin, Inc., full-time faculty member:

Class 1….. $ 346     Class 3… .$ 1,383

Class 2…..$ 622       Class 4… .$ 2,282

  (e) For physicians who practice part-time:

  1. For a physician who practices fewer than 500 hours during the fiscal year, limited to office practice and nursing home and house calls, and who does not practice obstetrics or surgery or assist in surgical procedures:   ..$ 216.

  2. For a physician who practices 1040 hours or less during the fiscal year, including those who practice fewer than 500 hours during the fiscal year whose practice is not limited to office practice, nursing homes or house calls or who do practice obstetrics, surgery or assist in surgical procedures:

    Class 1…..$ 519       Class 3….$ 2,078

    Class 2…..$ 935       Class 4….$ 3,428

  (f) For a physician for whom this state is not a principal place of practice:

    Class 1…..$ 433       Class 3….$ 1,732

    Class 2…..$ 779     Class 4….$ 2,858

  (g) For a nurse anesthetist for whom this state is a principal place of practice:                   $ 213

  (h) For a nurse anesthetist for whom this state is not a principal place of practice:……………………………………………………………………………………………$ 107

  (i) For a hospital, all of the following fees:

  1. Per occupied bed………………………………………………………………………$ 52

2. Per 100 outpatient visits during the last calendar year for which totals are available:………………………………………………………………………………………….$ 2.61

  (j) For a nursing home, as described under s. 655.002 (1) (j) , Stats., that is wholly owned and operated by a hospital and that has health care liability insurance separate from that of the hospital by which it is owned and operated:

  Per occupied bed……………………………………………………………………….…..$ 1 0

  (k) For a partnership comprised of physicians or nurse anesthetists, organized for the primary purpose of providing the medical services of physicians or nurse anesthetists, all of the following fees:

  1. a. If the total number of partners and employed physicians and nurse anesthetists is from 2 to 10………………………………………………………… …………………… …………$ 30

    b. If the total number of partners and employed physicians and nurse anesthetists is from 11 to 100………………………………………………………… …………………… ……..$ 299

  c. If the total number of partners and employed physicians and nurse anesthetists exceeds 100……………………………………………………..…………… ……………….. …$ 744

  2. The following fee for each full-time equivalent allied health care professional employed by the partnership as of the most recent completed survey submitted:

  Employed Health Care Professionals               Fund Fee

  Nurse Practitioners…………………………………………… …… … .. ………………..….$ 216

  Advanced Nurse Practitioners………………………………… ……. ……………..………… 303

  Nurse Midwives……………………………………………………… .. …..………………… 1,903

  Advanced Nurse Midwives………………………………………… … …..………………… 1,990

  Advanced Practice Nurse Prescribers   …………………………… ….. …………..………….. 303

  Chiropractors………………………………………………………… … ………………..……... 346

  Dentists………………………………………………………………… .. ………………..…….. 173

  Oral Surgeons………………………………………………………… … ………..………….. 1,298

  Podiatrists-Surgical………………………………………………… …. ………………..…… 3,678

Optometrists……………………………………………………… .. … … ……..………………. 173

Physician Assistants………………………………………… … ………………………..….. 173

  (L) For a corporation, including a service corporation, with more than one shareholder organized under ch. 180 , Stats., for the primary purpose of providing the medical services of physicians or nurse anesthetists, all of the following fees:

  1. a. If the total number of shareholders and employed physicians and nurse anesthetists is from 2 to 10……………………………………………………………...…….$ 30

    b. If the total number of shareholders and employed physicians and nurse anesthetists is from 11 to 100…………………………………………………………..……$ 299

  c. If the total number of shareholders and employed physicians or nurse anesthetists exceeds 100……………………………………………………….…………….$ 744

  2. The following fee for each full-time equivalent allied health care professional employed by the corporation as of the most recent completed survey submitted:

Employed Health Care Professionals         Fund Fee

  Nurse Practitioners…………………………………………… . ………………………….$ 216

  Advanced Nurse Practitioners……………………………… .. ……..……………………… 303

  Nurse Midwives………………………………………………..…………………………… 1,903

  Advanced Nurse Midwive s………………………………… . ………..…………………… 1,990

  Advanced Practice Nurse Presc ribers   …………………… .. ………………………..…… …. 303   Chiropractors……………… …………………………………… . ………………..…………... 346

  Dentists…………………… …………………………………………………..……………….. 173

  Oral Surgeons…………………………………………… ……… . ………..……………….. 1,298

  Podiatrists-Surgical…… ………………………………………… .. ……………..………… 3,678

  Optometrists…………… …………………………………………… .. ……………..…………. 173

  Physician Assistants…… …………………………………………… .. ……..……………….. 173

  (m) For a corporation organized under ch. 181 , Stats., for the primary purpose of providing the medical services of physicians or nurse anesthetists, all of the following fees:

  1. a. If the total number of employed physicians and nurse anesthetists is from 1 to 10………………………………… …………………………..……………………………….$ 30

  b. If the total number of employed physicians and nurse anesthetists is from 11 to 100………………………… ……………………………………………………………… ….. .$ 299

  c. If the total number of employed physicians or nurse anesthetists exceeds 100………………………………… ……………………………………………………..……….$ 744

  2. The following fee for each full-time equivalent allied health care professional employed by the corporation as of the most recent completed survey submitted:

Employed Health Care Professionals         Fund Fee

  Nurse Practitioners ……………………………………………………………… . … … ….$ 216

  Advanced Nurse Practitio ners…………………………………………………… . …… … .… 303

  Nurse Midwives………… ……………………………………………………………… .. ..… 1,903

  Advanced Nurse Midwive s………………………………………………………… … .…… 1,990

  Advanced Practice Nurse Prescr ibers   ……………………………… … ……………… …. ….. 303

  Chiropractors……………… …………………………………………… … ………………..…... 346

  Dentists…………………… ……………………………………………… .. ………………..….. 173

  Oral Surgeons……………… ……………………………………………… . ………..… .. ….. 1,298

  Podiatrists-Surgical…… ……………………………………………..…… . … . ……… .. …… 3,678

  Optometrists………… ………………………………………………………………….…… … . 173

  Physician Assistants ……………………………………………………………………… …. . 173

  (n) For an operational cooperative sickness care plan as described under s. 655.002 (1) (f) , Stats., all of the following fees:

  1. Per 100 outpatient visits during the last calendar year for which totals are available……………………… … ………………………………………………….………………$0. 07

  2. 2.5 % of the total annual fees assessed against all of the employed physicians.

  3. The following fee for each full-time equivalent allied health care professional employed by the operational cooperative sickness plan as of the most recent completed survey submitted:

Employed Health Care Professionals         Fund Fee

  Nurse Practitioners……… ………………………………………………………… .. …….$ 216

  Advanced Nurse Practitioners………………………………………………………… …. … 303

  Nurse Midwives………………………………………………………………………..…… . 1,903

  Advanced Nurse Midwives…………………………………………………..…………… . 1,990

  Advanced Practice Nurse Prescribers   ………………………………………..………… … .. 303

  Chiropractors……………………………………………………………………..……… . …... 346

  Dentists……………………………………………………………………………………..…. . 173

  Oral Surgeons………………………………………………………………………..… . ….. 1,298

  Podiatrists-Surgical………………………………………………………………..…… .. … 3,678

  Optometrists………………………………………………………………………….… .. ……. 173

  Physician Assistants……………………………………………………….………… .. …….. 173

  (o) For a freestanding ambulatory surgery center, as defined in s. DHS 120.03 (13) , per 100 outpatient visits during the last calendar year for which totals are available:……………… ………………………………………………………………………….$ 13.50

  (p) For an entity affiliated with a hospital, the greater of $100 or whichever of the following applies:

  1. 7.0 % of the amount the entity pays as premium for its primary health care liability insurance, if it has occurrence coverage.

  2. 10.0 % of the amount the entity pays as premium for its primary health care liability insurance, if it has claims-made coverage.

  (q) For an organization or enterprise not specified as a partnership or corporation that is organized and operated in this state for the primary purpose of providing the medical services of physicians or nurse anesthetists, all of the following fees:

  1. a. If the total number of employed physicians and nurse anesthetists is from 1 to 10………………………………………………………………………………...… …… ………$ 30

  b. If the total number of employed physicians and nurse anesthetists is from 11 to 100………………………………… …………………………………………………………...$ 299

  c. If the total number of employed physicians or nurse anesthetists exceeds

100………………………… ……………………………………………………………………$ 744

  2. The following for each full-time equivalent allied health care professional employed by the organization or enterprise not specified as a partnership, corporation, or an operational cooperative health care plan as of the most recent completed survey submitted:

Employed Health Care Professionals         Fund Fee

  Nurse Practitioners……… ……………………………………………………………….$ 216

  Advanced Nurse Practitioners…………………………………………..… .. ……………… 303

  Nurse Midwives………… ……………………………………………………..…………… 1,903

  Advanced Nurse Midwives…………………………………………………… . …..……… 1,990

  Advanced Practice Nurse Prescribers   ……………………………………… ….. ………….. 303

  Chiropractors……………… ………………………………………………………. . .………... 346

  Dentists…………………… ……………………………………………………..…………….. 173

  Oral Surgeons………………………………………………………………..…………… … 1,298

  Podiatrists-Surgical …………………………………………………………..……… … … 3,678

  Optometrists……………………………………………………………………….…… …. …. 173

  Physician Assistants………………………………………………………………..……… …. . 173

Section 1.

Office of the Commissioner of Insurance

Fiscal Estimate

for Section s Ins 17.01 , 17.28 (6) relating to Injured Patients and Families Compensation Fund Annual fund and Mediation Panel Fees for the fiscal year beginning July 1, 201 5 and affecting small business

This rule change will have no significant effect on the private sector as this proposed rule reduces fees to participants in the fund by 34% from last fiscal year and slightly increases mediation panel fees to $13.50 for physicians and $2.70 per hospital bed . The fund is a segregated account and does not impact state funds. The rule decreases fund fees and slightly increases mediation panel fee and therefore will not have an effect on county, city, village, town, school district, technical college district and sewerage district fiscal liabilities and revenues.

STATE OF WISCONSIN DEPARTMENT OF ADMINISTRATION DOA-2049 (C04/2011)	Division of Executive Budget and Finance 101 East Wilson Street, 10th Floor P.O. Box 7864 Madison, WI 53707-7864 FAX: [phone]
ADMINISTRATIVE RULES – FISCAL ESTIMATE
1.   Fiscal Estimate Version
Original Updated Corrected
2.   Administrative Rule Chapter Title and Number   INS 1728
3.   Subject   Injured Patients and Families Compensation Fund Annual fund and Mediation Panel Fees for the fiscal year beginning July 1, 201 5 and affecting small business
4.   State Fiscal Effect:
No Fiscal Effect Indeterminate	Increase Existing Revenues Decrease Existing Revenues NONE	Increase Costs Yes No   May be possible to absorb   within agency’s budget. Decrease Costs NONE
5.   Fund Sources Affected: GPR   FED   PRO   PRS   SEG   SEG-S	6.   Affected Ch. 20, Stats. Appropriations: None
7.   Local Government Fiscal Effect:
No Fiscal Effect Indeterminate	Increase Revenues Decrease Revenues	Increase Costs Decrease Costs NONE
8.   Local Government Units Affected: Towns   Villages   Cities   Counties   School Districts   WTCS Districts   Others: None
9.   Private Sector Fiscal Effect (small businesses only):
No Fiscal Effect Indeterminate	Increase Revenues Decrease Revenues Yes No   May have significant   economic impact on a   substantial number of   small businesses	Increase Costs Yes No   May have significant   economic impact on a   substantial number of   small businesses Decrease Costs
10.   Types of Small Businesses Affected:
Small businesses that employ physicians or other health care professionals participating in the Fund.
11.   Fiscal Analysis Summary
No significant impact. Decease of 34% for fund fees and slight increase for medical mediation fees.
12.   Long-Range Fiscal Implications
None
13.   Name - Prepared by Julie E. Walsh	Telephone Number [phone]	Date May 8 , 2015
14.   Name – Analyst Reviewer	Telephone Number	Date
Signature—Secretary or Designee	Telephone Number (608) 267- 1233	Date