1. Non-visualized airway, to treat patients who are either not breathing or their airway has been compromised due to trauma or other means; and

2. The administration of epinephrine, for patients who have suffered a severe allergic reaction.

A copy of the full text of the proposed rules can be obtained at no charge from the Wisconsin Administrative Rules website at http://adminrules.wisconsin.gov or by contacting the contact person listed below.

This revised administrative rule will allow first responders to obtain certain skills in addition to those that are provided in the national standards curriculum. If first responders choose to acquire these skills, the purchase of a medical kit at a cost of approximately $150 would be required. The cost of this kit could be reimbursed by the ambulance service which works with the first responder, so there would be no net cost to the first responder for this kit. Since this provision is not mandatory, it is not known how many first responders would seek to obtain these skills. Therefore, it is not possible to estimate the fiscal effect of this provision on local emergency medical services providers. A copy of the full text of the fiscal estimate may be obtained at no charge at the Wisconsin Administrative Rules website at:
http://adminrules.wisconsin.gov or by contacting the contact person listed below.

The department does not currently certify first responder service providers other than first responders that are certified to defibrillate and does not believe that these proposed rules affect small businesses other than private business entities that provide first responder services. The department invites comments from members of the public, including private entities who are first responder service providers, and other small businesses who believe that these proposed rules will have a fiscal impact on their small business.

The proposed changes do not include reporting or bookkeeping requirements.

Dan Williams

Department of Health and Family Services

Division of Public Health - Emergency Medical Services

1 West Wilson Street Room 118

P.O. Box 2659

Madison, WI 53701-2659

608-261-6870

Fax: 608-261-6392

Small Business Regulatory Coordinator

Rosie Greer

Department of Health and Family Services

1 W. Wilson St. Rm. 658

Madison, WI 53702

608-266-1279

Fax: 608-267-1434

NOTICE IS HEREBY GIVEN that pursuant to ss. 149.143 (2) (a) 2., 3., and 4., Stats., and 227.11 (2) Stats., interpreting ss. 149.14 (5m), 149.142, 149.143, 149.146, and 149.165, Stats., the Department of Health and Family Services will hold a public hearing to consider the proposed permanent rules and emergency rules amending HFS 119.07 (6) (b) to (d) and 119.15 (2) and (3), relating to operation of the health insurance risk-sharing plan (HIRSP) at the following time and location. The Department anticipates the emergency rules will take effect on July 1, 2005.

The public hearing will be held:

Monday, July 11, 2005, 1:00 p.m. to 3:00 p.m.

Conference Room B272 (Floor 2B)

State Office Building

1 West Wilson Street

Madison, WI

The hearing site is fully accessible to people with disabilities. If you are hearing or visually impaired, do not speak English, or have circumstances that might make communication at a hearing difficult and if you, therefore, require an interpreter or a non-English, large print or taped version of the hearing document, contact the person at the address or phone number given above at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.

Written comments may be submitted at the public hearing. In lieu of attending the public hearing, written comments and materials may be submitted to the Department using the Wisconsin Administrative Rules website at http://adminrules.wisconsin.gov or submitted by regular mail or email to the Department's contact person listed below:

Randy McElhose

Division of Health Care Financing

P.O. Box 309, Room B274

1 W. Wilson St.

Madison, WI 53701-0309

Phone: (608) 267-7127 or if you are hearing impaired, (608) 266-1511 (TTY)

Fax: (608) 264-7720

The deadline for submitting comments is 4:30 p.m., on July 18, 2005.

The State of Wisconsin in 1980 established a Health Insurance Risk-Sharing Plan (HIRSP). HIRSP provides major medical health insurance for persons who are covered under Medicare because they are disabled, persons who have tested positive for HIV, and persons who have been refused coverage or who cannot get coverage at an affordable price in the private health insurance market because of their mental or physical health conditions. Also eligible for coverage are persons who recently lost employer-sponsored insurance coverage if they meet certain criteria. According to state law, HIRSP policyholder premium rates must fund sixty percent of plan costs, except for costs associated with premium and deductible reductions. The remaining funding for HIRSP is to be provided by insurer assessments and adjustments to provider payment rates, in co-equal amounts.

HIRSP Plan 1 is for policyholders that do not have Medicare. Ninety-one percent of the 18,530 HIRSP policies in effect in February 2005 were enrolled in Plan 1. Plan 1 has Option A ($1,000 deductible) or Option B ($2,500 deductible). The rates for Plan 1 contained in this rulemaking order increase an average of 15.0% for policyholders not receiving a premium reduction. The average rate increase for policyholders receiving a premium reduction is 12.1%. Rate increases for individual policyholders within Plan 1 range from 7.0% to 16.8%, depending on a policyholder's age, gender, household income, deductible and zone of residence within Wisconsin. Plan 1 rate increases reflect and take into account the increase in costs associated with Plan 1 claims.

HIRSP Plan 2 is for persons eligible for Medicare because of a disability or because they become age-eligible for Medicare while enrolled in HIRSP. Plan 2 has a $500 deductible. Nine percent of the 18,530 HIRSP policies in effect in February 2005 were enrolled in Plan 2. The rate increases for Plan 2 contained in this rulemaking order increase an average of 20.3% for policyholders not receiving a premium reduction. The average rate increase for policyholders receiving a premium reduction is 17.3%. Rate increases for individual policyholders within Plan 2 range from 11.2% to 22.2%, depending on a policyholder's age, gender, household income and zone of residence within Wisconsin. Plan 2 premiums are set in accordance with the authority and requirements set out in s. 149.14 (5m), Stats.

HIRSP has the purpose of making health insurance coverage available to medically uninsured residents of the state. This order updates HIRSP premiums for policyholders effective July 1, 2005. It also adjusts total HIRSP insurer assessments and provider payment rates for the 12-month period beginning July 1, 2005. This adjustment process is occurring in order to reflect changing HIRSP costs and satisfy a statute-specified calculation methodology, in order to fund total HIRSP costs.

The fiscal adjustments contained in this order were developed by an independent actuarial firm on behalf of HIRSP. The projected adjustments have been reviewed by DHFS staff and approved by the HIRSP Board of Governors. The Board is a diverse body composed of consumers, insurers, health care providers, small business and other affected parties. By statute, these adjustments include estimates for the annual reconciliation process, which is based on the previous calendar year and implemented in the subsequent plan year. The fiscal adjustments are based upon a combination of a retrospective reconciliation process, current HIRSP expenses, inflation trends in medical care and statutory requirements. The resulting adjustments are then applied to the time-period beginning July 1, 2005. Similar annual fiscal adjustments to the HIRSP rules have occurred in each state fiscal year (SFY) since 1998.

HIRSP funding will increase by $29,432,763 in SFY 2006 as a result of the proposed changes contained in this order. This annual amount is comprised of an increase of $6,433,230 in insurer assessments, an increased adjustment (levy) of $9,708,019 regarding provider payment rates, and a projected increase of $13,291,514 in policyholder premiums. This increase in HIRSP program revenues is expected to equal the increase in program expenditures for provided services. As a result, the net overall fiscal effect is estimated to be zero.

HIRSP affects policyholders, insurers and health providers. Under HIRSP, policyholders are required by law to fund 60% of its costs, except for costs associated with premium and deductible reductions. The remaining funding for HIRSP is to be provided by insurer assessments and adjustments to provider payments rates, in co-equal amounts. HIRSP offers health insurance to high medically at-risk citizens, at rates subsidized by healthcare insurers and healthcare providers of service. HIRSP has approximately 18,530 policyholders, or 0.3% of Wisconsin's population of about 5.5 million. HIRSP increases the number of Wisconsin citizens with health insurance. Wisconsin citizens receive health insurance coverage that would otherwise be unaffordable or unobtainable. Citizens improve their health status. Healthcare insurers are enabled to provide coverage to an underserved marketplace niche. Healthcare providers receive additional customers.

HIRSP program statutes require an assessment of insurers and providers in order to help finance HIRSP. The rule changes do not affect health insurers who are small businesses as "small business" is defined in s. 227.114 (1) (a), Stats. The rules changes may affect some health care providers that are small businesses. The net fiscal impact of HIRSP on these small health care providers is unknown.

A copy of the full text of the rules and the full text of the fiscal estimate, and other documents associated with this rulemaking may be obtained, at no charge, from the Wisconsin Administrative Rules website at http://adminrules.wisconsin.gov. At this website you can also register to receive email notification whenever the Department posts new information about this rulemaking and, during the public comment period, you can submit comments on the rulemaking order electronically and view comments that others have submitted about the rule.

A copy of the full text of the rule and the fiscal estimate may also be obtained by contacting the Department's representative listed below:

Randy McElhose

Division of Health Care Financing

P.O. Box 309, Room B274

1 W. Wilson St.

Madison, WI 53701-0309

Phone: (608) 267-7127 or if you are hearing impaired, (608 266-1511 (TTY)

Fax: (608) 264-7720

Rosie Greer

Greerrj@dhfs.state.wi.us

608-266-1279

NOTICE IS HEREBY GIVEN that pursuant to authority vested in the Marriage and Family Therapy, Professional Counseling and Social Work Examining Board in ss. 15.08 (5) (b), 227.11 (2) and 457.03, Wis. Stats., and interpreting s. 457.08 (4) (b) 1. and 2., Wis. Stats., the Marriage and Family Therapy, Professional Counseling and Social Work Examining Board will hold a public hearing at the time and place indicated below to consider an order to repeal MPSW 2.01 (9) (b); and to amend MPSW 2.01 (9) (intro.) and 3.09 (1), relating to postgraduate education and field experience for licensure as a clinical social worker.

Interested persons are invited to present information at the hearing. Persons appearing may make an oral presentation but are urged to submit facts, opinions and argument in writing as well. Facts, opinions and argument may also be submitted in writing without a personal appearance by mail addressed to the Department of Regulation and Licensing, Office of Legal Counsel, P.O. Box 8935, Madison, Wisconsin 53708, or by email to pamela.haack@drl.state.wi.us. Written comments must be received on or before July 11, 2005 to be included in the record of rule-making proceedings.

Analysis prepared by the Department of Regulation and Licensing.