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.

Section 457.08 (4) (b) 1. and 2., Stats.

Sections 15.08 (5) (b), 227.11 (2) and 457.03, Stats.

Currently, s. MPSW 2.01 (9) requires clinical courses to comprise at least 40% of an applicant's non-field placement credits in his or her social work degree program. That provision has resulted in unintended inequities for applicants because it requires some individuals to take more courses than others depending upon how many credits are required for the particular degree program. By requiring specific clinical courses, rather than a percentage of them, applicants will have to meet uniform criteria, regardless of how many credits are required in their degree program, thereby eliminating any existing inequities.

Section MPSW 3.09 (1) presently requires that applicants for licensure as clinical social workers provide evidence that, as part of their degree program, they took a course of study which included a clinical focus and a supervised field training. The underlying statutory provision was amended by the legislature in 2003 Wisconsin Act 301, permitting applicants to obtain their clinical requirements in a postgraduate setting, instead of only during their degree programs. This proposal will now be in conformity with the statute and will permit applicants to substitute their hours of supervised clinical work experience in lieu of their supervised field training.

Prior to the enactment of 2003 Wisconsin Act 301, s. 447.08 (4), Stats., required that applicants for licensure as a clinical social worker had to provide evidence that during the applicant's degree program, he or she took a course of study that included a clinical focus and a supervised field training. Because the law did not provide a means of achieving postgraduate clinical credit, this provision was found to be overly restrictive and was therefore amended by the legislature with 2003 Wisconsin Act 301. The amendment permitted applicants to obtain their clinical requirements in a postgraduate setting, rather than just during their degree programs.

The proposed rule changes would implement 2003 Wisconsin Act 301 by setting forth a specific number of hours of supervised clinical work experience which, in turn, could be substituted for the supervised clinical field training. Additionally, the proposal would amend s. MPSW 2.01 (9), which defines the term “clinical concentration in social work." Currently the rule requires clinical courses to comprise at least 40% of their non-field placement credits in their degree program. This rule has resulted in unintended inequities for applicants, depending on how many credits are required for each degree program. By requiring specific clinical courses, instead of a percentage of them, applicants will have to meet uniform criteria, regardless of how many credits are required in their degree program.

SECTION 1. Section MPSW 2.01 (9) (intro.) is amended. Under the existing rule, in order to graduate with a “clinical social work concentration" in either a master's or doctoral program, clinical courses must comprise at least 40% of the non-field placement credits. The existing rule also delineates the areas in which the theory and practice courses must be taken, for example, in case management, psychopathology in social work, clinical assessment and treatment of specific populations, psychopharmacology, psychotherapeutic interventions, and social work related electives.

The proposal eliminates the 40% non-field placement credit requirement. Instead, the rule would require students to take one psychopathology in social work course and two theory and practice courses from the following groups: case management, clinical assessment and treatment of specific populations and problems, psychopharmacology, psychotherapeutic interventions, and social work related electives.

SECTION 2. Section MPSW 2.01 (9) (b) is repealed because the psychopathology in social work course would now be a mandatory course, rather than an elected one.

SECTION 3. Section MPSW 3.09 (1) is amended. The existing rule requires applicants for licensure as clinical social workers to have either a master's or doctoral degree in social work with a concentration in clinical social work. It also requires the completion of supervised field training as part of the degree program. This amendment enables applicants to substitute 1,500 hours of supervised clinical work experience in lieu of their supervised field training by submitting an affidavit indicating that they have completed 1,500 hours of supervised clinical social work experience in not less than one year in clinical setting, and which also includes at least 500 hours of supervised, face-to-face client contact.

The department finds that this rule has no significant fiscal effect on the private sector.

The department estimates that this rule will require staff time in the Division of Professional Credentialing and Office of Legal Counsel to revise applications, and to provide customer service. The value of these staffs' salary and fringe benefits for this work is estimated at $828.

Pursuant to s. 227.114 (1) (a), Stats., these proposed rules will have no significant economic impact on a substantial number of small businesses. The Department's Small Business Regulatory Review Coordinator may be contacted by email at christopher.klein@drl.state.wi.us, or by calling (608) 266-8608.

Pamela Haack, Department of Regulation and Licensing, Office of Legal Counsel, 1400 East Washington Avenue, Room 171, P.O. Box 8935, Madison, Wisconsin 53708-8935. Telephone: (608) 266-0495.
Email: pamela.haack@drl.state.wi.us. Copies of the notice of hearing are available upon request.

Comments may be submitted to Pamela Haack, Department of Regulation and Licensing, 1400 East Washington Avenue, Room 171, P.O. Box 8935, Madison, Wisconsin 53708-8935.
Email pamela.haack@drl.state.wi.us. Comments must be received on or before July 11, 2005, to be included in the record of rule-making proceedings.

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 (3), Wis. Stats., and interpreting s. 457.14 (1) (a) to (d) 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 amend s. MPSW 3.11 (5), relating to expiration of a temporary credential issued by the Social Worker Section.

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.

Statutes interpreted: Section 457.14 (1) (a) to (d) and (2), Stats.

Sections 15.08 (5) (b), 227.11 (2) and 457.03 (3), Stats

Currently, s. MPSW 3.11 provides that a temporary credential expires upon notification of having failed the required examination or 9 months after having been issued, whichever is earlier. This proposal would permit applicants to retake the failed examination without having to surrender their temporary certificate or license, thereby allowing them to remain in practice while they await the next examination opportunity. However, the temporary certificate or license would still expire 9 months from the date of its issuance.

The current rule provides that a temporary social worker license will expire when the holder fails the required examination, or after the 9 month period passes, whichever is earlier. The person who fails the required examination must then return their license to the social worker section. Furthermore, this temporary license may not be renewed.

The proposed rule-making order would eliminate the expiration of the temporary license upon the failure of the required examination and that the license holder must then return the license. The proposed change would allow the temporary license holder to retake the required examination until they are able to pass the examination during the 9 month period of time. Therefore, the license will only expire at the end of the 9 month period of the license and may not be renewed.

The proposed rule change is good because it eliminates the loss of the temporary license and streamlines the licensing process while maintaining the protection of the public. The protection is maintained because under either version of the rule – current or proposed – the license holder could retake the examination; however, with the proposed change, the license holder would still be able to practice while retaking the examination. Previously, at best the person could only practice case management; at worst they may be terminated due to the loss of the temporary license. Furthermore, small business will not be affected and there may be a small benefit as the temporary credential holder may remain in practice while they are attempting to pass the required examination.

The department finds that this rule has no significant fiscal effect on the private sector.