Comments submitted through the Wisconsin Administrative Rule Web site at: http://adminrules.wisconsin.gov on the proposed rule will be considered.

The deadline for submitting comments is 4:00 p.m. on the 14th day after the date for the hearing stated in this Notice of Hearing.

For a summary of the rule see the analysis contained in the attached proposed rulemaking order below. There will be no state or local government fiscal effect. The full text of the proposed changes, a summary of the changes and the fiscal estimate may be obtained form the contact person noted below.

The Commissioner of Insurance finds that an emergency exists and that the attached proposed emergency rule is necessary for the immediate preservation of the public peace, health, safety, or welfare. Emergency Rule 1117 (EmR1117), was effective November 16, 2011 and is to be first applicable on January 1, 2012. EmR1117 contained provisions modifying Wisconsin's insurance regulations governing grievances and independent review processes to comply with federal law provisions of 42 USC 300gg 19 (a) and (b), as implemented by 45 CR 147.136, as amended. It has been determined that this may not be in the best interest of the state.

The proposed emergency rule will repeal EmR1117 in its entirety and maintain Wisconsin's prior existing regulations and oversight of the grievance and independent review process. To avoid full implementation of EmR1117 and industry and consumer confusion, the Commissioner has determined that this emergency rule must be effective prior to January 1, 2012.

Sections 600.01, 628.34 (12), 632.73, 632.76, 632.81, 632.83, 632.835, and 632.84, Stats.

Sections 600.01 (2), 601.41 (3), 628.34 (12), 632.73, 632.76, 632.81, 632.835 (5) and (8), and 632.84, Stats.

The OCI has authority to promulgate rules interpreting s. 632.83 and 632.835, Stats., implementing grievance and independent review requirements and procedures. In addition s. 632.835, Stats., permits the OCI to promulgate rules for the certification of independent review organizations.

None.

The proposed emergency rule reinstates all provisions of Ch. Ins 18, Wis. Adm. Code as it existed prior to November 16, 2011.

Amendments to the Public Health Service Act (42 USC 300gg-19 (a) and (b)) created an internal appeal and external review right for consumers covered by group or individual health insurance. Section 2719 of the Public Health Service Act is implemented by interim final rules and guidance as issued by the US Department of Health and Human Services (45 CFR 147.136, as amended).

Illinois: Effective August 26, 2011, Illinois passed House Bill 224 further implementing the Patient Protection and Affordable Care Act (PPACA) by including provisions for preexisting conditions and rescissions and modifying review timeframes to comply with federal requirements. This builds on Illinois' managed care reform and patients right act 215 ILCS 134, providing to insureds for insured enrolled in health maintenance organizations a right to external review of medical necessity determinations. Also on January 5, 2010, Illinois enacted the health carrier external review act that broadens the right to external review to all Illinois residents enrolled in health insurance plans under 215 ILCS 180.

Iowa: Effective March 23, 2011, Iowa enacted House File 597 to enact new procedures for external review in order to comply with federal law. Iowa updated its regulations 191- ch. 76 effective July 8, 2011 and is compliant with federal requirements.

Michigan: Effective October 1, 2000, Michigan offers external review for adverse determinations based upon medical necessity that are unresolved internally by the plan. 2000 PA 251, MCL 550.1911. Michigan is compliant with federal requirements.

Minnesota: Effective 2000 Minnesota enacted a law that provides external review relating to medical necessity determinations from managed care plans and indemnity carriers. Minn. Stat. 72A.327. Minnesota is compliant with federal requirements.

The office reviewed state and federal law and regulations that reflect the National Association of Insurance Commissioners Uniform Health Carrier External Review Model Act and the Department of Labor's regulations for ERISA plans. Insurers and independent review organizations are required to comply with the federal requirements and state requirements by promulgation of this emergency rule. This rule reinstates Ch. Ins 18 Wis. Adm. Code, as it read prior to November 16, 2011.

The independent review organizations are certified by the commissioner's designee to conduct independent reviews in the state and several are small businesses. The additional cost for complying with this rule is no different for an independent review organization cost for complying with the federal law. Further, if there is additional cost it will be primarily borne by large insurers who are required to pay for the cost of an independent review, not the independent review organizations. The proposed rule places few additional requirements on the independent review organizations and in clarifying what is and is not eligible for reviews, the costs incurred will be limited.

This rule change will have no significant effect on the private sector regulated by OCI.

This rule will have little or no effect on small businesses.

Notice is hereby further given that pursuant to s. 227.114, Stats., the proposed rule may have an effect on small businesses. The initial regulatory flexibility analysis is as follows:

Notice is hereby further given that pursuant to s. 227.14 (2g), Stats., the proposed rule may have an economic impact on small businesses.

The OCI small business coordinator is Louie Cornelius and may be reached at phone number (608) 264-8113 or at email address Louie.Cornelius@wisconsin.gov.

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:

SECTION 1. Repeal EmR 1117.

SECTION 2. These changes first apply to claims occurring on or after January 1, 2012.

SECTION 3. This chapter may be enforced under ss. 601.41, 601.64, 601.65, 628.10, Stats., or ch. 645, Stats., or any other enforcement provision of chs. 600 to 646, Stats.

SECTION 4. These emergency rule changes will take effect on December 29, 2011, as provided in s. 227.24 (1) (c), Stats.

NOTICE IS HEREBY GIVEN THAT, pursuant to section 227.11 (2) (a), Stats., the Department of Revenue will hold a public hearing to consider permanent rules creating section Tax 11.10, relating to wind, solar, and certain gas powered products.

The hearing will be held:

Handicap access is available at the hearing location.

Interested persons are invited to appear at the hearing and may make an oral presentation. It is requested that written comments reflecting the oral presentation be given to the department at the hearing. Written comments may also be submitted to the contact person listed below no later than February 3, 2012, and will be given the same consideration as testimony presented at the hearing.

This rule is not subject to s. 227.135 (2), as affected by 2011 Wisconsin Act 21. The statement of scope for this rule, published in Register No. 666 on June 14, 2011, was sent to Legislative Reference Bureau prior to the effective date of 2011 Wisconsin Act 21.

Section 77.54 (56), Stats.

Section 227.11 (2) (a), Stats.

Section 227.11 (2) (a), Stats., provides that each agency may promulgate rules interpreting the provisions of any statute enforced or administered by it, if the agency considers it necessary to effectuate the purpose of the statute.

Section Tax 11.68 (4), (5), and (6) provide information on the determination of the classification of property, including products defined and exemplified in this rule, after installation.

This rule defines the term “product" as it applies to the sales and use tax exemption under s. 77.54 (56), Stats., provides examples of items that are and are not considered products, and clarifies the exemption requirements and scope.