Payments shall be applied to the oldest period of service for which a liability remains, except as provided in the following paragraphs of this subsection.
When a responsible party has liability for adult inpatient care and for some other type of service, payments shall not be applied to the adult inpatient liability until other liabilities have been satisfied according to these rules.
Payment from one responsible party shall have no effect on decreasing the liability of other responsible parties except as total liability is decreased.
When private insurers or government agencies make payments against claims or statements that specify dates of service, such payments shall be applied to liability for the period indicated.
For clients residing in facilities, payments from client's own income shall be applied to the liability incurred during the month the income is received except that retroactive benefits may be applied to liability incurred back to the date of entitlement. The priority of payments for clients residing in facilities is as follows:
DHS 1.05(13)(a)(a) Definition.
An account is considered delinquent when a determination has been made that ability to pay currently exists, that no payment has been made over a period of 90 days, and that 3 or more contacts have been made to secure a payment.
(b) Follow-up of accounts.
Each billing/collection unit shall have a procedure to review accounts periodically for follow-up. When no payment is made on the initial billing, a second billing showing accumulated monthly charges shall be sent during the next calendar month. A note shall be enclosed explaining the bill and the amount now due. No response after 30 days following the second billing suggests checking with the service staff to see if there are any known reasons why collection efforts should not be pursued. Options are to:
Modify the approach by writing individualized letters or making telephone or other contacts.
(bm) Determining courses of action for unclear cases.
The payment approval authority shall determine the course of action for unclear cases. Actions taken shall be documented in the client's collection file.
(c) Referral of accounts for collection.
Agencies shall refer accounts for collection when the accounts are considered delinquent as defined in par. (a)
and when the agency's own collection unit has completed required follow-up procedures.
The following channels shall be utilized, depending on their availability and potential for timely handling of the account:
District attorney or corporation counsel handling legal matters for the county department of social services, or 51.42, 51.437 or 46.23 board involved.
No referral may be made to a private collection agency or private law office without the written permission of the bureau of fiscal services.
The following information shall be sent to the collection unit when referring an account for collection:
Referring agencies are responsible to follow-up on the status of referred accounts.
Responsible parties involved shall be notified in writing when the agency plans to refer the account for collection.
(14) Enforcement of Parental Support for Court-ordered Substitute Care.
When a child is placed in substitute care, as defined in s. DHS 1.07 (2) (i)
, pursuant to an order under s. 48.355
, Stats., or under s. 938.355
, Stats., payment approval authorities shall use the provisions of ss. 46.10 (14) (e)
, Stats., and chs. 767
, Stats., as applicable, to enforce the collection of parental support payments.
DHS 1.05 History
Cr. Register, August, 1978, No. 272
, eff. 9-1-78; renum. (1) to be (1) (a), cr. (1) (b) to (e), renum. (2) to be (2) (a) and cr. (2) (b), renum. (5), (6) and (7) to be (6), (12) and (13), and am., cr. (5) and (7) to (11), Register, November, 1979, No. 287
, eff. 1-1-80; am. (12) (b) and (e), Register, December, 1980, No. 300
, eff. 1-1-81; correction in (2) (d) under s. 13.93 (2m) (b) 7., Stats., and in (3) under s. 13.93 (2m) (b) 4., Stats., Register, September, 1984
; am. (4), (7) and (13) (c) (intro.), Register, September, 1984, No. 345
, eff. 10-1-84; renum. (13) (c) 1. b. to be 1. c. and am., cr. (13) (c) 1. b., Register, December, 1987, No. 384
; corrections made under s. 13.93 (2m) (b) 6, Stats., Register, August, 1994, No. 464
; emerg. cr. (2) (c) and (14), eff. 1-22-97; cr. (2) (c), (14), am. (13) (c) 1. b., Register, August, 1997, No. 500
, eff. 9-1-97; correction in (10) (d) made under s. 13.92 (4) (b) 7., Stats., Register June 2008 No. 630
DHS 1.06 Record-keeping, reports, confidentiality requirements, and disclosure authority. DHS 1.06(1)
Except as provided in statutes and these rules, information regarding a client and all interested parties, collected by a facility or agency subject to these rules, shall remain confidential.
Confidentiality provisions shall not prohibit disclosure of information in the following situations:
Disclosure of financial and service information without informed consent for services provided under ch. 51, Stats.
, may be made to the department, the program director of a board established under s. 51.42
, Stats., a qualified staff member designated by the program director or a county department of social services only under conditions specified in s. 51.30
, Stats., and rules promulgated thereunder.
Disclosure of financial and service information without informed consent for all other services under the uniform fee system may be made to the department, qualified staff members of a board established under s. 51.42
, Stats., or qualified staff members of a county department of social services when the information disclosed is for billing and collection purposes.
Further disclosure of financial and service information obtained under pars. (a)
may be made without informed consent by a board established under s. 51.42
, Stats., or a county department of social services to the county district attorney or corporation counsel for the purpose of enforcing the collection of delinquent accounts in the courts.
DHS 1.06 Note
Note: The district attorney or corporation counsel must be seen as the legitimate counsel to the county agencies named in this section.
Billings sent to the following persons shall not constitute unlawful re-disclosure of financial or service information when such information is obtained by the agency in accordance with s. 51.30 (4) (b) 2.
The parent, guardian or person acting in loco parentis for a minor client.
The representative payee for benefits owing to the client from social security or SSI.
The guardian of the estate of a person adjudged incompetent under ch. 54, Stats.
Except where prohibited by a federal regulations relating to alcohol and drug treatment records, the persons named in s. 51.30 (5) (a)
, Stats., may consent in place of the client for the release of medical information in order to obtain insurance benefits owing to the client, the client's spouse or the parents of a client.
DHS 1.06(3)(a)(a) Records.
Clear, exact and auditable records shall be established and maintained for each client regardless of the client's financial status or services involved. Such information shall include:
The nature of the contact (professional service or paraprofessional service).
In the case of residential services, the actual days of care must be documentable.
DHS 1.06 Note
Note: This does not mean that all of these records must be reported to the agency's billing unit; but, if necessary, the provider's records should include or allow for each client, the potential for reporting to the billing unit enough information to prepare a billing statement that establishes liability for and by each calendar month during which services are provided.
(b) Individual account control record.
Each billing and collection unit has broad flexibility to design a system that best fits the agency's needs and also satisfies the requirements of the uniform fee system. A record system is required that brings together all units of services provided for those clients whose accounts must be set up for billing a responsible party or third-party under the uniform fee system. For such cases, financial information forms and other information to prepare billings must be reported to the billing unit. The billing and collection unit is responsible for posting data to individual account control records from information received as soon as possible, including services provided and payments made as well as dates of service and dates of payments.
(c) Client collection file.
There shall be a client collection file for every account billed. The file shall include:
Copies of financial information forms for all responsible parties who elect to be billed according to their ability to pay.
Updated information after each year (6 months for social service clients) concerning the family's ability to pay when billing extends for more than one year (6 months for social service clients).
Closing client records; record retention period.
Client records may be closed after the department or payment approval authority determines that any one of the conditions listed under s. DHS 1.03 (20) (a)
applies. Closed client records shall be maintained for at least 5 years.
(4) Agency records.
Each agency or facility covered by these rules shall keep complete, clear, and exact records of allocation of staff time, service units delivered, and all revenues and gross expenditures.
(5) Required reports.
Each facility or agency covered by these rules shall submit to the department such reports on client liability, billings, and collections as the department may require.
DHS 1.06 History
Cr. Register, August, 1978, No. 272
, eff. 9-1-78; am. (1), r. and recr. (2) (a) and (b), cr. (2) (c) to (e), r. and recr. (3) (a), renum. (3) (b) and (c) to be (3) (d) and (e), cr. (3) (b) and (c), Register, November, 1979, No. 287
, eff. 1-1-80; correction in (2) (d) 5. made under s. 13.92 (4) (b) 7.
, Stats., Register June 2008 No. 630
; CR 10-146
: r. and recr. (3) (d), r. (3) (e) Register May 2011 No. 665
, eff. 6-1-11.
DHS 1.065 Children's long-term support parental payment limits. DHS 1.065(1)(a)(a)
This section establishes a parental payment limit for certain children's long-term support services identified in this subsection. These provisions apply to all county administrative agencies that administer the services to which this section applies.
This section applies to children's services of a type that may be reimbursed under a waiver under the disabled children's long-term support program as defined in s. 46.011 (1g)
, Stats., regardless of whether those services are actually reimbursed under that program, under the community integration program waivers under s. 46.275
, Stats., under the community options program waiver under s. 46.27 (11)
, Stats., or otherwise with federal, state or county funds.
This section applies to services for children under the family support program under s. 46.985
“County administrative agency" means the county department designated to administer and provide or contract for children's services covered by this section in that county.
“Service plan" means a written plan for providing services covered by this section.
(3) Determining parental payment limits.
The county administrative agency shall determine the parental payment limit for each child receiving services covered by this section. Notwithstanding s. DHS 1.03 (12) (c)
, the county administrative agency shall determine the parental payment limit for services covered by this section in the following manner:
Determine the annual parental income. If the parents live in separate households and the child receiving services covered by this section resides in both households, determine a separate parental payment limit for each household.
Allowable medical or dental expenses claimed for the child on schedule A of the parent's most recent internal revenue service tax form 1040 that was filed with the internal revenue service.
DHS 1.065 Note
The Internal Revenue Service (IRS) has a web-based guide to assist in identifying which expenses may be claimed to Schedule A of the 1040 form for allowable medical and dental expenses that would qualify as itemized deductions. Please see IRS Publication 502 at the following address http:www.irs.gov/publications/p502/index.html
Determine the federal poverty level based on current federal poverty guidelines for the family size. If the parents live in separate households and the child resides in both households, determine the family size and federal poverty level for each household.
Determine whether the income, adjusted as provided in under par. (b)
is at or above 330% of the federal poverty level and identify the percentage of the annual service plan costs owed based on the most current Children's Long-term Support Parental Payment Limit Worksheet provided by the department. Use Table DHS 1.065 to determine the percentage of service plan costs for which the parents may be liable.
DHS 1.065 Note
The federal poverty guidelines are adjusted yearly by the federal Office of Management and Budget under 42 USC § 9902 (2) and are published annually in the Federal Register. The federal poverty guidelines and the CLTS Parental Payment Limit Worksheet are distributed annually by the Department to counties for use in calculating the parental payment limit. To receive the current federal poverty guidelines and the CLTS Parental Payment Limit Worksheet, contact the Children's Services Section, at the Division of Long Term Care, P.O. Box 7851, Madison, WI 53707-7851, or fax at 608-223-7703 or visit the Department's website at http://www.dhs.wisconsin.gov/children/clts/ppl/index.htm
Compute the annual cost of the child's service plan. Subtract administrative and support and service coordination functions.
For families with an income over 330% of the federal poverty level, multiply the percentage established in par. (d)
by the amount established in par. (e)
If a parent refuses to provide financial information to the administering agency, then their parental payment limit shall be 41% of the annual cost of the child's service plan.