Ch. DHS 1 Note
Note: Chapter HSS 1 as it existed on August 31, 1978 was replaced and a new chapter HSS 1 was created effective September 1, 1978. Chapter HSS 1 was renumbered chapter HFS 1 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats.,
Register, April, 1997, No. 496. Chapter HFS 1 was renumbered chapter DHS 1 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats.,
Register November 2008 No. 635. Chapter DHS 1 was substantially revised,
Register December 2019 No. 768, eff. 1-1-20.
DHS 1.01
DHS 1.01
Authority and purpose. This chapter is authorized by s.
227.11 (2) and interprets ss.
46.03 (18) and
46.10, Stats., to establish a system for determining fees, liability, billing, and collection practices for services.
DHS 1.01 History
History: Cr.
Register, August, 1978, No. 272, eff. 9-1-78; am. (1), (3), (4) (b) and (5), renum. (2) (j) to (l) to be (2) (k) to (m), cr. (2) (j), renum. (4) (d) to be (4) (d) 1., cr. (4) (d) 2. to 5.,
Register, November, 1979. No. 287, eff. 1-1-80; am. (2) (j), (4) (c) 1. and (d) 2., r. (5),
Register, December, 1980, No. 300, eff. 1-1-81; correction in (3) under s. 13.93 (2m) (b) 4., Stats.,
Register, September, 1984, No. 345; am. (1), (2) (g) and (4) (c),
Register, September, 1984, No. 345, eff. 10-1-84; r. and recr. (1), (2) (e), (h) and (j),
Register, December, 1987, No. 384, eff. 1-1-88; emerg. am. (1), eff. 1-22-97; am. (1),
Register, August, 1997, No. 500, eff. 9-1-97; corrections in (2) (h) and (4) (b) made under s. 13.93 (2m) (b) 7., Stats.,
Register, June, 2001, No. 546;
CR 08-017: am. (1) and (2) (j)
Register June 2008 No. 630, eff. 7-1-08; corrections in (2) (b), (L) and (4) (d) 4. made under s. 13.92 (4) (b) 6., Stats.,
Register November 2008 No. 635; correction in (1) made under s. 13.92 (4) (b) 7., Stats.,
Register February 2017 No. 734;
CR 19-020: r. and recr.
Register December 2019 No. 768, eff. 1-1-20.
DHS 1.02(1)(1)
“Administratively unfeasible” means the cost of collection would likely exceed the fee established for a service.
DHS 1.02(2)
(2) “
Client” means a person who has received services.
DHS 1.02(3)
(3) “
Collection period” means the period of time calculated for each unit of service, which begins on the day a service is provided and ends as provided in ss.
893.87 and
893.40, Stats., when the liability has been paid in full, or as provided under any other applicable statute of limitations. The cause of action accrues the month the service is provided.
DHS 1.02(4)
(4) “
County department” means any of the following:
DHS 1.02(4)(c)
(c) A county department of developmental disabilities services under s.
51.437, Stats.
DHS 1.02(5)
(5) “
Department” means the department of health services.
DHS 1.02(7)
(7) “
Minor” means a person under 18 years of age.
DHS 1.02(8)(a)
(a) A person who has legal custody under Wisconsin law of a minor client who receives services, or who had legal custody under Wisconsin law of a minor at the time services were provided, unless a court determined or ordered that the person is not liable or otherwise responsible for their payment.
DHS 1.02(8)(b)
(b) A resident of the state appointed guardian of a child by a foreign court who brought a child into this state for the purpose of adoption.
DHS 1.02(9)
(9) “
Services” means services provided to a person by the department or a county department, or care, maintenance, services and supplies described in s.
46.10 (2), Stats., except:
DHS 1.02(9)(b)
(b) Community-based juvenile delinquency-related services.
DHS 1.02(9)(f)
(f) Services for which the department or a county department determines fee collection would be administratively unfeasible, or assignment of liability for the service would prevent accomplishing the purpose of the service.
DHS 1.02(9)(g)
(g) Any other services for which the department or a county department may not legally assess a fee, establish liability, or collect payment.
DHS 1.02(10)(a)
(a) A person who is currently married, as recognized by Wisconsin law, to a person who received services.
DHS 1.02(10)(b)
(b) A person who was married, as recognized by Wisconsin law, to a person who received services at the time services were provided.
DHS 1.02 History
History: Cr.
Register, August, 1978, No. 272, eff. 9-1-78; am. (1), (2) (b), renum. (3) and (4) to be (8) and (9) and am. (8) (a) and (9), cr. (3) to (7),
Register, November, 1979, No. 287, eff. 1-1-80; emerg. am. (6) (intro.) and (b) and (7), eff. 7-1-80; am. (6) (intro.) and (b) and (7),
Register, October, 1980, No. 298, eff. 11-1-80; am. (2) (intro.), r. (2) (a) and (b), (6) and (7), renum. (8) and (9) to be (6) and (7) and am. (6),
Register, December, 1980, No. 300, eff. 1-1-81; am. (1), r. and recr. (6),
Register, September, 1984, No. 345, eff. 10-1-84; am. (6) (a) and (e),
Register, December, 1987, No. 384, eff. 1-1-88; r. (4) (d),
Register, August, 1997, No. 500, eff. 9-1-97;
CR 08-017: am. (6) (d), cr. (6) (f)
Register June 2008 No. 630, eff. 7-1-08;
CR 19-020: r. and recr.
Register December 2019 No. 768, eff. 1-1-20; correction in (3), (4) (a), (9) (a) made under s.
35.17, Stats.,
Register December 2019 No. 768; correction in (9) (a) made under s.
13.92 (4) (b) 7., Stats.,
Register March 2022 No. 795.
DHS 1.03(1)(1)
The department shall establish fees for services provided. Fee schedules are updated annually each fall for use in the following calendar year. The maximum monthly payment schedule is calculated using the Consumer Price Index for the Midwest region, gross monthly income, and number of persons living in the family.
DHS 1.03(2)
(2) Fees for services provided by the county department under s.
51.42, Stats., shall be established and approved annually by a county board of supervisors.
DHS 1.03 History
History: Cr.
Register, August, 1978, No. 272, eff. 9-1-78; am. (2) to (6), renum. (7) to (14) to be (8), (11), (12), (14), (17) to (20) respectively and am. (8), (11), (14), (17), (18) (b) and (20), r. and recr. (18) (a), cr. (7), (9), (10), (13), (15) and (16),
Register, November, 1979, No. 287, eff. 1-1-80; emerg. am. (18) (a), eff. 7-1-80; am. (18) (a),
Register, October, 1980, No. 298, eff. 11-1-80; r. and recr. (18) (a), cr. (18) (c) and (21),
Register, December, 1980, No. 300, eff. 1-1-81; cr. (13m),
Register, June, 1981, No. 306, eff. 7-1-81; am. (8), (10), (13), (13m), (14) (a), (15) and (18) (c), r. and recr. (11) (b) 4. and (12), r. (11) (b) 5.,
Register, September, 1984, No. 345, eff. 10-1-84; am. (11) (b) 1., (13) and (18) (c), r. (16) (b) 3., renum. (16) (b) 4. to be 3., r. and recr. (18) (a) and (21),
Register, December, 1987, No. 384, eff. 1-1-88; emerg. cr. (12m), eff. 1-22-97; cr. (12m),
Register, August, 1997, No. 500, eff. 9-1-97; correction in (13m) made under s. 13.93 (2m) (b) 7., Stats.,
Register, June, 2001, No. 546;
CR 08-017: am. (12) (c) (intro.) and (21) (intro.)
Register June 2008 No. 630, eff. 7-1-08; correction in (13m) made under s. 13.92 (4) (b) 7., Stats.,
Register November 2008 No. 635;
CR 10-146: r. and recr. (20) (c)
Register May 2011 No. 665, eff. 6-1-11;
CR 19-020: r. and recr.
Register December 2019 No. 768, eff. 1-1-20.
DHS 1.04(1)(1)
General. Unless otherwise provided by law, the following persons are liable for services provided to a client:
DHS 1.04(1)(d)
(d) A person that a court determines or orders to be liable or otherwise responsible for payment of services provided to a minor.
DHS 1.04(2)
(2) Amount of liability. The amount of liability of any person under sub.
(1) for services provided to a client shall be based upon the fee established under s.
DHS 1.03, subject to subs.
(4) and
(5).
DHS 1.04(3)
(3) Enforcement. The department may bring action to declare the liability of any person or entity under sub.
(1), or to enforce payment toward such liability.
DHS 1.04(4)(a)(a) The department or a county department may permanently waive the liability for a service rendered to a client for any of the following reasons:
DHS 1.04(4)(a)2.
2. The client receives Social Security Disability or Supplemental Security Income.
DHS 1.04(5)
(5) Non-compliance. The liability of a person under sub.
(1) may not be waived as provided in sub.
(4) if the department determines that the person does any of the following:
DHS 1.04(5)(a)
(a) Refuses to complete a financial responsibility form or to provide documentation required to verify information provided in a financial responsibility form.
DHS 1.04(5)(b)
(b) Intentionally misrepresents any information provided in a financial responsibility form.
DHS 1.04(6)
(6) Cost-share exception. Subsections
(1) to
(3) do not apply to an individual who is required to meet department cost-sharing requirements under s.
49.45 (18), Stats., for receiving services from community based residential facilities or any other assisted living facility.
DHS 1.04 History
History: Cr.
Register, August, 1978, No. 272, eff. 9-1-78; am. (1) (intro.) and (a), renum. (1) (d) and (e) to be (1) (g) and (h), r. and recr. (1) (g), cr. (1) (d) to (f),
Register, November, 1979, No. 287, eff. 1-1-80; am. (1) (d) (intro.) and (2) (e), cr. (2) (f),
Register, September, 1984, No. 345, eff. 10-1-84; am. (1) (intro.), (g) 1. and 2., r. and recr. (1) (d) and (2) (a),
Register, December, 1987, No. 384, eff. 1-1-88;
CR 19-020: r. and recr.
Register December 2019 No. 768, eff. 1-1-20.
DHS 1.05(1)(1)
General. Each month during the collection period, the department or county department shall, as applicable, issue a billing statement that indicates any outstanding liability to each of the following:
DHS 1.05(2)
(2) Third-party payers. The department or a county department shall file a claim with any third-party payers in a manner consistent with s.
Ins 3.40. Medical Assistance shall be the payer of last resort.
DHS 1.05(3)
(3) Authorized representative.
Upon receipt of proof of any such relationship, billing statements shall be issued to a legal representative of a client, including a guardian of the estate, a representative payee, or any other person or entity authorized by law or through the client's written consent, to receive such information.
DHS 1.05(4)
(4) Amount. The monthly payment amount established in s.
DHS 1.03 (1) billed and subject to collections, if any, shall be based upon liability established under this chapter, the maximum monthly payment schedule, and ability to pay. All of the following apply in determining the monthly payment amount:
DHS 1.05(4)(a)
(a)
Ability to pay. Ability to pay shall be determined by use of a financial responsibility form that gives due regard to relationship and the present needs of the person or of the lawful dependents. Subject to par.
(b) and s.
DHS 1.04 (5), ability to pay may be determined at any of the following times during the collection period:
DHS 1.05(4)(a)1.
1. Upon receipt of a financial responsibility form by the department or county department from a person liable under s.
DHS 1.04 (1).
DHS 1.05(4)(a)2.
2. When the department or a county department receives notice that there has been a change in the financial circumstances of a person liable under s.
DHS 1.04 (1).
DHS 1.05(4)(b)
(b)
Best able to pay. After investigation of the liable persons' ability to pay, the department or, if applicable, the county department shall make collection from the person who in the opinion of the department under all of the circumstances is best able to pay as provided in s.
46.10 (3), Stats.
DHS 1.05(4)(c)
(c)
Shortcut Method. A person may be deemed unable to pay under par.
(a) if any of the following apply:
DHS 1.05(4)(c)2.
2. The person is receiving Social Security Disability or Supplemental Security Income.
DHS 1.05(4)(d)
(d)
Services received by a minor without consent. If a minor receives services without consent of a parent or guardian under s.
51.138 or
51.47, Stats., the department or, if applicable, the county department shall base the fee solely on the minor's ability to pay.
DHS 1.05(4)(e)
(e)
Adjustments. The department may adjust a past determination of ability to pay, looking back 90 days from the date of receipt of a financial responsibility form under sub.
(4) (a).
DHS 1.05(5)
(5) Billing statements. At a minimum, a billing statement shall include all of the following information:
DHS 1.05(5)(a)
(a) An itemization of any services provided during the billing period, including the date the service was provided, the number of units, and the fee amount.
DHS 1.05(5)(b)
(b) Any claim filed with a third-party payer and any expected payment on the claim.
DHS 1.05(5)(c)
(c) The date and amount of any other payments received during the billing period.
DHS 1.05(5)(d)
(d) The total outstanding liability as of the date of the statement.
DHS 1.05(5)(f)
(f) The due date and amount of monthly payment required under sub.
(4).
DHS 1.05(6)
(6) Other requirements. The department or county department shall:
DHS 1.05(6)(a)
(a) Maintain documentation of compliance with this section. Counties shall provide such documentation to the department upon request.
DHS 1.05(6)(b)
(b) Establish a documented procedure to periodically review accounts for accuracy and compliance with this chapter.
DHS 1.05(6)(c)
(c) Establish a written grievance procedure for actions relating to liability determination, billing, and collections.
