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 HistoryHistory: 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. DHS 1.05(6)(d)(d) Not issue a billing statement or collect from the parent of a minor client who is receiving treatment for alcohol or drug abuse without the consent of a parent or guardian, as provided in s. 51.47, Stats. DHS 1.05 HistoryHistory: 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; CR 19-020: r. and recr. Register December 2019 No. 768, eff. 1-1-20; correction in (1) (c), (4) (e) made under s. 35.17, Stats., Register December 2019 No. 768. DHS 1.06(1)(1) General. Subject to s. 46.10 (3) and (16), Stats., the department or county department shall collect payment from any liable person, in the amount established under s. DHS 1.05 (4). DHS 1.06(2)(2) Delinquent account. A client’s account is delinquent when all of the following have occurred: DHS 1.06(2)(b)(b) The department or county department has notified all applicable liable persons under s. DHS 1.04 (1) at least 3 times using 30, 60, and 90 day dunning letters or their equivalent of the missed payments and documented each notification attempt. DHS 1.06(3)(3) Non-pursuit. The department or county department may not attempt to engage in collection efforts established under this chapter any time that a liable person does not have ability to pay under s. DHS 1.05 (4). DHS 1.06(4)(4) Enforcement. The department or county department may enter into agreement or settlement with a liable person, or issue an order to compel payment as provided under s. 46.10, Stats. The department or county department shall send an order to compel by certified mail to the last known address of a liable person. DHS 1.06(5)(5) Use of collection agencies. The department may establish a written agreement with a collection agency or with the Wisconsin department of revenue to perform any duties and responsibilities under this section, or under ss. 71.93 and 71.935, Stats. A collection agency shall comply with the requirements specified in s. 218.04, Stats. DHS 1.06(6)(6) Appeals. A person aggrieved by an order to compel payment, issued by the department under sub. (4), may appeal the order as a contested case under ch. 227, Stats., as follows: DHS 1.06(6)(a)(a) A request for appeal must be mailed to the department of administration’s division of hearings and appeals, within 30 days after the date of the order. DHS 1.06(6)(b)(b) A request shall be deemed filed on the day that it is received by the department of administration’s division of hearings and appeals. DHS 1.06 NoteNote: Divisions of Hearings and Appeals
DHS 1.06 NoteP.O. Box 7875
DHS 1.06 Note4822 Madison Yards Way #5
DHS 1.06 NoteMadison, WI 53707-7875
DHS 1.06 HistoryHistory: 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; CR 19-020: r. and recr. Register December 2019 No. 768, eff. 1-1-20; correction in (2) (intro.), (5) made under s. 35.17, Stats., Register December 2019 No. 768. DHS 1.065DHS 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. DHS 1.065(1)(b)(b) 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, 46.277 or 46.278, Stats., or otherwise with federal, state or county funds. DHS 1.065(1)(c)(c) This section applies to services for children under the children’s community options program under s. 46.272, Stats. DHS 1.065(2)(a)(a) “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. DHS 1.065(2)(b)(b) “Service plan” means a written plan for providing services covered by this section. DHS 1.065(3)(3) Determining parental payment limits. The county administrative agency shall determine the parental payment limit for each child receiving services covered by this section. The county administrative agency shall determine the parental payment limit for services covered by this section in the following manner: DHS 1.065(3)(a)(a) 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. DHS 1.065(3)(b)2.2. 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 NoteNote: 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 DHS 1.065(3)(c)(c) 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. DHS 1.065(3)(d)(d) 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. Table DHS 1.065
DHS 1.065 NoteNote: 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 Division of Medicaid Services, P.O. Box 7851, Madison, WI 53707-7851, or visit the Department’s website at http://www.dhs.wisconsin.gov/children/clts/ppl/index.htm. DHS 1.065(3)(e)(e) Compute the annual cost of the child’s service plan. Subtract administrative and support and service coordination functions. DHS 1.065(3)(f)(f) 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). DHS 1.065(3m)(b)(b) 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. DHS 1.065(3m)(c)(c) A county may consider a family’s financial hardship when determining the parental payment limit. DHS 1.065(4)(4) Notification of parental financial obligation. The county administrative agency shall provide written notice to the parents of the amount of annual parental financial obligation due before the service plan is implemented, or as soon thereafter as administratively possible, that includes all of the following: DHS 1.065(4)(a)(a) The date of the implementation of the parental financial obligation, which is the start date on the service plan. DHS 1.065(4)(b)(b) The annual amount due, with a breakdown of monthly minimum requirements. DHS 1.065(4)(c)(c) Procedures offered by the county administrative agency for reconsideration of the parental financial obligation.
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