(r)
Any other person, entity, or estate with liability as provided under s. 46.10, Stats. AMOUNT OF LIABILITY. Liability of any person, entity, or estate under sub. (1) for services shall be based upon the fee established under s. DHS 1.03, subject to subs. (4) and (5). 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.
WAIVER. (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:
The client receives Medicaid.
The client receives Social Security Disability or Supplemental Security Income.
(s)
Any liability that is waived under sub. (4) shall be documented, as provided in s. DHS 1.05 (5) (e). NON-COMPLIANCE. A person, entity, or estate under sub. (1) may be deemed liable and billed for the entire fee amount established under s. DHS 1.03 if the department determines that the person, entity, or estate does any of the following: (t)
Refuses to complete a financial responsibility form or to provide documentation required to verify information provided in a financial responsibility form. (u)
Intentionally misrepresents any information provided in a financial responsibility form.COST-SHARE EXCEPTION. Subsections (1) to (3) do not apply to individuals that are 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. SECTION 6. DHS 1.05 is repealed and recreated to read:
DHS 1.05 Billing.
(1)
GENERAL. Each month during the collection period, the department shall, as applicable, issue a billing statement that indicates any outstanding liability to the following:(a)
A client who is not a minor.(c)
Any and all authorized representatives under sub. (3). (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. Medicaid shall be the payer of last resort. (3)
AUTHORIZED REPRESENTATIVE. Upon receipt of proof of any such relationship, billing statements shall be issued to any legal representative of a client, such as a guardian of the estate, a representative payee, or any other person or entity authorized by law or through the client’s informed consent, to receive such information. (4)
AMOUNT. The monthly payment amount 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. (d)
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. Except as provided in par. (b) or s. DHS 1.04 (5), ability to may be determined at all of the following times during the collection period:1.
Upon receipt of a financial responsibility form to the department or county department by a person, entity, or estate under s. DHS 1.04 (1).2.
When there has been a change in the financial circumstances of a person, entity, estate under s. DHS 1.04 (1).3.
Every 12 months, while services are being rendered. 4.
At the conclusion of services rendered.
(e)
Shortcut Method. A person may be deemed unable to pay under par. (a) if any of the following apply:1.
The person received Medicaid. The person received Social Security Disability or Supplemental Security Income.
(f)
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. par. (4) (a).(g)
Payment Plans. The department may establish a payment plan for any amount billed under this subsection. (5)
BILLING STATEMENTS. At a minimum, billing statements shall include all of the following information: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.
Any claim filed with a third-party payer and any expected payment on the claim.
The date and amount of any other payments received during the billing period.
The total outstanding liability as of the date of the statement.
The due date and amount of monthly payment required under sub. (4).
(1)
OTHER REQUIREMENTS. The department or county department shall:(v)
Maintain documentation of compliance with this section. Counties shall provide such documentation to the department upon request.(w)
Establish a documented procedure to periodically review accounts for accuracy and compliance with this chapter.(x)
Establish a written grievance procedure for actions relating to liability determination, billing, and collections.(y)
Shall not issue a billing statement or collect from the parent of a minor client who is receiving treatment for alcohol or drug abuse, as provided in s. 51.47, Stats.SECTION 7. DHS 1.06 is repealed and recreated to read:
DHS 1.06 Collections.
(1)
GENERAL. Subject to s. 46.10 (16), Stats., the department shall collect payment from any liable person, entity, or estate in the amount established under s. DHS 1.05 (4). (2)
DELINQUENT ACCOUNT. The department may deem a client’s account to be delinquent, when all of the following have occurred: (a)
No payment toward the amount established under s. DHS 1.05 (4) has been received for 90 consecutive days. (b)
The department has notified all applicable persons or entities under s. DHS 1.05 (1) at least three times of the missed payments and documented each notification attempt. (3)
NON-PURSUIT. The department shall not attempt to enforce payment of any liability established under this chapter at any time that a liable person, entity, or estate does not have ability to pay under s. DHS 1.05 (4).(4)
ENFORCEMENT. The department may enter into agreement or settlements with liable persons, entities, or estates, or issue orders to compel payment as provided under s. 46.10, Stats. The department shall send an order to compel by certified mail to the last known address of a liable person, entity, or estate. (5)
USE OF COLLECTION AGENCIES. The department may establish a written agreement with a collection agency, or the Wisconsin department of revenue, to perform any duties and responsibilities under this section. Collection agencies must be licensed or certified by the Wisconsin department of financial institutions. (6)
COLLECTION REFERRAL. A county department may refer a delinquent account under sub. (1) to the department for collections. (Note) A referral may be made by contacting the Division of Enterprises services at: 608-267-
7104.
(7)
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:(c)
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. (d)
A request shall be deemed filed on the day that it is received by the department of administration’s division of hearings and appeals.(Note) PO BOX 7875
4822 Madison Yards Way #5
Madison, WI 53707-7875
SECTION 8. DHS 1.065 (1) (c) is amended to read:
DHS 1.065 (1) DHS 1.065(1)(c)(c) This section applies to services for children under the family support children’s community options program under s. 46.98546.272, Stats.
SECTION 9. DHS 1.065 (1) (c) (Note) is repealed.
SECTION 10. DHS 1.065 (3) (d) (Note) is amended to read:
DHS 1.065 Note (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 Division of Long Term Care Medicaid Services, 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. SECTION 11. DHS 1.07 is repealed and recreated to read:
DHS 1.07 Delegation
(1)
GENERAL. The department may delegate duties and responsibilities under this chapter, as provided in ss. 46.03 (18 (e) and 46.10 (16), Stats. (2)
PROCESS. A request for delegation under sub. (1) shall be submitted to the department. The department shall notify a county requesting any such delegation of its approval or denial, and specify any conditions of such delegation.
