Wisconsin Legislature: 002 - CR 19-020 Rule Text

Barry.Kasten@dhs.wisconsin.gov

Statement on quality of agency data

The Department did not rely upon any data in preparing the proposed rule.

Place where comments are to be submitted and deadline for submission

Comments may be submitted to the agency contact person that is listed above or by accessing https://www.dhs.wisconsin.gov/rules/permanent.htm until the deadline given in the upcoming notice of public hearing. The notice of public hearing and deadline for submitting comments will be published in the Wisconsin Administrative Register and to the department’s website, at https://www.dhs.wisconsin.gov/rules/permanent.htm. Comments may also be submitted through the Wisconsin Administrative Rules Website, at: https://docs.legis.wisconsin.gov/code/chr/active.

RULE TEXT

SECTION 1. DHS 1 (Title) is repealed and recreated to read:

Uniform Fees, Liability and Collections

SECTION 2. DHS 1.01 is repealed and recreated to read:

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.

SECTION 3. DHS 1.02 is repealed and recreated to read:

DHS 1.02 Definitions.

“Administratively unfeasible” means the cost of collection would likely exceed the fee established for a service.

“Client” means a person that has received services.

“County department” means any of the following:

(a)

A county department of social services under ss. 46.215, 46.22, or 46.23, Stats.

(b)

A county department of community programs under s. 51.42, Stats.

(c)

A county department of developmental disabilities services under s. 51.437, Stats.

“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, 893.40, Stats., or as provided under any other applicable statute of limitations.

“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:

(d)

Services provided by the department or a county department under ch. 48, subch. III of ch. 49, Stats.

(e)

Community-based juvenile delinquency-related services.

(f)

Juvenile correctional services.

(g)

Services provided to courts.

(h)

Outreach, information, and referral services.

(i)

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.

(j)

Any other services for which the department or a county department may not legally assess a fee, establish liability, or collect payment.

“Department” means the department of health services.

“Fee” means the amount established for a service under s. DHS 1.03.

“Minor” means a person under 18 years of age.

“Parent” means any of the following:

A person who currently 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, except when a court determined or ordered that the person is not liable or otherwise responsible for their payment.

(k)

A person that a court determines or orders to be liable or otherwise responsible for payment of services provided to a minor.

(l)

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, as described in s. 48.839 (1), Stats.

“Spouse” means any of the following:

(m)

A person who is currently married, as recognized by Wisconsin law, to a person who received services.

(n)

A person who was married, as recognized by Wisconsin law, to a person who received services at the time services were provided.

SECTION 4. DHS 1.03 is repealed and recreated to read:

DHS 1.03 Fees.

(1)

The department shall establish fees for services provided by department institutions.

(1)

(2)

Fees for services provided by the county department under s. 51.42, Stats., shall be established and approved annually by the county board of supervisors.

(2)

SECTION 5. DHS 1.04 is repealed and recreated to read:

DHS 1.04 Liability.

(1)

GENERAL. Unless otherwise provided by law, the following are liable for services provided to a client:

(o)

A client who is not a minor.

(p)

A spouse.

(q)

A parent.

(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.

No payments are required under s. DHS 1.05 (4).

The liability is for a service, meeting the exception in s. DHS 1.02 (5) (f).

(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.

(b)

Any and all parents.

(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:

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).

When there has been a change in the financial circumstances of a person, entity, estate under s. DHS 1.04 (1).

Every 12 months, while services are being rendered.

At the conclusion of services rendered.