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:
(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.(5)
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. 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 DHS 1.05 is repealed and recreated to read: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 or county department shall, as applicable, issue a billing statement that indicates any outstanding liability to each of the following:(a)
A client who is not a minor.(c)
Each 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. Medical Assistance shall be the payer of last resort. (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. (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: (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. 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:1.
Upon receipt of a financial responsibility form by the department or county department from a person liable under s. DHS 1.04 (1).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).3.
Every 12 months, while services are being rendered. 4.
At the conclusion of services rendered.
(e)
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.(f)
Shortcut Method. A person may be deemed unable to pay under par. (a) if any of the following apply:1.
The person is receiving Medical Assistance. The person is receiving Social Security Disability or Supplemental Security Income.
(g)
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.(h)
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 par. (4) (a).(5)
BILLING STATEMENTS. At a minimum, a billing statement 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)
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.SECTION 7. DHS 1.06 is repealed and recreated to read:
DHS 1.06 Collections.
(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). (2)
DELINQUENT ACCOUNT. A client’s account is delinquent, when all of the following have occurred: (a)
The amount established under s. DHS 1.05 (4) has not been received for 90 consecutive days. (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. (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).(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. (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, 71.935. A collection agency shall comply with the requirements specified in s. 218.04, Stats. (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:(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) Divisions of Hearings and Appeals
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 children’s community options program under s. 46.272, 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 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. 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.SECTION 12. EFFECTIVE DATE: This rule shall take effect on the first day of the month following publication in the Wisconsin administrative register, as provided in s. 227.22 (2) (intro.), Stats. Wisconsin Department of Health Services
Dated: __________________________________
Andrea Palm, Secretary-designee
SEAL:
