CR 19-020 Rule Text

The Department was unable to locate federal regulations that were sufficiently analogous to the proposed rules. However, 42 CFR 51c.303 and 42 CFR 56.303, for example, discuss similar fee, billing, ability to pay and collection requirements to be used by certain federal health centers. Specific program requirements are further contained in compliance manuals (see, for example, Chapter 16, https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-16.html).

Comparison with rules in adjacent states

Provisions relating to similar subjects of the proposed rule are contained in various sections of code from adjacent states. The Department identified that many of the same concepts Wisconsin utilizes, such as ability to pay and calculation of fees, are included in the regulations of adjacent states. See below citations for examples and references.

Illinois

Illinois Admin. Code. tit. 59 §106 (Services Charges). This title covers the calculation of charges for mental health services and determination of ability to pay.

Illinois Admin Code tit. 89 § 20 (Support Responsibility of Relatives). This title covers the obligation of relatives of care recipients.

Illinois Admin Code tit. 89 § 545 (Ratemaking). This title defines how rates patients are charged get established.

Illinois Admin Code tit. 89 § 562 (Customer Financial Participation). This title identifies when a financial analysis should be completed and how it should be utilized.

Iowa

Iowa Administrative Code Rules 441.11 (Collection of Public Assistance Debts). This rule establishes when a claim should be created for services provided, how payments should be applied to that claim, and when tax offsets may be applied.

Iowa Administrative Code Rules 441.36 (Facility Assessments). This rule determines the fees and assessments that will be charged for services.

Iowa Administrative Code Rules 441.95 (Collections). This rule defines the establishment of collection amounts and how they should be applied to accounts.

Michigan

Michigan Admin. Code r. 330.8005-330.8284 (Financial Liability for Mental Health Services). This code establishes liability determination and ability to pay calculations and collections for mental health services.

Minnesota

Minnesota Administrative Rules ch. 9550 Part 9550.6240 (Collections). This rule establishes county and department responsibility for collections.

Minnesota Administrative Rules ch. 9515 Part 9515.2200 (Sources of Income Considered). This rule identifies when insurance, a client’s income and/or property should be considered in the ability to pay calculation.

Minnesota Administrative Rules ch. 9515 Part 9515.2600 (Responsible Relative’s Ability to Pay). This rule sets limitations of a relative’s ability to pay in the event of client liability

Summary of factual data and analytical methodologies

The Department established an advisory committee comprised of representatives from Jackson, Portage, Marathon, Walworth, Green and Outagamie counties, as well as a representative from the Department of Children and Families. The advisory committee held nine open meetings in 2016 and 2017. The Department also reviewed policies and procedure materials from the Western Region of Integrated Care Consortia (Jackson, Monroe and La Crosse counties), Portage, Walworth, Green, Lafayette, Outagamie, and Marathon County collection procedures. In addition, the department solicited comments about the proposed rulemaking through its website and throughout the entire rule promulgation process.

Analysis and supporting documents used to determine effect on small business

The Department collected public comments in regards to economic impact from August 6, 2018 to August 20, 2018. The Department also established an advisory committee comprised of representatives from Jackson, Portage, Marathon, Walworth, Green and Outagamie counties, as well as a representative from the Department of Children and Families. The advisory committee held nine open meetings in 2016 and 2017. The Department also reviewed policies and procedure materials from the Western Region of Integrated Care Consortia (Jackson, Monroe and La Crosse counties), Portage, Walworth, Green, Lafayette, Outagamie, and Marathon County.

Effect on small business

The proposed rule does not affect small business.

Agency contacts

Barry Kasten

Administrative Rule Coordinator

Division of Enterprise Services

[phone]

[e-mail]

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.

[See PDF for proper formatting of the rule]

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 who has received services.

“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., 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.

“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.

“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:

(d)

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.

(e)

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.

“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:

(f)

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

(g)

Community-based juvenile delinquency-related services.

(h)

Juvenile correctional services.

(i)

Services provided to courts.

(j)

Outreach, information, and referral services.

(k)

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.

(l)

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

“Spouse” means any of the following: