Chapter DHS 2

Chapter DHS 2

RECOUPMENT OF BENEFIT OVERPAYMENTS

DHS 2.01   Authority and purpose.

DHS 2.02   Applicability.

DHS 2.03   Definitions.

DHS 2.04   Recovery of incorrectly paid benefits.

DHS 2.05   Waiver of recovery.

DHS 2.06   Appeal rights.

Ch. DHS 2 Note Note: Chapter HFS 2 was renumbered to chapter DHS 2 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

Ch. DHS 2 Note Note: This chapter applies to Department of Health Services and Department of Children and Families programs until such time as each of the departments can adopt separate rules.

DHS 2.01 DHS 2.01 Authority and purpose. This chapter is promulgated under ss. 48.57 (3m) (h) and (3n) (h), 48.62 (6), 48.975 (4m), 49.847 and 227.11 (2) (a), Stats., to establish procedures for the recovery of incorrectly paid benefits. This chapter interprets ss. 16.51 (4), 48.57 (3m) and (3n), 48.62, 48.975, 49.77, 49.775, 49.847, and 49.85, Stats., and other statutes concerning benefits programs.

DHS 2.01 History History: CR 03-085: cr. Register June 2006 No. 606, eff. 7-1-06.

DHS 2.02 DHS 2.02 Applicability. This chapter does not apply to any of the following:

DHS 2.02(1) (1) Payments that are not allowed to be recouped under federal or state laws.

DHS 2.02(2) (2) Persons or entities with whom the department or a county has a contractual relationship where the contract specifies the terms of repayments.

DHS 2.02 History History: CR 03-085: cr. Register June 2006 No. 606, eff. 7-1-06.

DHS 2.02 Note Note: This chapter applies to Department of Health Services and Department of Children and Families programs until such time as each of the departments can adopt separate rules.

DHS 2.03 DHS 2.03 Definitions. In this chapter:

DHS 2.03(1) (1) “Administrative costs” means an entity’s costs associated with administering the receipt of benefits paid on behalf of an eligible individual and for which a contract between the department a county, or an elected governing body of a federally recognized American Indian tribe and the entity exists specifying the payment of funds to administer the benefit payments on behalf of eligible individuals.

DHS 2.03(2) (2) “Department” means the department of health services.

DHS 2.03 Note Note: This chapter applies to Department of Health Services and Department of Children and Families programs until such time as each of the departments can adopt separate rules.

DHS 2.03(3) (3) ”Benefits” means payments made under chs. 48 and 49, Stats., or other benefit programs that provide financial assistance to individuals. Benefits include payments made to a person or entity authorized to receive benefits on behalf of an individual.

DHS 2.03(4) (4) “Eligible individual” means an individual for whom benefits are paid.

DHS 2.03(5) (5) “Incorrectly paid benefits” means benefits paid for an individual not eligible for any benefits during the period for which the payment was made or paid in an amount in excess of the amount that the individual was eligible to receive.

DHS 2.03 History History: CR 03-085: cr. Register June 2006 No. 606, eff. 7-1-06; correction in (2) made under s. 13.92 (4) (b) 6., Stats., Register November 2008 No. 635.

DHS 2.04 DHS 2.04 Recovery of incorrectly paid benefits.

DHS 2.04(1) (1) 

DHS 2.04(1)(a) (a) Subject to applicable law, if the department, a county or an elected governing body of a federally recognized American Indian tribe finds that incorrectly paid benefits under chs. 48 or 49, Stats., have been made, the department, county or elected governing body may seek recovery from the eligible individual or from the person or entity authorized to receive benefits on behalf of the eligible individual or from both. The total amount recovered may not exceed the amount of the incorrectly paid benefits, and shall be offset by any amounts that are owed the eligible individual or the person or entity authorized to receive benefits on behalf of the eligible individual because of a previous underpayment of benefits.

DHS 2.04(1)(b) (b) The recovery period for incorrectly paid benefits shall be limited to one year prior to the date that the overpayment is discovered.

DHS 2.04(1g) (1g) Interest may not be accrued or collected on incorrectly paid benefits.

DHS 2.04(1r) (1r) Administrative costs may be recouped only from the entity who actually received the incorrectly paid benefits.

DHS 2.04(2) (2) If payments for administrative costs are made in addition to the benefits paid to an entity authorized to receive benefits on behalf of an eligible individual, recovery of the administrative costs associated with the incorrectly paid benefits may also be sought from the entity.

DHS 2.04(3) (3) Except as provided under s. DHS 2.05, recovery of incorrectly paid benefits from an individual currently eligible to receive benefits may be made by reducing the amount of the individual’s benefits by no more than 10% each month until the full amount of the incorrectly paid benefits is recovered, unless the individual requests a larger percentage deduction. A written notice of intent to recover shall be provided to the individual as required under sub. (6).

DHS 2.04(4) (4) 

DHS 2.04(4)(a) (a) Except as provided under s. DHS 2.05, recovery of incorrectly paid benefits from an individual who is no longer eligible to receive benefits may be made by sending a notice of intent to recover under sub. (6) requesting the individual to voluntarily repay the amount of the incorrectly paid benefits.

DHS 2.04(4)(b) (b)

DHS 2.04(4)(b)1. 1. The individual shall repay the amount specified under par. (a) within 30 calendar days after the date of the notice of intent to recover unless the individual appeals as specified under s. DHS 2.06 (2) or makes other payment arrangements. Notice of intent to recover shall be sent by certified mail.

DHS 2.04(4)(b)2. 2. If the individual refuses to voluntarily repay the amount specified under par. (a), collection or court action may be taken.

DHS 2.04(5) (5) 

DHS 2.04(5)(a) (a) Recovery of benefits paid to persons or entities that currently receive benefits on behalf of eligible individuals. If the incorrectly paid benefits were paid to a person or entity that currently receives benefits on behalf of eligible individuals, the amount of the incorrectly paid benefits may be recovered by reducing the amount of the payments currently made to the person or entity by no more than 10% each month until the full amount of incorrectly paid benefits are recovered, unless the person or entity requests a larger percentage deduction.

DHS 2.04(5)(b) (b) Recovery of benefits paid to persons or entities that no longer receive benefits on behalf of eligible individuals. If a person or entity no longer receives benefits on behalf of eligible individuals, the procedures under sub. (4) may be used to recover the incorrectly paid benefits.

DHS 2.04(5)(c) (c) Notice. The entity shall be provided written notice of intent to recover under sub. (6), including the entity’s right to appeal under ch. HA 1 and ch. 227, Stats.

DHS 2.04(6) (6) 

DHS 2.04(6)(a) (a) Except as provided under s. DHS 2.05, no recovery may be made unless at least 20 days prior written notice of the intention to recover some or all of the amount determined to have been overpaid. The notice shall specify all of the following:

DHS 2.04(6)(a)1. 1. The months for which benefits were incorrectly paid.

DHS 2.04(6)(a)2. 2. The amount of the intended recovery.

DHS 2.04(6)(a)3. 3. The amount, if any, by which the amount owed was offset by any applicable previous underpayments of benefits to the individual or entity.

DHS 2.04(6)(a)4. 4. A summary of the basis for the finding that incorrectly paid benefits were made.

DHS 2.04(6)(a)5. 5. The effective date of the intended action.

DHS 2.04(6)(a)6. 6. The right to appeal the intended action as provided in ch. HA 3 and ch. 227, Stats.

DHS 2.04(6)(b) (b) The notice under par. (a) shall also include notice of a right to appeal the incorrectly paid benefit determination if a right to appeal that determination was not previously provided.

DHS 2.04(7) (7) Other action as authorized by law, including state tax refund setoff, may be used to recover incorrectly paid benefits that are not recovered under the methods provided in this section.

DHS 2.04 History History: CR 03-085: cr. Register June 2006 No. 606, eff. 7-1-06.

DHS 2.05 DHS 2.05 Waiver of recovery. Recovery of incorrectly paid benefits may be waived when the recovery of the overpayment is considered to be against equity or when it causes undue hardship, or the recovery impedes efficient and effective administration of programs due to the small amount involved or the age of the account.

DHS 2.05 History History: CR 03-085: cr. Register June 2006 No. 606, eff. 7-1-06.

DHS 2.06 DHS 2.06 Appeal rights.

DHS 2.06(1) (1) Administrative review. An action taken under s. DHS 2.04 (1) or (2) is subject to review under ch. 227, Stats., and ch. HA 3.

DHS 2.06(2) (2) Request for hearing on recovery action.