CR 19-020 Rule Text

PROPOSED ORDER OF

DEPARTMENT OF HEALTH SERVICES

TO ADOPT PERMANENT RULES

The Wisconsin Department of Health Services (the Department) proposes an order to repeal DHS 1.065 (1) (c) (Note); to amend DHS 1.065 (3) (d) (Note); and to repeal and recreate ch. DHS 1 (Title), DHS 1.01 to 1.06, and 1.07, relating to uniform fee system.

RULE SUMMARY

Statutes interpreted

Sections 46.03 (18) (a), (b), (c), (d), and (e), and 46.10 (3), (4) (a), (5), (7), (8) (c) to (e), (10), (11), (14) (a) and (16), Stats.

Statutory authority

Section 227.11 (2) (a) and (b), Stats.

Explanation of agency authority

The Legislature directed the Department to establish a uniform system of fees for certain services provided or purchased by the Department or certain county departments. The Department is also directed to make collections, determine ability to pay, enforce or compromise liability and to delegate some of these responsibilities to counties. The proposed rules are necessary to effectuate the purposes of the statutes listed in the “interpreted statutes” section. In addition, the proposed rules are necessary to comply with s. 227.10 (1) and (2m), Stats.

Related statute or rule

None.

Plain language analysis

The Department proposes to restate provisions to minimize confusion and inconsistency of interpretation and application of Chapter DHS 1 at the local level.

Summary of, and comparison with, existing or proposed federal regulations

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.