DHS 153.07(2)(h) (h) When total family income is more than 400% of the federal poverty guidelines, 4.5% of that income.

DHS 153.07(3) (3) Participant coinsurance.

DHS 153.07(3)(a) (a) A participant shall pay a coinsurance amount to cover part of the cost of blood products and home care supplies.

DHS 153.07(3)(b) (b) A participant’s coinsurance amount shall be determined at the time the patient is certified for eligibility and annually thereafter.

DHS 153.07(3)(c) (c) The amount of a participant’s coinsurance shall be related to family size and to family income rounded to the nearest whole dollar, in accordance with the schedule in Table 153.07.

DHS 153.07(3)(d) (d) The amount that a patient pays in coinsurance annually may not exceed the following applicable percentage of the family’s income, rounded to the nearest whole dollar:

DHS 153.07(3)(d)1. 1. For an income of up to $10,000, 3%;

DHS 153.07(3)(d)2. 2. For an income of $10,001 to $20,000, 4%;

DHS 153.07(3)(d)3. 3. For an income of $20,001 to $40,000, 5%;

DHS 153.07(3)(d)4. 4. For an income of $40,001 to $60,000, 6%;

DHS 153.07(3)(d)5. 5. For an income of $60,001 to $80,000, 7%;

DHS 153.07(3)(d)6. 6. For an income of $80,001 to $100,000, 9%; and

DHS 153.07(3)(d)7. 7. For an income of $100,001 and over, 10%.

DHS 153.07(4) (4) Participant copayment. When a pharmacy directly bills the hemophilia home care program for a prescription received by a program participant, the participant is responsible for a $7.50 copayment amount for each generic drug and a $15.00 copayment amount for each brand name drug.

DHS 153.07(5) (5) Estate recovery.

DHS 153.07(5)(a) (a) An heir or beneficiary of the estate of a participant or a participant’s surviving spouse may apply to the department for a waiver of an estate claim filed by the department pursuant to s. 49.682 or 49.849, Stats. The criteria for granting waivers in s. DHS 108.02 (12) (b) shall apply to applications under this subsection. All of the procedures and rights in s. DHS 108.02 (12) (b) to (e) shall apply to this subsection.

DHS 153.07(5)(b) (b) For purposes of applying s. DHS 108.02 (12) (b) to (e) to this subsection the following definitions apply:

DHS 153.07(5)(b)1. 1. “Beneficiary” means any person nominated in a will to receive an interest in property other than in a fiduciary capacity;

DHS 153.07(5)(b)2. 2. “Decedent” means a deceased participant or the deceased surviving spouse of a participant who received benefits that are subject to recovery under s. 49.682 or 49.849, Stats.;

DHS 153.07(5)(b)3. 3. “Heir” means any person who is entitled under the statutes of intestate succession, ch. 852, Stats., to an interest in property of a decedent;

DHS 153.07(5)(b)4. 4. “Recipient” means a participant who received reimbursement under s. 49.685, Stats.; and

DHS 153.07(5)(b)5. 5. “Waiver applicant” means a beneficiary or heir of a decedent who requests the department to waive an estate claim filed by the department pursuant to s. 49.682 or 49.849, Stats.

DHS 153.07(5)(c) (c) The department may make adjustments to and settle estate claims filed under s. 49.682 or 49.849, Stats., to obtain the fullest amount practicable.

Table 153.07
Patient Coinsurance Liability for the Direct Cost of Treatment

- See PDF for table

DHS 153.07 Note Note: To illustrate how a patient’s coinsurance liability is calculated, assume that the family has 2 members and an annual income of $38,000, and that a bill has been received for treatment in the amount of $600. The patient would be liable for 16% of that bill, or $96.

DHS 153.07 History History: Cr. Register, December, 1994, No. 468, eff. 1-1-95; emerg. cr. (5), eff. 11-1-95; cr. (5), Register, April, 1996, No. 484, eff. 5-1-96; CR 02-070: am. (4) Register October 2002 No. 562, eff. 11-1-02; CR 04-051: am. (2) and (4), cr. (2) (f) to (h) Register November 2004 No. 587, eff. 12-1-04; corrections in (5) (a) and (b) (intro.) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637; corrections in (5) (a), (b) 2., 5., (c) made under s. 13.92 (4) (b) 7., Stats., Register December 2014 No. 696.

DHS 153.08 DHS 153.08 Standards for comprehensive treatment centers.

DHS 153.08(1) (1) Compliance. A comprehensive hemophilia treatment center shall comply with the standards in this section.