DHS 153.037DHS 153.037 Retroactive eligibility. Retroactive eligibility is not available under the hemophilia home care program. Patients who are found to be eligible under s. DHS 153.03 become eligible for benefits on the date the application was received.

DHS 153.04(1)(1) Application. To apply for assistance in paying for the costs of blood products and supplies used in the home care of hemophilia, a patient shall complete a form available from a comprehensive hemophilia treatment center, and shall submit the completed form either to the center or directly to the department. The completed form shall include a signed certification by the physician director of the center that the patient has successfully participated in a home care program, and that the physician director will review the patient’s maintenance program every 6 months and, on request of the department, will verify that the patient is complying with the program.

DHS 153.04(2)(2) Notification of applicant. The department shall certify a patient as eligible for reimbursement for part of the costs of blood products and supplies used in the home treatment of hemophilia if all requirements under s. DHS 153.03 are met. The department shall notify the patient, in writing, of its decision within 60 days after the department receives an application for assistance. If the application is denied, the notice shall include the reason for denial with information that the patient may request a hearing under sub. (7) on that decision.

DHS 153.04(3)(3) Recertification. Certification is for one year. To be recertified, a participant shall complete, sign and submit to the department a financial statement form received from the department. The participant shall provide to the department full, truthful and correct information necessary for the department to determine eligibility and liability.

DHS 153.04(4)(4) Revocation or nonrenewal of certification. The department may revoke or not renew a participant’s certification if the department finds that the participant is no longer eligible for the program. The department shall send written notice of revocation or nonrenewal to the participant, stating the reason for it and with information that the participant may request a hearing under sub. (7) on that decision.

DHS 153.04(5)(5) Participant responsibility to provide information.

DHS 153.04(5)(a)(a) A participant shall inform the department within 30 days of any change in address, other source of health care coverage or family size, or any change in income of more than 10%.

DHS 153.04(5)(b)(b) The department may verify or audit a participant’s total family income. The department may redetermine a participant’s estimated total family income for the current year based on a change in the family’s financial circumstances.

DHS 153.04(6)(6) Confidentiality of patient information. All personally identifiable information provided by or on behalf of a patient to the department shall remain confidential and may not be used for any purpose other than to determine program eligibility, patient liability and the payment of claims. Statistical analyses of program data may not reveal patient identity.

DHS 153.04(7)(7) Appeal. A patient denied assistance under sub. (2) or a participant whose certification is revoked or not renewed under sub. (4) may request a hearing on that decision under ss. 227.44 to 227.50, Stats., by the department of administration’s division of hearings and appeals. The request for a hearing shall be in writing and shall be sent to the division of hearings and appeals so that it is received there within 30 days after the date of the notice of denial, revocation or nonrenewal of certification.

DHS 153.05(1)(1) Comprehensive hemophilia treatment centers.

DHS 153.05(1)(a)1.1. To be reimbursed by the program for blood products and supplies, including case management services, provided to program participants, a center treating hemophilia patients shall submit an application to the department and shall comply with the standards in s. DHS 153.08. Within 60 days after receiving a complete application for certification, the department shall either approve or deny the application. If the application is denied, the department shall give the applicant reasons, in writing, for the denial.

DHS 153.05(1)(a)2.2. As part of its application for certification under par. (a), a hemophilia treatment center shall execute a written agreement with the department to be a comprehensive hemophilia treatment center and to receive state reimbursement. This agreement shall, unless terminated by either party, remain in full force and effect from the date of execution.

DHS 153.05(1)(b)(b) Border state treatment centers. The department may approve a hemophilia treatment center in a state bordering on Wisconsin as a comprehensive hemophilia treatment center if the center is within 100 miles of the Wisconsin border, has a practice which includes providing blood products and supplies to Wisconsin residents and meets the requirements for certification specified in s. DHS 153.08. A border state treatment center is subject to the same rules and contractual agreements as comprehensive hemophilia treatment centers located in Wisconsin.

DHS 153.05(1)(c)(c) List of approved sources. A comprehensive hemophilia treatment center shall, upon request of the department, furnish in writing the names and addresses of all vendors of blood products and supplies provided to participants in the hemophilia home care program.

DHS 153.05(2)(2) Other providers. To receive reimbursement, a source approved by a comprehensive hemophilia treatment center shall either:

DHS 153.06(1)(1) Claim forms.

DHS 153.06(1)(a)(a) A provider shall use claim forms furnished or prescribed by the department or its fiscal agent, except that a provider may submit claims by electronic media or electronic submission if the provider or billing service is approved by the department for electronic claims submission.