Section DHS 1.05 - Billing(1) GENERAL. Each month during the collection period, the department or county department shall, as applicable, issue a billing statement that indicates any outstanding liability to each of the following:(a) A client who is not a minor.(c) Each authorized representative under sub. (3).(2) THIRD-PARTY PAYERS. The department or a county department shall file a claim with any third-party payers in a manner consistent with s. Ins 3.40. Medical Assistance shall be the payer of last resort.(3) AUTHORIZED REPRESENTATIVE. Upon receipt of proof of any such relationship, billing statements shall be issued to a legal representative of a client, including a guardian of the estate, a representative payee, or any other person or entity authorized by law or through the client's written consent, to receive such information.(4) AMOUNT. The monthly payment amount established in s. DHS 1.03(1) billed and subject to collections, if any, shall be based upon liability established under this chapter, the maximum monthly payment schedule, and ability to pay. All of the following apply in determining the monthly payment amount: (a)Ability to pay. Ability to pay shall be determined by use of a financial responsibility form that gives due regard to relationship and the present needs of the person or of the lawful dependents. Subject to par. (b) and s. DHS 1.04(5), ability to pay may be determined at any of the following times during the collection period: 1. Upon receipt of a financial responsibility form by the department or county department from a person liable under s. DHS 1.04(1).2. When the department or a county department receives notice that there has been a change in the financial circumstances of a person liable under s. DHS 1.04(1).3. Every 12 months, while services are being rendered.(b)Best able to pay. After investigation of the liable persons' ability to pay, the department or, if applicable, the county department shall make collection from the person who in the opinion of the department under all of the circumstances is best able to pay as provided in s. 46.10(3), Stats.(c)Shortcut Method. A person may be deemed unable to pay under par. (a) if any of the following apply: 1. The person is receiving Medical Assistance.2. The person is receiving Social Security Disability or Supplemental Security Income.(d)Services received by a minor without consent. If a minor receives services without consent of a parent or guardian under s. 51.138 or 51.47, Stats., the department or, if applicable, the county department shall base the fee solely on the minor's ability to pay.(e)Adjustments. The department may adjust a past determination of ability to pay, looking back 90 days from the date of receipt of a financial responsibility form under sub. (4) (a). (5) BILLING STATEMENTS. At a minimum, a billing statement shall include all of the following information: (a) An itemization of any services provided during the billing period, including the date the service was provided, the number of units, and the fee amount.(b) Any claim filed with a third-party payer and any expected payment on the claim.(c) The date and amount of any other payments received during the billing period.(d) The total outstanding liability as of the date of the statement.(e) Any liability that was waived under s. DHS 1.04(4).(f) The due date and amount of monthly payment required under sub. (4).(6) OTHER REQUIREMENTS. The department or county department shall:(a) Maintain documentation of compliance with this section. Counties shall provide such documentation to the department upon request.(b) Establish a documented procedure to periodically review accounts for accuracy and compliance with this chapter.(c) Establish a written grievance procedure for actions relating to liability determination, billing, and collections.(d) Not issue a billing statement or collect from the parent of a minor client who is receiving treatment for alcohol or drug abuse without the consent of a parent or guardian, as provided in s. 51.47, Stats.Wis. Admin. Code Department of Health Services DHS 1.05
Cr. Register, August, 1978, No. 272, eff. 9-1-78; renum. (1) to be (1) (a), cr. (1) (b) to (e), renum. (2) to be (2) (a) and cr. (2) (b), renum. (5), (6) and (7) to be (6), (12) and (13), and am., cr. (5) and (7) to (11), Register, November, 1979, No. 287, eff. 1-1-80; am. (12) (b) and (e), Register, December, 1980, No. 300, eff. 1-1-81; correction in (2) (d) under s. 13.93(2m) (b) 7, Stats., and in (3) under s. 13.93(2m) (b) 4, Stats., Register, September, 1984; am. (4), (7) and (13) (c) (intro.), Register, September, 1984, No. 345, eff. 10-1-84; renum. (13) (c) 1. b. to be 1. c. and am., cr. (13) (c) 1. b., Register, December, 1987, No. 384; corrections made under s. 13.93(2m) (b) 6, Stats., Register, August, 1994, No. 464; emerg. cr. (2) (c) and (14), eff. 1-22-97; cr. (2) (c), (14), am. (13) (c) 1. b., Register, August, 1997, No. 500, eff. 9-1-97; correction in (10) (d) made under s. 13.92(4) (b) 7, Stats., Register June 2008 No. 630.Amended by, CR 19-020: r. and recr. Register December 2019 No. 768, eff. 1-1-20; correction in (1) (c), (4) (e) made under s. 35.17, Stats., Register December 2019 No. 768, eff. 1/1/2020