Section 1.02. Liability for paying fees.

 

(1)   Responsible parties. Whenever a client receives a service which is subject to this chapter, the client, the spouse of a married client, the parents of a minor client, and any other persons specified by statute as having liability payable according to ss. 46.03 (18) , 46.10 , 48.837 (7) and 48.839 (1) , Stats., shall be responsible for paying for the service in the manner set forth in this chapter.

(2)   Extent of liability. Liability for a service shall equal the fee, as determined pursuant to these rules, times the number of units of service provided.

(3)   Recording units of service to establish liability. Except as provided in sub. (5) , facilities shall maintain records of all clients receiving fee-chargeable services using the following specified data. For each client receiving a fee-chargeable service, units of service shall be as follows unless an exception is granted by the secretary or a designee:

(a) Rounded to the next highest 1 ⁄ 4 hour for outpatient, counseling and similar services.

(b) Rounded to the nearest whole hour for child day care, homemaker services, day services, or similar services.

(c) Per day for residential care services including those in the following settings: (Also see sub. (4) for additional provisions.)

1. Mental hygiene inpatient facilities

2. Foster homes

3. Group homes

4. Child caring institutions

5. Community based residential facilities

6. Juvenile correctional facilities

(d) For other services, supplies or materials, where the cost is the fee, an itemized statement describing the service and cost will suffice.

(4)   Additional provisions for recording per day units of service.

(a) Except as otherwise stated, a charge shall be made for each day a patient or resident is physically at the institution or facility at midnight of the day. No charge shall be made for the day the patient or resident leaves.

(b) A charge shall be made if the patient or resident both enters and leaves during the same day.

(c) No charge shall be made for any day during which a patient or resident has been granted a leave or furlough or is on unauthorized absence for one or more overnights.

(5)   Reporting exception for social services. For fee-chargeable services of the type that have no potential for third-party payment recovery, a simplified reporting system may be established to eliminate the reporting of units of service to the facility's or agency's billing unit for clients and other responsible parties who show a documented zero ability to pay according to s. DHS 1.03 . However, agency records shall contain information specified in s. DHS 1.06 .

(6)   Discharge of liability other than by means of full payment. Except where statutes require payment of full liability, the liability of responsible parties remaining after recovery of benefits from all applicable insurance shall be considered discharged if responsible parties provide department or agency staff who have billing responsibility with full financial information and pay according to the following provisions:

(a) For adult inpatient care and services or for disability-related modifications of the home or vehicle of an adult client, when the remaining liability exceeds $1,000 or discharge of liability at the maximum monthly payment rate would exceed 5 years, a responsible party may enter into an agreement with the appropriate payment approval authority to pay a substantial portion of the outstanding liability as a lump sum.

(b) For adoption investigations and non-residential services specified in s. 48.837 , Stats., a responsible party shall pay the lesser of full liability or 24 times the monthly payment amount as calculated according to s. DHS 1.03 (12) or (13) .

(c) For care and services in non-medical facilities, clients shall pay the lesser of full liability each month or the monthly payment rate calculated according to s. DHS 1.03 (2) to (6) for each month the client is a resident of the facility. Other responsible parties shall pay according to the provisions of par. (d) .

(d) For all other care and services, the liability of responsible parties may be discharged by less than full payment if they pay the lesser of liability remaining after crediting third party payments each month or the monthly payment rate as calculated under s. DHS 1.03 (12) or (13) and adjusted, as appropriate, under s. DHS 1.03 (14) or under s. DHS 1.065 . When inpatient clients are minors who receive medical assistance, parents shall be billed before the medical assistance program is billed, and medical assistance claims shall be reduced by the amount of parental payments.

(e) The department may set annual minimum payment amounts for services billable under par. (c) or (d) . An annual minimum payment may not exceed $1,000 unless there is a specific statutory mandate for a higher amount. An annual minimum payment shall be applied to the client's uninsured liability. Any uninsured liability beyond the annual minimum payment shall be subject to the provisions of par. (c) or (d) , as applicable. For medical services, the department may credit a family payment for an annual minimum payment up to the amount the family pays for medical insurance in a year if the insurance pays at least the amount of the credit. Where the statutes set other minimum amounts, bond amounts, deductibles or copayments, those provisions supersede this paragraph. The department may also establish as a minimum payment amount the actual deductible used by an insurer in processing a claim.

(f) When a child participates simultaneously in multiple human service programs subject to parental liability under this chapter, the parents are responsible for the financial obligation of the program with the greatest parental financial obligation.

(7)   Exemption from liability. If it is determined in the case of a particular family that the accomplishment of the purpose of a service would be significantly impaired by the imposition of liability, the accrual of liability during a period not to exceed 90 days may be voided in whole or in part by the appropriate payment approval authority. If the need to avoid imposition of liability continues, a further cancellation may be granted.

History: Cr. Register, August, 1978, No. 272 , eff. 9-1-78; am. (1), (2) (b), renum. (3) and (4) to be (8) and (9) and am. (8) (a) and (9), cr. (3) to (7), Register, November, 1979, No. 287 , eff. 1-1-80; emerg. am. (6) (intro.) and (b) and (7), eff. 7-1-80; am. (6) (intro.) and (b) and (7), Register, October, 1980, No. 298 , eff. 11-1-80; am. (2) (intro.), r. (2) (a) and (b), (6) and (7), renum. (8) and (9) to be (6) and (7) and am. (6), Register, December, 1980, No. 300 , eff. 1-1-81; am. (1), r. and recr. (6), Register, September, 1984, No. 345 , eff. 10-1-84; am. (6) (a) and (e), Register, December, 1987, No. 384 , eff. 1-1-88; r. (4) (d), Register, August, 1997, No. 500 , eff. 9-1-97; CR 08-017 : am. (6) (d), cr. (6) (f) Register June 2008 No. 630 , eff. 7-1-08.

Note

Chapter 81, Laws of 1981 , added proposed adoptive parents (s. 48.837 (7) , Stats.) and guardians of foreign children (s. 48.839 (1) , Stats.) to those liable to pay for services that clients receive which are subject to this chapter. Microsoft Windows NT 6.1.7601 Service Pack 1