Section 1.06. Record-keeping, reports, confidentiality requirements, and disclosure authority.

 

(1)   Confidentiality. Except as provided in statutes and these rules, information regarding a client and all interested parties, collected by a facility or agency subject to these rules, shall remain confidential.

(2)   Exception. Confidentiality provisions shall not prohibit disclosure of information in the following situations:

(a) Disclosure of financial and service information without informed consent for services provided under ch. 51 , Stats. , may be made to the department, the program director of a board established under s. 51.42 , 51.437 or 46.23 , Stats., a qualified staff member designated by the program director or a county department of social services only under conditions specified in s. 51.30 , Stats., and rules promulgated thereunder.

(b) Disclosure of financial and service information without informed consent for all other services under the uniform fee system may be made to the department, qualified staff members of a board established under s. 51.42 , 51.437 or 46.23 , Stats., or qualified staff members of a county department of social services when the information disclosed is for billing and collection purposes.

(c) Further disclosure of financial and service information obtained under pars. (a) and (b) may be made without informed consent by a board established under s. 51.42 , 51.437 or 46.23 , Stats., or a county department of social services to the county district attorney or corporation counsel for the purpose of enforcing the collection of delinquent accounts in the courts.

(d) Billings sent to the following persons shall not constitute unlawful re-disclosure of financial or service information when such information is obtained by the agency in accordance with s. 51.30 (4) (b) 2. , Stats.:

1. The client.

2. The spouse of the client.

3. The parent, guardian or person acting in loco parentis for a minor client.

4. The representative payee for benefits owing to the client from social security or SSI.

5. The guardian of the estate of a person adjudged incompetent under ch. 54 , Stats.

(e) Except where prohibited by a federal regulations relating to alcohol and drug treatment records, the persons named in s. 51.30 (5) (a) , Stats., may consent in place of the client for the release of medical information in order to obtain insurance benefits owing to the client, the client's spouse or the parents of a client.

(3)   Client records.

(a) Records. Clear, exact and auditable records shall be established and maintained for each client regardless of the client's financial status or services involved. Such information shall include:

1. Dates of service contacts.

2. Times and duration of such contacts.

3. The nature of the contact (professional service or paraprofessional service).

4. In the case of residential services, the actual days of care must be documentable.

(b) Individual account control record. Each billing and collection unit has broad flexibility to design a system that best fits the agency's needs and also satisfies the requirements of the uniform fee system. A record system is required that brings together all units of services provided for those clients whose accounts must be set up for billing a responsible party or third-party under the uniform fee system. For such cases, financial information forms and other information to prepare billings must be reported to the billing unit. The billing and collection unit is responsible for posting data to individual account control records from information received as soon as possible, including services provided and payments made as well as dates of service and dates of payments.

(c) Client collection file. There shall be a client collection file for every account billed. The file shall include:

1. Copies of financial information forms for all responsible parties who elect to be billed according to their ability to pay.

2. Updated information after each year (6 months for social service clients) concerning the family's ability to pay when billing extends for more than one year (6 months for social service clients).

3. Copies of all invoices sent to responsible parties.

4. Copies of all invoices sent to third-party payers.

5. Copies of all correspondence.

6. Documentation of all other actions taken on the account.

(d) Closing client records; record retention period. Client records may be closed after the department or payment approval authority determines that any one of the conditions listed under s. DHS 1.03 (20) (a) to (c) applies. Closed client records shall be maintained for at least 5 years.

(4)   Agency records. Each agency or facility covered by these rules shall keep complete, clear, and exact records of allocation of staff time, service units delivered, and all revenues and gross expenditures.

(5)   Required reports. Each facility or agency covered by these rules shall submit to the department such reports on client liability, billings, and collections as the department may require.

History: Cr. Register, August, 1978, No. 272 , eff. 9-1-78; am. (1), r. and recr. (2) (a) and (b), cr. (2) (c) to (e), r. and recr. (3) (a), renum. (3) (b) and (c) to be (3) (d) and (e), cr. (3) (b) and (c), Register, November, 1979, No. 287 , eff. 1-1-80; correction in (2) (d) 5. made under s. 13.92 (4) (b) 7. , Stats., Register June 2008 No. 630 ; CR 10-146 : r. and recr. (3) (d), r. (3) (e) Register May 2011 No. 665 , eff. 6-1-11.

Note

The district attorney or corporation counsel must be seen as the legitimate counsel to the county agencies named in this section. Microsoft Windows NT 6.1.7601 Service Pack 1 This does not mean that all of these records must be reported to the agency's billing unit; but, if necessary, the provider's records should include or allow for each client, the potential for reporting to the billing unit enough information to prepare a billing statement that establishes liability for and by each calendar month during which services are provided. Microsoft Windows NT 6.1.7601 Service Pack 1