Wisconsin Administrative Code

DE 9.01 Authority. The provisions in this chapter are adopted pursuant to authority in ss. 15.08 (5) and 227.11 (2) (a), Stats., and ch. 447, Stats. History: Cr. Register, April, 1972, No. 196, eff. 5-1-72; renum. from DE 6.01

DE 9.015 Definitions. In this chapter: (1) XDental laboratoryY means any dental workroom directly or indirectly engaged in the construction, repair, or alteration of appliances to be used as substitutes for or as a part of natural teeth or jaws or associated structures, or for th…

DE 9.02 Work authorizations. Work authorizations shall include all of the following: (1) The patient[s name or identification number. (2) The dentist[s name. (3) Prescription information. History: Cr. Register, April, 1972, No. 196, eff. 5-1-72; renum. from DE 6.02 and am., Regis…

DHS 1.01 Authority and purpose. This chapter is authorized by s. 227.11 (2) and interprets ss. 46.03 (18) and 46.10, Stats., to establish a system for determining fees, liability, billing, and collection practices for services. History: Cr. Register, August, 1978, No. 272, eff. 9…

DHS 1.02 Definitions. (1) XAdministratively unfeasibleY means the cost of collection would likely exceed the fee established for a service. (2) XClientY means a person who has received services. (3) XCollection periodY means the period of time calculated for each unit of service,…

DHS 1.03 Fees. (1) The department shall establish fees for services provided. Fee schedules are updated annually each fall for use in the following calendar year. The maximum monthly payment schedule is calculated using the Consumer Price Index for the Midwest region, gross month…

DHS 1.04 Liability. (1) GENERAL. Unless otherwise provided by law, the following persons are liable for services provided to a client: (a) A client who is not a minor. (b) A spouse. (c) A parent. (d) A person that a court determines or orders to be liable or otherwise responsible…

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. (b) Each parent. (c) Eac…

DHS 1.06 Collections. (1) GENERAL. Subject to s. 46.10 (3) and (16), Stats., the department or county department shall collect payment from any liable person, in the amount established under s. DHS 1.05 (4). (2) DELINQUENT ACCOUNT. A client[s account is delinquent when all of the…

DHS 1.065 Children[s long-term support parental payment limits. (1) AUTHORITY, PURPOSE AND SCOPE. (a) This section establishes a parental payment limit for certain children[s long-term support services identified in this subsection. These provisions apply to all county administra…

DHS 1.07 Delegation. (1) GENERAL. The department may delegate duties and responsibilities under this chapter, as provided in ss. 46.03 (18) (e) and 46.10 (16), Stats. (2) PROCESS. A request for delegation under sub. (1) shall be submitted to the department. The department shall n…

DHS 10.11 Authority and purpose. This chapter is promulgated under the authority of ss. 46.281 (1n) (b) 1., 46.286 (4) to (7), 46.287 (2) (a) 1. (intro.), 46.288, 50.02 (2) (d), and 227.11 (2) (a), Stats., to implement a program called family care that is designed to help familie…

DHS 10.12 Applicability. This chapter applies to all of the following: (1) The department and its agents. (2) County agencies designated by the department to determine financial eligibility for the family care benefit. (3) All organizations seeking or holding contracts with the d…

DHS 10.13 Definitions. In this chapter: (1) XAdverse benefit determinationY means any of the following: (a) Any of the following acts taken by an aging and disability resource center or county economic support unit: 1. Denial of eligibility under s. DHS 10.31 (5) or 10.32 (4). 2.…

DHS 10.21 Contracting. (1) The department may contract for resource center operation only with entities that do all of the following: (a) Comply with the general requirements specified in s. 46.283, Stats., and s. DHS 10.22. (b) Meet the standards for performance by resource cent…

DHS 10.22 General requirements. (1) TARGET POPUEach contract for operation of a resource center shall specify the target population that the resource center will serve. The target population to be served by the resource center includes all members of the specified group who resid…

DHS 10.23 Standards for performance by resource centers. (1) COMPLIANCE. An aging and disability resource center shall comply with all applicable statutes, all of the standards in this section and all requirements of its contract with the department. (2) SERVICES. A resource cent…

DHS 10.24 Department responsibilities for monitoring resource center quality and operations. (1) MONITORING. The department shall monitor the performance and operations of the resource center in all of the following areas: (a) Providing information about long-term care options to…

DHS 10.31 Application and eligibility determination. (1) DEFINITION. In this section, XagencyY means any county agency, or any resource center that is not a county agency, that is responsible for all or part of determination of functional, financial, and other conditions of eligi…

DHS 10.32 General conditions of eligibility. (1) CONDITIONS. To be eligible for the family care benefit, a person shall meet all of the following conditions: (a) Age. The person is at least 18 years of age at the time of application. (b) Residency. The person is a resident of a c…

DHS 10.33 Conditions of functional eligibility. (1) DEFINITIONS. In this section: (a) XADLY means activities of daily living. (b) XIADLY means instrumental activities of daily living. (c) XAppropriatelyY means suitable in terms of time and place. (d) XLong-term or irreversible co…

DHS 10.34 Financial eligibility and cost sharing. (1) DEFINITIONS. In this section: (a) XActual maintenance costsY means the sum of the following: 1. Shelter costs determined according to s. 49.455 (4) (d) 1. and 2., Stats. 2. An amount equal to the maximum food stamp allotment f…

DHS 10.35 Protections against spousal impoverishment. The provisions related to spousal impoverishment under s. 49.455, Stats., and s. DHS 103.075 apply to all family care spouses, regardless of their eligibility for medical assistance.

DHS 10.36 Eligibility and entitlement. (1) ENTITLEMENT. Except as provided in sub. (2), a person who meets all of the conditions of eligibility under s. DHS 10.32 is entitled to enroll in a care management organization and to receive the family care benefit if any of the followin…

DHS 10.37 Private pay individuals. (1) DEFINITIONS. In this section: (a) XCase managementY means assessment, care planning, assistance in arranging and coordinating services in the care plan, assistance in filing grievances and appeals and obtaining advocacy services, and periodi…

DHS 10.41 Family care services. (1) ENROLLMENT REQUIRED. The family care benefit is available to eligible persons only through enrollment in a care management organization (CMO) under contract with the department. (2) SERVICES. Services provided under the family care benefit shal…

DHS 10.42 Certification and contracting. (1) No entity may receive payment of funds for the family care benefit as a care management organization unless it is certified by the department as meeting all of the requirements of s. 46.284, Stats., and this chapter and is under contra…

DHS 10.43 CMO certification standards. If an organization applies for a contract to operate a CMO, the department shall determine whether the organization meets the requirements of s. 46.284 (2) and (3), Stats., and all of the following standards: (1) CASE MANAGEMENT CAPABILITY. …

DHS 10.44 Standards for performance by CMOs. (1) COMPLIANCE. A care management organization shall comply with all applicable statutes, all of the standards in this subchapter and all requirements of its contract with the department. (2) CASE MANAGEMENT STANDARDS. The CMO shall pr…

DHS 10.45 Operational requirements for CMOs. (1) GOVERNING BOARD. A care management organization shall have a governing board that reflects the ethnic and economic diversity of the geographic area served by the CMO. At least one-fourth of the members of the governing board shall …

DHS 10.46 Department responsibilities for monitoring CMO quality and operations. (1) MONITORING. The department shall monitor CMO operations to assure quality of services and delivery, including consumer satisfaction. The department shall develop indicators to measure and assess …

DHS 10.51 Client rights. Clients shall have the rights in family care that are outlined in the applicant information materials they receive when contacting a resource center and in the member handbook they receive prior to enrollment in a care management organization. The departm…

DHS 10.52 Required notifications. (1) NOTIFICATION OF GENERAL CLIENT RIGHTS AND RESPONSIBILITIES. Each resource center, county agency and CMO shall provide clients with written notification of their rights and responsibilities in accordance with timelines and other requirements e…

DHS 10.54 Department reviews. (1) DEPARTMENT REVIEW PROCESS FOR GRIEVANCES FILED WITH A RESOURCE CENTER. The department shall review, investigate, and analyze the facts surrounding client grievances in an attempt to resolve concerns and problems informally, whenever either of the…

DHS 10.55 Fair hearing. (1) RIGHT TO FAIR HEARING IN RESOURCE CENTER AND COUNTY AGENCY ADVERSE BENEFIT DETERMINATIONS. Except as limited in sub. (3) and s. DHS 10.62 (4), a client may contest any of the following adverse benefit determinations by filing, within 45 days of receipt…

DHS 10.56 Continuation of services. (1) REQUEST FOR CONTINUATION OF SERVICES PENDING OUTCOME OF CMO APPEAL. Prior to reducing, suspending or terminating services under the family care benefit, a CMO shall provide to the enrollee prior notification of its intent to reduce, suspend…

DHS 10.61 Recovery of incorrectly paid benefits. County agencies, on behalf of the department, shall recover benefits incorrectly paid under the family care benefit, whether paid on behalf of individuals eligible for medical assistance or not, according to provisions of s. 49.497…

DHS 10.62 Recovery of correctly paid benefits. (1) RECOVERY FROM THE ESTATE OF AN ENROLLEE. The department shall file a claim against the estate of an enrollee to recover all medical assistance services provided to an individual 55 years or older while the individual was enrolled…

DHS 10.73 Information and referral requirements for long-term care facilities. (1) PURPOSE. This section implements ss. 50.034 (5m) to (5n) and (8), 50.035 (4m) to (4n) and (11) and 50.04 (2g) to (2h), Stats., which establish requirements for adult family homes, residential care …

DHS 10.74 Requirements for resource centers. The department shall establish, through its contracts with resource centers, minimum timeliness requirements for completion of resource center duties related to responding to referrals from long-term care facilities. Minimum timeliness…

DHS 101.01 Authority and purpose. This chapter and chs. DHS 102 to 108 are promulgated pursuant to ss. 49.45 (10) and 49.665 (3), (4) and (5), Stats., for the purpose of administering the medical assistance (MA) program in Wisconsin which finances necessary health care services f…

DHS 101.02 Applicability. This chapter and chs. DHS 102 to 108 apply to all recipients of MA, all providers of MA and all persons engaged in the administration of MA.

DHS 101.03 Definitions. In this chapter and chs. DHS 102 to 109: (1) “Access,” for purposes of BadgerCare Plus, means a family member living in the household has the ability to sign up and be covered by an employer’s group health plan in the current month, or had the ability to s…

DHS 102.01 Application.

DHS 102.02 Refusal to provide information.

DHS 102.03 Verification of information.

DHS 102.035 Verification of United States citizenship.

DHS 102.036 Verification of immigration status.

DHS 102.04 Eligibility determination.

DHS 102.05 Fraud. Note: Chapter HSS 102 as it existed on February 28, 1986, was repealed and a new chapter HSS 102 was created effective March 1, 1986. Chapter HSS 102 was renumbered Chapter HFS 102 under s. 13.93, Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., S…