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Billing Procedures, Uniform Fees, Liabilities, and Collections

An order from a Wisconsin Circuit Court or United States Federal Court supersedes any and all portions of this document as applicable. 

These procedures do not apply to the Intoxicated Driver Program Assessment (per DHS 32.11).

Housing and Inpatient Treatment are not services provided by Juneau County Department of Human Services (JCDHS). Therefore, payments for circumstances in which JCDHS has assisted citizens in obtaining placement at community based residential facilities (including rehabilitation and treatment facilities), or assisted living facilities (including residential care apartment complexes, group homes, and adult family homes) are also not subject to these procedures. In these circumstances, JCDHS is not establishing and collecting fees for services provided, rather citizens are reimbursing JCDHS for paying these costs to third parties on their behalf.

Process:
Prior to services beginning (unless a crisis situation) any consumer of JCDHS shall meet with our billing department to complete all billing paperwork upon referral from manager or designee or as described below.  This meeting may be held telephonically with consumer signatures obtained as soon as possible.   Paperwork to be completed includes but is not limited to:
  1. Consent to bill insurance
  2. Financial Information Sheet (F-80130) and financial responsibility form
  3. Provide a copy of insurance card
  4. If uninsured, as part of the process to verify information provided in the financial responsibility form, apply for Medical Assistance/Badger Care through the Capital Consortium (exceptions only to be made by Director or Deputy Director at request of staff and manager). Billing Department shall give an uninsured (or self-pay) individual, or their authorized representative, a good faith estimate of expected charges after an item or service is scheduled, or upon request. The good faith estimate will include a list of items and services expected to be provided.
  5. For all cases, Juneau County Finance Department will verify income/benefit information with Economic Support, Forward Health, other insurance company, or by other means.  
Juneau County Finance Department shall bill for JCDHS services as referred by MyEvolv (JCDHS Electronic Health Record and Billing System) or JCDHS staff. The Finance Department shall make attempts to bill and receive payment from health insurance (i.e. Medicaid, Medicare, HMO, private health insurance company, etc.) for services rendered. Any services not covered by health insurance shall be subject to payment by individuals deemed liable for these costs as described in this document (except that per Medicaid policies, Medicaid patients may not be billed services deemed to be non-medically necessary). The liability of a person may not be waived if he/she refuses to complete a financial responsibility form, provide verification as required, or intentionally misrepresents any information provided.  In these circumstances, the person will be charged the full cost of services provided and are not eligible for the sliding scale fees.   

Fees and collections shall be based on:
  1. Fees for services provided under 51.42 Wisconsin State Statutes are established by the Juneau County Board of Supervisors.
  2. The cost of other services provided to consumers are established and approved by JCDHS.   
  3. Sliding scale Maximum Monthly Payment schedule, which is determined yearly and calculated on the Consumer Price Index for Midwest Region gross monthly income and number of persons living in the family as provided by the Wisconsin Department of Health Services.  Consumers will pay maximum monthly payment as determined by this sliding scale, or other agreed upon amount as arranged by Juneau County Finance Department, until fees are paid in full.   Consumers who are engaging in ongoing preventative care, such as outpatient mental health/substance use disorder treatment or community based services, as determined by the assigned clinician and manager, will only be charged the maximum monthly payment.
Liability shall be based on:
  1. Unless otherwise provided by law, the following persons are liable for services provided to a consumer:
    1. A consumer who is not a minor
    2. A spouse
    3. A parent
    4. A person that a court determines or orders to be liable or otherwise responsible for payment of services provided
    5. Any other person liable provided under s. 46.10, Stats such as any person, including but not limited to a person admitted, committed, protected or placed under guardianship, protective placement, emergency detention, involuntarily committed, secure detention or is admitted to community programs that treat mental health and/or substance use or voluntary protective services
    6. After investigation of the liable persons’ ability to pay, the JCDHS shall make collection from the person who is best able to pay, giving due regard to relationship and the present needs of the person or lawful dependents
Billing:
  1. Each month, JCDHS shall issue a billing statement that indicates any outstanding liability to each of the following:
    1. A consumer who is not a minor
    2. Each parent
    3. Each authorized representative including guardian of estate, representative payee or any other person or entity authorized by law or through the consumer’s written consent to receive such information.
  2. Third Party Payers. JCDHS 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 (i.e. all other insurances must be billed first).
  3. Amount.
    1. Ability to pay for services rendered shall be based on the consumer’s ability to pay by using the financial responsibility form which can be determined at any of the following times:
      1. Upon receipt of the financial responsibility form
      2. When the JCDHS receives notice that there has been a change in financial circumstances
      3. Once every 12 months while services are being rendered
      4. At the conclusion of services rendered.     
    2. Services received by a minor without consent.  If a minor receives services without the consent of a parent or guardian, JCDHS will not charge/bill for these services.   
  4. Adjustments.  JCDHS may adjust past determination of ability to pay looking back 90 days from the date of receipt of a financial responsibility form. 
  5. Other Requirements.  Juneau County Finance Department utilizes MyEvolv to maintain appropriate documentation and review bills/accounts monthly for accuracy and compliance with this policy.  Finance and JCDHS meet monthly to review billing procedures for accuracy, compliance, and consistency.  Grievances regarding liability determination, billing, and collections shall be responded to in accordance to JCDHS Client Rights and Grievance Procedure.   
Services to be billed for include:
  1. Behavioral Health/Community Support Program/Comprehensive Community Services
    1. Mental Health Assessments and Individual therapy
    2. Substance Use Assessments and Substance Use Counseling
    3. Psychological Evaluations
    4. Psychiatry
    5. Groups
    6. Case Management
    7. Crisis Initial Intervention and Crisis Linkage and Follow-up will be billed to those private insurances that pay and Medicaid/Medicare, however the consumer will not be billed for these services (approved by DHS Board on May 15, 2018).  Similarly, consumers who are placed by JCDHS at state institutes for mental disease (i.e. Winnebago and Mendota) will not be billed for these services, nor will consumers be billed for interpreting services not covered by insurance, Medicaid, or Medicare. 
  2. Adult Protective Services
    1. Psychological Evaluations
    2. Case management
  3. Children, Youth and Families
    1. Psychological and similar evaluations
    2. Therapy and other treatment services
    3. Certain parenting services
    4. Case management—for Chapter 938 court orders/consent decrees, this is a service provided to the Court for community based juvenile delinquency related services.   Court establishes this fee and it is not subject to ability to pay.  Payment plan may be established.  Finance Department to receive copy of court order or consent decree.   
    5. Electronic monitoring-- for Chapter 938 court orders/consent decrees, this is a service provided to the Court for community based juvenile delinquency related services.  Court establishes this fee and it is not subject to ability to pay.  Payment plan may be established.  Finance Department to receive copy of court order or consent decree.   
    6. Secure Detention-- for Chapter 938 court orders/consent decrees, this is a service provided to the Court for community based juvenile delinquency related services.   Court establishes this fee and it is not subject to ability to pay. Payment plan may be established.  Finance Department to receive copy of court order or consent decree.    
Delinquent Account.  The consumer’s account is delinquent when:
  1. The monthly payment amount established under ability to pay sliding scale fee has not been received for 90 consecutive days and
  2. JCDHS has notified all applicable liable persons at least three times using 30, 60, and 90-day dunning letters. 
  3. Or has otherwise been determined by the Corporation Counsel and/or Fiscal Manager.  
Delinquent accounts will not be written off unless approved by the JCDHS Director or Deputy Director.   Delinquent accounts will only be written off for situations in which the consumer’s only source of income is SSI, account is delinquent over ten years (or twenty years if court judgement obtained), account is closed and less than $50 and has been delinquent for a period of six months or more, consumer is deceased and account has been assigned to collection agency for a period of over two years (or corporate guardian confirms that estate has no assets), the Wisconsin Department of Revenue sends back account as uncollectible, it’s discovered that the bill or part of the bill was charged to the consumer’s account in error, or mental health status or other special needs of consumer requires account be written off for their immediate wellbeing as determined by the assigned clinician, manager, and Director/Deputy Director.   Other payment arrangements/negotiations may be considered by management team on an individual/case-by-case basis.  

Use of Collection Agency.   JCDHS utilizes the Wisconsin Department of Revenue to perform collection duties and responsibilities for collections on delinquent accounts.  JCDHS will not engage in collection efforts for costs which are subject to these procedures if financial form, financial responsibility form and Economic Support records support that the liable person does not have the ability to pay.  According to the Wisconsin Department of Health Services Office of Legal Counsel, this includes costs set by co-insurance, co-pays, and deductibles (March 29, 2022).  If these costs exceed $500, or other special circumstances exist as determined by the manager and Director/Deputy Director (such as when it is known or suspected the individual will soon have the ability to pay), JCDHS will hold open the account and periodically review ability to pay.      

Consumer Rights and Grievance Procedure
When consumers receive any JCDHS service, they have certain rights.   Please see “Juneau County Department of Human Services, Client Rights and Grievance Procedure” and “Complaint/Grievance Report”.   Please give these documents to any consumer indicating they believe their rights have been violated or they have a grievance.   
 
See Appendix I for Billing Procedures for Children’s Long Term Support and Birth-to-Three Programs   

Appendix I

Children’s Long-Term Support (CLTS) parental payment limits shall be established by JCDHS Children, Youth and Family Services in the following manner:
  1. Determining Parental Payment Limits.  JCDHS shall determine the parental payment limit for each child receiving CLTS services in the following manner:
    1. Determine the annual parental income.  If the parents live in separate households and the child receiving CLTS services resides in both households, determine a separate parental payment limit for each household.
    2. Subtract the higher from the following:
      1. The Wisconsin Department of Health Service’s standard disability allowance
      2. Allowable medical or dental expenses claimed for the child on schedule A of the parent’s most recent internal revenue service tax form 1040 that was filed with the IRS
    3. Determine the federal poverty level based on current federal poverty guidelines for the family size.  If the parents live in separate households and the child resides in both households, determine the family size and federal poverty level for each household. 
    4. Determine whether the income is at or above 330% of the federal property level and identify the percentage of the annual service plan costs owed based on the most current CLTS Parental Payment Limit Worksheet.
    5. Compute the annual cost of the child’s service plan.  Subtract administrative and support and service coordination functions.
    6. For families with an income over 330% of the federal poverty level, multiply the percentage established in section d by the amount established in section e.
  2. Amending Calculated Payment Limits
    1. If a parent refuses to provide financial information, then their parental payment limit shall be 41% of the annual cost of the child’s service plan.
  3. Notification of Parental Financial Obligation
    1. JCDHS shall provide written notice to the parents of the amount of the annual parental financial obligation due before the service plan is implemented or as soon thereafter as possible, that includes all of the following:
      1. Date of the implementation of the parental financial obligation, which is the start date on the service plan
      2. The annual amount due with the breakdown of monthly minimum requirements
      3. Statement regarding steps for reconsideration of the parental financial obligation (specifically, contact the CLTS Manager). 
Birth to Three (B3) parental cost share:
  1. JCDHS shall determine the parental cost share for each child receiving B3 services in the following manner:
    1. Calculate the total income of the parents by using the most recent federal tax return or other sources.
    2. Determine adjusted annual income by giving parents:
      1. Credit for each family member participating in the B3 program
      2. Credit for each additional child in the family under the age of 19 with a disability
    3. Compare your adjusted annual income and family size to the federal poverty guidelines. 
    4. Determine parental cost share by using the parental cost share tables provided to the County by Wisconsin Department of Health Services. 
Updated December 2023