Wis. Admin. Code Department of Health Services 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 in family care. Recoveries from the estates of all family care enrollees shall be made in accordance with the provisions in ss. 49.496 (1), (3), (6m), and (7), and 49.849, Stats., and s. DHS 108.02 (11) and (12). The amount to be recovered under this section shall be equal to the amount of the total capitated payment made by the department to the CMO for the enrollee.

(a) The amount to be recovered under this section shall be the actual cost of services received by an enrollee through the family care benefit as reported to the department by the CMO in which the person was enrolled.

Note: Paragraph (a) was inadvertently left in by rule CR 23-046 and will be removed in future rulemaking.

(2) LIENS ON THE HOMES OF NURSING HOME RESIDENTS AND INPATIENTS AT HOSPITALS. The department may obtain a lien on an enrollee's home if the enrollee resides in a hospital and is required to contribute to the cost of care, or if the enrollee resides in a nursing home, and the enrollee cannot reasonably be expected to be discharged from the hospital or nursing home and return home. The department shall obtain liens under this subsection in accordance with the provisions in s. 49.496 (1) and (2), Stats. The lien is for the amount that is recoverable under sub. (1) and for costs that are recoverable under ss. 49.496 and 49.849, Stats.

(3) USE OF FUNDS. The department shall deposit amounts recovered under this section to the appropriation under s. 20.435 (4) (im), Stats.

(4) HEARING RIGHTS. An enrollee's exclusive administrative hearing rights are those specified in s. 49.496 (2), Stats., and ch. HA 3 for liens and in s. DHS 108.02 (12) for hardship waivers.

Notes

Wis. Admin. Code Department of Health Services DHS 10.62

Cr. Register, October, 2000, No. 538, eff. 11-1-00; corrections in (1) (intro.), (b) (intro.) and (4) made under s. 13.92(4) (b) 7, Stats., Register November 2008 No. 635; correction in (1) (b) (intro.) made under s. 13.92(4) (b) 7, Stats., Register November 2009 No. 647; corrections in (1), (2) made under s. 13.92(4) (b) 7, Stats., Register December 2013 No. 696. Amended by, corrections in (3) (b) made under s. 13.92(4) (b) 7, Stats., Register November 2015 No. 719, eff.12/1/2015 Amended by CR 22-026: am. (1) (b) Register May 2023 No. 809, eff. 6/1/2023 Amended by, CR 23-046: renum. (1) to (1) (intro.) and am., r. (1) (b), renum. (3) (intro.) to (3) and am., r. (3) (a), (b) Register April 29 No. 820, eff. 5/1/2024