reglab/statecodes huggingface dataset:
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter III - Use of Force and Related Matters › Section DHS 98.17 - Definitions

Current through June 24, 2024
In this subchapter:
(1) "Bodily injury" means physical pain or
				  injury, illness, or any impairment of physical condition.
(2) "Deadly force" means force which the user
				  reasonably believes will create a substantial risk of causing death or great
				  bodily injury to another.
(3)
				  "Force" means the exercise of strength or power to overcome resistance or to
				  compel another to act or to refrain from acting in a particular way. It
				  includes the use of mechanical and physical power or strength.
(4) "Great bodily injury" means bodily injury
				  which creates a high probability of death, or which causes serious permanent
				  disfigurement, or which causes a permanent or protracted loss or impairment of
				  the function of any bodily member or organ.
(5) "Non-deadly force" means force which the
				  user reasonably believes will not create a substantial risk of causing death or
				  great bodily injury to another.
(6)
				  "Reasonably believes" means that the actor believes that a certain fact
				  situation exists and such belief under the circumstances is reasonable even
				  though it may be erroneous.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter III - Use of Force and Related Matters › Section DHS 98.18 - Use of force

Current through June 24, 2024
(1) Whenever feasible, field staff shall rely
				  on law enforcement authorities to exercise force against clients when force is
				  necessary. When that assistance is not practical, field staff may use force
				  subject to this section. Only so much force may be used as is reasonably
				  necessary to achieve the objective for which it is used.
(2) Corporal punishment of clients is
				  forbidden. This prohibition allows no exceptions and applies to public and
				  private programs.
(3) Non-deadly
				  force may be used by field staff against clients only if the user of force
				  reasonably believes it is immediately necessary to realize one of the following
				  purposes:
(a) To prevent death or bodily
				  injury to oneself or another;
(b)
				  To prevent unlawful damage to property that may result in death or bodily
				  injury to oneself or another;
(c)
				  To prevent a client from fleeing the control of a field staff member;
(d) To change the location of a client;
				  or
(e) To prevent unlawful damage
				  to property.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter III - Use of Force and Related Matters › Section DHS 98.19 - Mechanical restraints

Current through June 24, 2024
(1) Mechanical restraints are limited to
				  handcuffs, handcuffs with restraining belt or chain, restraining chain, leg
				  restraints, and leather and plastic restraints. These may be used to restrain
				  and transport a client, but only in accordance with this section.
(2) Mechanical restraints may only be used in
				  the following circumstances:
(a) To protect
				  staff or others from a client who poses an immediate risk of flight or physical
				  injury to others, unless restrained;
(b) To protect a client who poses an
				  immediate threat of physical injury to himself or herself, unless
				  restrained;
(c) When taking a
				  client into custody; or
(d) To
				  transport a client.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter III - Use of Force and Related Matters › Section DHS 98.20 - Chemical agents and firearms

Current through June 24, 2024
(1) Chemical agents
				  shall not be used by field staff against clients.
(2) Field staff shall not carry firearms or
				  other weapons during their working hours.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter III - Use of Force and Related Matters › Section DHS 98.21 - Search and seizure

Current through June 24, 2024
(1) GENERAL POLICY. A search of a client or
				  the client's living quarters or property may be made at any time, but only in
				  accordance with this section.
(2)
				  PERSONAL SEARCH.
(a) In this subsection,
				  "personal search" means a search of a client's person, including but not
				  limited to the client's pockets, frisking the client's body, an examination of
				  the client's shoes and hat, and a visual inspection of the client's
				  mouth.
(b) A personal search of a
				  client may be conducted by any field staff member under one or more of the
				  following circumstances:
1. If the staff
				  member has reasonable grounds to believe that the client possesses
				  contraband;
2. At the direction of
				  a supervisor;
3. Before a client
				  enters and after a client leaves the security enclosure of a correctional
				  institution, jail or detention facility; or
4. When a client is taken into
				  custody.
(c) A written
				  report of every personal search shall be prepared by the staff member who
				  conducted the search and shall be filed in the client's case record.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter III - Use of Force and Related Matters › Section DHS 98.22 - Custody and detention

Current through June 24, 2024
(1) Whenever feasible, staff shall rely on
				  law enforcement authorities to take a client into custody. When that assistance
				  is not practical, field staff shall take clients into custody in accordance
				  with this section.
(2) A client
				  shall be taken into custody and detained if the client is alleged to have been
				  involved in assaultive or dangerous conduct. A regional chief may permit
				  exceptions to this requirement.
(3)
				  A client may be taken into custody and detained:
(a) For investigation of an alleged violation
				  by the client;
(b) After an alleged
				  violation by the client to determine whether to commence revocation
				  procedures;
(c) To prevent a
				  possible violation by the client; or
(d) For disciplinary purposes.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter III - Use of Force and Related Matters › Section DHS 98.23 - Transporting clients in custody

Current through June 24, 2024
(1) A field staff
				  member may transport a client to jail or other detention facility, to an
				  institution or to court.
(2) A
				  client may be handcuffed or otherwise appropriately restrained when being
				  transported by field staff.
Note: When a client is being taken into custody, it is
					 usually desirable to restrain the client.
(3) Two field staff members shall transport a
				  client whenever feasible, and the client shall be informed of the reasons why
				  he or she is being transported prior to such transport.
(4) Relevant records relating to transport of
				  a client shall be maintained in the client's record.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter IV - Records and Reports › Section DHS 98.24 - Predispositional investigation report

Current through June 24, 2024
(1) PURPOSE. The
				  primary purpose of the predispositional investigation report is to provide the
				  court with accurate and relevant information upon which to base its
				  dispositional decision. The report is also important in the planning process.
				  It is used for such things as determining levels of supervision,
				  classification, program assignment, release planning and in the overall
				  treatment of offenders.
(2) COURT
				  ORDER. Upon order of the court, the department shall prepare a predispositional
				  investigation report. It shall contain the information provided for under this
				  section unless the court orders otherwise.
(3) CONTENT.
(a)
Information.
A
				  predispositional report should contain the following information relating to
				  the client:
1. Present offense;
2. Prior criminal record;
3. Prior correctional institution
				  record;
4. Victim's
				  statement;
5. Family information;
				  and
6. Personal history.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter IV - Records and Reports › Section DHS 98.25 - Modified predispositional investigation report

Current through June 24, 2024
(1) Upon order of
				  the court, department staff may prepare a predispositional investigation report
				  that contains only the information that the court orders, notwithstanding s.
				  DHS
				  98.24.
(2)
				  Upon order of the court, department staff may present the report orally in open
				  court or in the judge's chambers. Defense counsel, district attorney, and
				  client may be present.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter IV - Records and Reports › Section DHS 98.26 - Sources of information for a predispositional report

Current through June 24, 2024
(1)
(a) All sources of information relied upon
				  for an investigation and report shall be identified in writing in the
				  predispositional investigation report unless otherwise ordered under s.
				  DHS
				  98.25. All sources shall be informed of this
				  requirement.
(b) No pledge of
				  confidentiality may be given to any person by department staff in return for
				  facts included in the report except in accordance with sub. (2).
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter IV - Records and Reports › Section DHS 98.27 - Recordkeeping

Current through June 24, 2024
(1) A case record of each client shall be
				  maintained by the department. That record shall include:
(a) Chronological log entries;
(b) Periodic case planning summaries prepared
				  in accordance with the department of correction's case classification
				  policies;
(c) Case transfer
				  summaries, if any;
(d) Supervisory
				  contact summaries;
(e) Records of
				  administrative decisions;
(f)
				  Reports from community-based residential facilities, if any;
(g) A record of all written disclosures of
				  information to social welfare agencies, law enforcement agencies or third
				  parties, and of all information disclosed pursuant to a written request for
				  specific information to social welfare agencies, law enforcement agencies or
				  third parties;
(h) The client's
				  court order and any court imposed conditions and obligations;
(i) Copies of the client's predispositional
				  investigation report prepared under s.
				  DHS
				  98.24 or
				  98.25.
(j) The rules and conditions of the client's
				  supervision and the reasons for them;
(k) Relevant information regarding
				  institutional experience;
(L)
				  Information relating to conditional release or transfer planning, decisions and
				  conditions; and
(m) Other
				  information as required by the court or the department.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter V - Lie Detector Testing › Section DHS 98.28 - Purpose, authority and applicability

Current through June 24, 2024
This subchapter is promulgated under the authority of s.
					 51.375(3),
					 Stats., to establish a lie detector program for clients who are sex offenders.
					 This subchapter applies to the department and to clients who are sex
					 offenders.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter V - Lie Detector Testing › Section DHS 98.29 - Lie detector requirement

Current through June 24, 2024
The department may require a client who is a sex offender
					 to submit to the lie detector examination process in accordance with s.
					 DHS
					 98.31 as a condition of supervision.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter V - Lie Detector Testing › Section DHS 98.30 - Purpose of lie detector program

Current through June 24, 2024
(1) The department
				  may use the lie detector examination process as a supervision tool for clients
				  who are sex offenders. Testing may be used to achieve any of the following
				  goals in supervising a client who is a sex offender:
(a) Disclosing offense pattern information
				  for treatment purposes.
(b) Holding
				  the client accountable for behaviors which occur while on
				  supervision.
(c) Verifying the
				  accuracy of self-reporting.
(d)
				  Assisting in the monitoring and early identification of rule violations and
				  other criminal behavior.
(e)
				  Providing a deterrent to re-offending.
(f) Identifying the clients who need more
				  intensive supervision or treatment.
(g) Providing more information for purposes
				  of assessment, treatment and monitoring.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter V - Lie Detector Testing › Section DHS 98.31 - Operation of lie detector program

Current through June 24, 2024
(1) SELECTION OF
				  PARTICIPANTS. Upon the approval of an agent's supervisor, an agent may require
				  a client who is a sex offender to participate in the lie detector program. The
				  agent may require a client who is a sex offender to submit to the lie detector
				  examination process based on the following:
(a) For a client who is a sex offender and
				  who is approaching release from confinement:
1. The client's criminal record of sexual
				  offenses.
2. The client's
				  adjustment under previous supervision.
3. The client's participation in
				  offense-related programming while incarcerated or institutionalized.
4. The client's motivation or refusal to
				  participate in continued programming in the community.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 98 - Field Supervision Of Clients › Subchapter V - Lie Detector Testing › Section DHS 98.32 - Lie detector fee

Current through June 24, 2024
The department shall establish a schedule of fees to
					 partially offset the costs of the lie detector program for clients who are sex
					 offenders and who are required to take a lie detector test. A client shall pay
					 for the costs of the test in accordance with the schedule of fees. The costs of
					 the tests may vary depending on the type of test used. A client shall also pay
					 a $5 administrative fee with each payment. The department shall do all of the
					 following in establishing a fee schedule for lie detector testing and in
					 collecting lie detector fees:
(1)
				  BASIS OF FEE. Base the lie detector fee payment schedule upon the client's
				  ability to pay, with the goal of receiving payment for the costs of
				  administering the test and a $5 administrative fee with each payment.
(2) TIMING OF PAYMENTS. Permit payment of the
				  fee to be paid in any of the following ways:
(a) Full payment of the fee within 30 days of
				  the date the client takes the lie detector test.
(b) Quarterly payment of the fee to be paid
				  in full within one year of the date the client takes the lie detector
				  test.
(c) Monthly installment
				  payments of the fee to continue until the fee is paid in full.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 99 - Persons qualified to conduct evaluations of persons alleged to be sexually violent › Section DHS 99.01 - Authority and purpose

Current through June 24, 2024
This chapter is promulgated under the authority of s.
				  980.04(4),
				  Stats., to provide rules that state the qualifications of persons who may
				  conduct an evaluation of a person for whom a petition has been filed alleging
				  that the individual is a sexually violent person, and therefore should be
				  committed to the custody of the department of health services, and for whom the
				  court has determined that there is probable cause to believe that the
				  individual is a sexually violent person.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 99 - Persons qualified to conduct evaluations of persons alleged to be sexually violent › Section DHS 99.02 - Applicability

Current through June 24, 2024
This chapter applies to facilities at which evaluations under
				  s.
				  980.04(3),
				  Stats., are conducted, to persons conducting evaluations under s.
				  980.04(3),
				  Stats., and to all persons ordered by a court under s.
				  980.04(3),
				  Stats., to be transferred to an appropriate facility for an
				  evaluation.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 99 - Persons qualified to conduct evaluations of persons alleged to be sexually violent › Section DHS 99.03 - Definitions

Current through June 24, 2024
In this chapter:
(1)
				"Licensed psychologist" means a psychologist licensed under ch. 455,
				Stats.
(2) "Mental disorder" means
				a congenital or acquired condition affecting the emotional or volitional
				capacity that predisposes a person to engage in acts of sexual
				violence.
(3) "Psychiatrist" means
				a physician licensed under ch. 448, Stats., to practice medicine and surgery
				who has completed 3 years of residency training in psychiatry in a program
				approved by the accreditation council for graduate medical education and is
				either certified or eligible for certification by the American board of
				psychiatry and neurology.
(4)
				"Sexually violent offense" has the meaning prescribed in s.
				980.01(6),
				Stats.
(5) "Sexually violent
				person" means a person who has been convicted of a sexually violent offense,
				has been adjudicated delinquent for a sexually violent offense, or has been
				found not guilty of or not responsible for a sexually violent offense by reason
				of insanity or mental disease, defect or illness, and who is dangerous because
				he or she suffers from a mental disorder that makes it substantially probable
				that the person will engage in acts of sexual violence.
Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 99 - Persons qualified to conduct evaluations of persons alleged to be sexually violent › Section DHS 99.04 - Qualifications

Current through June 24, 2024
A person conducting an evaluation under s.
				  980.04(3),
				  Stats., shall be either a psychiatrist or a licensed
				  psychologist.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 101 - Introduction And Definitions › Section DHS 101.01 - Authority and purpose

Current through June 24, 2024
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 for qualified persons whose financial resources are
				  inadequate to provide for their health care needs.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 101 - Introduction And Definitions › Section DHS 101.02 - Applicability

Current through June 24, 2024
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.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 102 - Application › Section DHS 102.01 - Application

Current through June 24, 2024
Application for medical assistance (MA) shall be made
				  pursuant to s. 49.47 (3),
				  Stats., for medically indigent persons, s.
				  49.46, Stats., for categorically
				  needy persons s. 49.473, Stats., for women
				  diagnosed with breast or cervical cancer or precancerous conditions, and s.
				  49.471, Stats., for persons
				  under BadgerCare Plus, and this chapter. Applications shall be made and
				  reviewed in accordance with the following provisions:
(1) RIGHT TO APPLY. Any person may apply for
				MA. The application shall be made via the department's internet website, over
				the telephone, by fax, on a paper form, or in person with the agency.
(2) APPLICATIONS FROM OUTSIDE WISCONSIN.
(a) Except as provided under par. (b),
				application for Wisconsin MA shall not be accepted for a person residing
				outside Wisconsin.
(b) If a
				Wisconsin resident becomes ill or injured when absent from the state or is
				taken outside the state for medical treatment, application for Wisconsin MA for
				that person shall be made on a Wisconsin application form and witnessed by the
				public welfare agency in the other state in accordance with
				42 CFR
				435.403.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 102 - Application › Section DHS 102.035 - Verification of United States citizenship

Current through June 24, 2024
(1) The agency
				shall verify citizenship through a data match with the Social Security
				Administration. If citizenship cannot be verified through a data match with the
				Social Security Administration, the agency must verify citizenship through
				satisfactory documentary evidence as specified in s.
				49.84 (6) (d),
				Stats., except that any of the following are exempt from the requirement to
				verify citizenship:
(a) Individuals receiving
				supplemental security income benefits under
				42 USC
				1381-1383f.
(b) Individuals entitled to or enrolled in
				any part of Medicare.
(c)
				Individuals receiving disability insurance benefits under
				42 USC
				423 or monthly benefits under
				42 USC
				402, based on the individual's
				disability.
(d) Individuals who are
				in foster care and who are assisted under
				42 USC
				621-629m, and individuals who are
				beneficiaries of foster care maintenance or adoption assistance payments under
				42 USC
				670-679c.
(e) Individuals who are or were deemed
				eligible for MA in Wisconsin on or after July 1, 2006, based on being born to a
				pregnant woman eligible for MA.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 102 - Application › Section DHS 102.036 - Verification of immigration status

Current through June 24, 2024
(1) The agency
				shall verify immigration status of persons declaring a satisfactory immigration
				status either through the electronic service established by the U.S. department
				of health and human services, or the department of homeland security.
(2) Persons applying for MA emergency
				services provided under 42
				USC 1396b(v) or applying for
				an unborn child under s.
				49.471, Stats. shall not be
				required to verify their immigration status.
(3) If immigration status cannot be promptly
				verified, a reasonable opportunity period of 95 days shall be provided to
				applicants during which efforts must continue to obtain verification or, if
				necessary, request documentation. Benefits shall not be delayed, denied,
				reduced, or terminated during the reasonable opportunity period if the
				individual is otherwise eligible for MA. An additional reasonable opportunity
				period may be granted when a change in immigration status is
				reported.
(4) Unless the individual
				reports a change in immigration status or information is received that
				indicates a potential change in the individual's status, the agency shall not
				re-verify or require an individual to re-verify immigration status at a renewal
				of eligibility or upon a subsequent application following a break in
				coverage.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 102 - Application › Section DHS 102.04 - Eligibility determination

Current through June 24, 2024
(1) DECISION DATE.
(a) As soon as possible but not later than 30
				days from the date the agency receives a signed application completed to the
				best of the applicant's ability, the agency shall determine the applicant's
				eligibility for MA.
(b) If medical
				examination reports are needed to determine disability or blindness, the agency
				shall make the disability decision no later than 60 days from the date the
				agency receives the signed application.
(c) If a delay in processing the application
				occurs because of a delay in securing necessary information, the agency shall
				notify the applicant in writing of all of the following:
1. That there is a delay in processing the
				application.
2. The reason for the
				delay.
3. The applicant's right to
				appeal the delay under s.
				49.45 (5),
				Stats.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 102 - Application › Section DHS 102.05 - Fraud

Current through June 24, 2024
When the agency director or a designee has reason to believe
				  that fraud has been committed by an applicant or recipient, or by the
				  representative of an applicant or a recipient, the case shall be referred to
				  the district attorney.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.01 - Introduction

Current through June 24, 2024
(1) PERSONS ELIGIBLE.
(a) Eligibility for medical assistance shall
				be determined pursuant to ss.
				49.453,
				49.454,
				49.455,
				49.46 (1),
				49.468,
				49.47 (4),
				49.471,
				49.472 and
				49.473, Stats., and this
				chapter, except that medical assistance shall be provided without eligibility
				determination to persons receiving SSI.
(b) Presumptive eligibility for pregnant
				women shall be determined under s.
				49.465, Stats., and this
				chapter.
(c) Presumptive
				eligibility for children shall be determined under s.
				49.471 (5) (b)
				2, Stats., and this chapter.
(d) Presumptive eligibility for women
				diagnosed with breast or cervical cancer or precancerous conditions shall be
				determined under s. 49.473 (3),
				Stats., and this chapter.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.04 - Asset and income limits

Current through June 24, 2024
The nonexempt assets and budgetable income of the MA group
				  or, when applicable, the fiscal test group, shall be compared to the following
				  asset and income limits established in this section to determine the
				  eligibility of the MA group:
(1)
				CATEGORICALLY NEEDY.
(a) The MA group or
				fiscal test group shall first be tested against the categorically needy
				standard. Persons who meet the non-financial eligibility conditions and who
				meet the income and asset standards specified in this subsection shall be
				determined eligible as categorically needy in accordance with s.
				49.46 (1) (e),
				Stats., and shall receive MA benefits in accordance with s.
				49.46 (2),
				Stats., and chs.
				DHS
				101 to
				108.
(b) The BadgerCare Plus-related categorically
				needy income standard for MA applicants shall be the appropriate standard as
				specified in s.
				DHS 103.03 (1)
				(a).
(c) The SSI-related categorically needy
				income standard shall be the maximum SSI payment including state supplement
				that a single person or a couple, as appropriate, could receive in Wisconsin
				under s. 49.77, Stats., or federal title
				XVI of the social security act of 1935, as amended. The SSI-related
				categorically needy asset standard shall be the same as specified in section
				1613 of title XVI of the social security act of 1935, as
				amended.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.05 - Determining assets and income in child-only cases

Current through June 24, 2024
(1) MEANING OF
				CHILD-ONLY CASE. A child-only case exists when any of the following occur:
(a) A family has been determined financially
				ineligible for BadgerCare Plus-related MA only and there is a child in the
				family who is SSI-related but not receiving SSI payments.
(b) A child under age 19 is not living with a
				parent.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.06 - Assets

Current through June 24, 2024
(1) SPECIAL SITUATIONS OF INSTITUTIONALIZED
				PERSONS.
(a) In determining the eligibility of
				an institutionalized person, only the assets actually available to that person
				shall be considered.
(b) The
				homestead property of an institutionalized person is not counted as an asset
				if:
1. The institutionalized person's home is
				currently occupied by the institutionalized person's spouse or a dependent
				relative. In this subdivision, "dependent relative" means a son, daughter,
				grandson, granddaughter, stepson, stepdaughter, in-law, mother, father,
				stepmother, stepfather, grandmother, grandfather, aunt, uncle, sister, brother,
				stepbrother, stepsister, halfsister, halfbrother, niece, nephew or cousin who
				is financially, medically or otherwise dependent on the institutionalized
				person;
2. The institutionalized
				person intends to return to the home and the anticipated absence from the home,
				as verified by a physician, is less than 12 months; or
3. The anticipated absence of the
				institutionalized person from the home is for more than 12 months but there is
				a realistic expectation, as verified by a physician, that the person will
				return to the home. That expectation shall include a determination of the
				availability of home health care services which would enable the recipient to
				live at home.
(c) If none
				of the conditions under par. (b) is met, the property is no longer the
				principal residence and becomes non-homestead property.
(d) When income that has been protected for
				institutionalized recipients accumulates to the point that the asset limit is
				exceeded, MA eligibility shall terminate. Eligibility may not be reinstated
				until the assets are below the limit at which time a new application shall be
				required.
(e) To maintain
				continuous MA eligibility the recipient may apply assets as a refund of MA
				benefits to the department. In no instance may refunds exceed benefits
				received.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.063 - Divestment prior to August 9, 1989

Current through June 24, 2024
(1) APPLICABILITY.
				This section applies to all applicants for MA and recipients of MA who disposed
				of a resource at less than fair market value prior to August 9, 1989 and to all
				inter-spousal transfers occurring before October 1, 1989. Section
				DHS
				103.065 applies to all institutionalized applicants
				and recipients who divest on or after August 9, 1989, except for inter-spousal
				transfers occurring before October 1, 1989.
(1m) PURPOSE. This section implements s.
				49.45(17),
				1987 Stats., which makes an applicant for or recipient of MA ineligible when
				the applicant or recipient disposed of a resource at less than fair market
				value within 2 years before or at any time after his or her most recent
				application for MA or any review of eligibility for MA. Section
				49.45(17)
				(d), 1987 Stats., is specifically concerned
				with an applicant for or recipient of MA who resides as an inpatient in a
				skilled nursing facility (SNF), intermediate care facility (ICF) or inpatient
				psychiatric facility and who disposed of homestead property at any time during
				or after the 2 year period prior to the date of the most recent application or
				any review of eligibility.
(2)
				DIVESTMENT OF NON-HOMESTEAD PROPERTY.
(a)
Amount of divestment.
For any person who disposed of a
				resource, except a homestead or other exempt resource, at less than fair market
				value within 2 years before or at any time after his or her most recent
				application for MA, or any review of eligibility, the agency shall determine
				the amount of the divestment in the following manner:
1. If the compensation received is less than
				net market value, the difference between the compensation received and the net
				market value is the divested amount and shall be considered an asset.
2. If the divested amount plus other
				nonexempt assets are equal to or less than the appropriate assets limit, the
				divestment shall not be considered a bar to eligibility.
3. If the divested amount plus the other
				nonexempt assets are greater than the appropriate assets limit, the excess over
				this limit shall be the amount of divestment to be expended for maintenance
				needs and medical care.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.07 - Income

Current through June 24, 2024
(1) SPECIAL SITUATIONS OF INSTITUTIONALIZED
				PERSONS.
(a)
Support received by
				institutionalized persons.
1. Any
				financial support or contribution received by an institutionalized person shall
				be considered available when determining the eligibility of that person for
				MA.
2. The income and assets of the
				parents of children under age 18 who reside in institutions shall be evaluated
				by the department to determine whether, pursuant to s.
				46.10 (14),
				Stats., collections may be made from one or both parents. If the child is
				residing in an institution not specified in s.
				46.10 (14),
				Stats., but the institution is approved to receive MA payments, the parental
				liability shall be the same as that provided in s.
				46.10 (14),
				Stats., and collected in the same manner.
3. The agency shall decide if the spouse of
				an institutionalized applicant or recipient should be referred for support
				action under s. 49.90, Stats. When deciding
				whether to refer for support action, the agency shall consider the spouse's
				basic essential needs and present and future expenses. In no case may support
				from the spouse of an institutionalized applicant or recipient be pursued when
				the spouse's assets, not counting homestead property and a motor vehicle, or,
				if applicable, not counting assets excluded under s.
				DHS 103.075 (5) (b)
				2., are less than the amount provided under
				s. 49.47 (4) (b)
				3g, Stats., or, if applicable, the spousal
				asset share under s. 49.455 (6) (b),
				Stats., and when the spouse's income is less than the spousal monthly income
				allowance under s. 49.455 (4) (b),
				Stats.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.08 - Beginning of eligibility

Current through June 24, 2024
(1) DATE. Except as
				provided in subs. (2) to (5), eligibility shall begin on the date on which all
				eligibility requirements were met, but no earlier than the first day of the
				month 3 months prior to the month of application. Retroactive eligibility of up
				to 3 months may occur even though the applicant is found ineligible in the
				month of application.
(2)
				SPEND-DOWN PERIOD.
(a)
1. The spend-down period shall begin on the
				first day of the month in which all eligibility factors except income were met,
				but no earlier than the first day of the month 3 months prior to the month of
				application. However, at the recipient's option, it may begin on the first day
				of any of the 3 months prior to the date of application if all eligibility
				factors, except income, were met in that month. A recipient's decision to
				choose an optional beginning date shall be recorded in the agency's case
				record. For persons who previously received MA and then reapply, the spend-down
				period cannot cover the time during which they were receiving MA.
2. The BadgerCare Plus-related or SSI-related
				MA group shall be eligible as of the date within the spend-down period on which
				the expenditure of excess income or the obligation to expend excess income is
				achieved.
3. The applicant shall be
				responsible for some bills or parts of bills for services received on the first
				day of eligibility if there is remaining unspent and unobligated excess income
				on that day.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.10 - Redetermination of eligibility

Current through June 24, 2024
The agency shall give the recipient timely advance notice of
				  the date on which the recipient's eligibility will be redetermined. This notice
				  shall be in writing and mailed to the recipient at least 15 calendar days but
				  no more than 30 calendar days before the redetermination date. The requirement
				  for timely advance notice of eligibility redetermination does not apply to
				  spend-down cases in which the period of certification is less than 60
				  days.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.11 - Presumptive eligibility for pregnant women and women diagnosed with breast or cervical cancer or precancerous conditions

Current through June 24, 2024
(1) REQUIREMENTS
				FOR PREGNANT WOMEN. Pregnant women may be determined presumptively eligible for
				MA on the basis of a statement of pregnancy, and preliminary household and
				financial information provided by the applicant. That determination shall be
				made by providers or hospitals designated by the department who are qualified
				in accordance with this section.
(1e) PROVIDER REQUIREMENTS. A provider
				qualified to make determinations of presumptive eligibility for pregnant women,
				and women diagnosed with breast or cervical cancer or precancerous conditions
				shall meet the following requirements:
(a) Be
				certified as an MA provider under ch. DHS 105.
(b) Provide one or more of the following
				services:
1. Outpatient hospital
				services.
2. Rural health clinic
				services.
3. Clinic services
				furnished by or under the direction of a physician.
(c) Receive funding or participate in a
				program under:
1. The migrant health center or
				community health center programs under section 330 of the public health service
				act.
2. The maternal and child
				health services block grant programs.
3. The special supplemental food program for
				women, infants and children under section 17 of the child nutrition act of
				1966, 42 USC
				1786.
4. The commodity supplemental food program
				under section 4 (a) of the agriculture and consumer protection act of
				1973.
5. A state prenatal
				program.
(d) Have been
				determined by the department to be a qualified provider under this
				section.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 104 - Recipient Rights And Duties › Section DHS 104.02 - Recipient duties

Current through June 24, 2024
(1) NOT TO SEEK DUPLICATION OF SERVICES. A
				recipient may not seek the same or similar services from more than one
				provider.
(2) PRIOR IDENTIFICATION
				OF ELIGIBILITY. Except in emergencies that preclude prior identification, the
				recipient shall, before receiving services, inform the provider that the
				recipient is receiving benefits under MA and shall present to the provider a
				current valid MA identification card.
(3) REVIEW OF BENEFITS NOTICE. Recipients
				shall review the monthly explanation of benefits (EOB) notice sent to them by
				the department and shall report to the department any payments made for
				services not actually provided. The explanation of benefits notice may not
				specify confidential services, such as family planning, and may not be sent if
				the only service furnished is confidential.
(4) INFORMATIONAL COOPERATION WITH PROVIDERS.
				Recipients shall give providers full, correct and truthful information
				requested by providers and necessary for the submission of correct and complete
				claims for MA reimbursement. This information shall include but is not limited
				to:
(a) Information concerning the recipient's
				eligibility status, accurate name, address and MA identification
				number;
(b) Information concerning
				the recipient's use of the MA card;
(c) Information concerning the recipient's
				use of MA benefits; and
(d)
				Information concerning the recipient's coverage under other insurance
				programs.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 104 - Recipient Rights And Duties › Section DHS 104.03 - Primary provider

Current through June 24, 2024
(1) REQUIRED DESIGNATION.
(a)
Required when program is
				abused.
If the department discovers that a recipient is abusing the
				program, including abuse under s.
				DHS
				104.02(5), the department may require
				the recipient to designate, in any or all categories of health care provider, a
				primary health care provider of the recipient's choice, except when free choice
				is limited under s.
				DHS
				104.035.
(b)
Selection of provider.
The department shall allow a recipient to choose a primary provider from the
				department's current list of certified providers, except when free choice is
				limited under s.
				DHS
				104.035. The recipient's choice shall become effective
				only with the concurrence of the designated primary provider. The type of
				service and identification number of the primary provider shall be endorsed on
				the recipient's MA card.
(c)
Failure to cooperate.
If the recipient fails to designate a
				primary provider after receiving a formal request from the department, the
				department shall designate a primary provider for the recipient in the
				proximity of the recipient's residence.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 104 - Recipient Rights And Duties › Section DHS 104.035 - Prudent buyer limitations

Current through June 24, 2024
Free choice of a provider may be limited by the department if
				  the department contracts for alternate service arrangements which are
				  economical for the MA program and are within state and federal law, and if the
				  recipient is assured of reasonable access to health care of adequate
				  quality.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 104 - Recipient Rights And Duties › Section DHS 104.05 - Preferred enrollment

Current through June 24, 2024
(1) CONTRACTS FOR SERVICES FROM GROUP PLANS.
				The department may enter into contracts for MA services with health maintenance
				organizations (HMOs) or prepaid health plans (PHPs). Each contract shall
				include specific information about services to be provided by the group, the
				number and types of practitioners who will provide the services, the geographic
				service area covered by the group plan, the period of time in which recipients
				are enrolled, the procedures for recipient enrollment, additional services
				which may be available, and the cost of services for each enrollee.
(2) ENROLLMENT RESPONSIBILITY. MA recipients
				within the geographic area stipulated in a group plan service contract shall
				have the choice of enrolling for service membership under the following
				conditions:
(a)
Minimum enrollment
				period.
The department may enter into arrangements with HMOs or PHPs
				which establish minimum enrollment periods for MA recipients.
(b)
Disenrollment period.
In
				geographic areas where there is only one certified group plan provider, each
				recipient may be automatically enrolled in the group plan. A recipient may
				disenroll from the group plan, and the effective date of the disenrollment
				shall be no later than one month from the month in which the recipient
				disenrolls.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.01 - Introduction

Current through June 24, 2024
(1) PURPOSE. This chapter identifies the
				terms and conditions under which providers of health care services are
				certified for participation in the medical assistance program (MA).
(2) DEFINITIONS. In this chapter:
(a) "Group billing provider" means an entity
				which provides or arranges for the provision of medical services by more than
				one certified provider.
(b)
				"Provider assistant" means a provider such as a physical therapist assistant
				whose services must be provided under the supervision of a certified or
				licensed professional provider, and who, while required to be certified, is not
				eligible for direct reimbursement from MA.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.02 - Requirements for maintaining certification

Current through June 24, 2024
Providers shall comply with the requirements in this section
				  in order to maintain MA certification.
(1) CHANGE IN PROVIDER STATUS. Providers
				shall report to the department in writing any change in licensure,
				certification, group affiliation, corporate name or ownership by the time of
				the effective date of the change. The department may require the provider to
				complete a new provider application and a new provider agreement when a change
				in status occurs. A provider shall immediately notify the department of any
				change of address but the department may not require the completion of a new
				provider application or a new provider agreement for a change of
				address.
(2) CHANGE IN OWNERSHIP.
(a)
Non-nursing home
				provider.
In the event of a change in the ownership of a certified
				provider, except a nursing home, the provider agreement shall automatically
				terminate, except that the provider shall continue to maintain records required
				by subs. (4), (6) and (7) unless an alternative method of providing for
				maintenance of these records has been established in writing and approved by
				the department.
(b)
Nursing
				home provider.
In the event of a change in the ownership of a nursing
				home, the provider agreement shall automatically be assigned to the new
				owner.