Which place’s debt rules apply—and who can help?

SettleADebt S_WI PASS-07 — Wisconsin hospital / medical-bill financial assistance, charity care, patient billing, and assistance-related collection protections

Actual fresh public-source access date: October 26, 2026, America/Los_Angeles; October 27, 2026 UTC. Historical baseline: October 22, 2026 Pacific. Chat/model: Regular Chat on GPT-5.6 Sol. No Pro label or measured-power ranking is claimed. Scope: This is the distinct medical financial-assistance component left open by PASS-04 row 9. P01-P03 remain unreviewed. P04-P06 supply only the expressly reviewed boundary information quoted in the prompt; no broader Wisconsin, component, parent, or A066 acceptance follows.

Executive findings

The strongest verified assistance regime for Wisconsin hospital bills is federal Internal Revenue Code §501(r), but it applies only to a qualifying 501(c)(3) hospital organization and separately to each hospital facility it operates. It is not a Wisconsin-wide right attaching to every hospital, clinic, physician, emergency group, laboratory, or medical bill. A hospital facility under the regulations is a facility a state requires to be licensed, registered, or similarly recognized as a hospital; a “hospital organization” is an organization recognized, or seeking recognition, under §501(c)(3) that operates one or more such facilities. S_WI-P07-C001–C004. U.S. Code+1

For covered facilities, the law is substantial. A written financial-assistance policy must specify its own eligibility criteria, assistance levels, charge-calculation method, application procedure, nonpayment actions or cross-reference a separate collection policy, and a provider-coverage list. Emergency and other medically necessary hospital care must be covered by the FAP; covered FAP-eligible patients cannot personally be charged more than amounts generally billed, or AGB, for emergency/medically necessary care. The facility must publicize the program and must make reasonable efforts to determine FAP eligibility before specified extraordinary collection actions. There is no federal uniform poverty-percentage cutoff or fixed charity discount. The facility's own compliant FAP supplies those eligibility terms. C005–C013. U.S. Code+3

The collection protection is considerably more precise than “wait 120/240 days.” The regulations create a 120-day minimum no-ECA period after the first post-discharge billing statement for the ordinary notification route, a 30-day advance ECA notice with a plain-language FAP summary and reasonable oral notification, and an application period generally extending through at least the 240th day after the first post-discharge statement, subject to the regulation's later-ending branches. A timely incomplete application triggers a missing-information process and suspension; a complete application triggers suspension, a written eligibility determination, corrected billing, qualifying refunds, and reversal of reasonably reversible ECAs if assistance is awarded. C014–C024. eCFR+3

The Wisconsin-specific result is more limited. Fresh official DHS guidance says “some hospitals offer charity care” and describes eligibility/process as hospital-dependent. I did not establish from the official Wisconsin materials read a universal statewide charity-care income cutoff, mandatory discount percentage, or general statutory FAP equivalent applying to every Wisconsin hospital. A current DHS publication for a narrow inpatient/residential behavioral-health/developmental-disability population says patients may examine their hospital bill and, on request, receive information about financial assistance available through the hospital. But an official 2023 proposed, not verified-final, rule order proposed repeal of DHS 124.06. I could not establish the provision's exact 2026 enforceable status from a current official rule body. That point therefore remains held, not treated as a universal Wisconsin right. C025–C028. Wisconsin Department of Health Services+4

G1. Facility, patient, and authority gateway

1. Federal §501(r) actor and facility gateway

26 U.S.C. §501(r) conditions §501(c)(3) treatment of a qualifying hospital organization on separate compliance with the community-health-needs, financial-assistance, charge, and billing/collection requirements. If an organization operates more than one hospital facility, the requirements apply separately to each facility. C001–C003. U.S. Code+1

The implementing regulation defines:

• hospital facility as a state-licensed, registered, or similarly recognized hospital facility;
• hospital organization as an organization recognized, or seeking recognition, under §501(c)(3) that operates at least one hospital facility;
• FAP as the written financial-assistance policy satisfying §1.501(r)-4(b);
• FAP-eligible as eligible under the facility's FAP for care covered by that FAP, whether or not the person actually applied;
• application period as beginning when care is provided and ending on the later regulatory endpoint described below. C003–C004, C014. eCFR+1

Actor / service classification matrix

C001–C004, C012, C023, C026.

2. Wisconsin's currently verified state layer

DHS's current consumer guide does not describe charity care as a universal entitlement. It states that “some hospitals” offer uncompensated or charity care and that the amount and process can vary by hospital. The page describes typical income documentation, governmental-assistance screening, payment-plan consideration, and hospital review as common practices—not a uniform statute. C025. Wisconsin Department of Health Services

DHS's current hospital-regulations page identifies Wisconsin Stat. ch. 50 and Wis. Admin. Code ch. DHS 124 as Wisconsin hospital authorities. The operative integrated DHS 124 body was not successfully recovered in this investigation. Wisconsin Department of Health Services

A current DHS publication released October 18, 2024 for people receiving inpatient or residential services for mental illness, alcoholism, drug abuse, or developmental disability states that within that publication's scope a patient has a right to examine the hospital bill, receive an explanation regardless of source of payment, and, on request, receive information relating to financial assistance available through the hospital. The PDF itself cites Wis. Stat. §§51.61(1), 51.30 and DHS 92, DHS 94, DHS 124, plus 42 CFR 482.13. C027. Wisconsin Department of Health Services+1

But an official Wisconsin DHS proposed omnibus rule order expressly states “DHS 124.06 is repealed.” The proposal is labeled “PROPOSED ORDER TO ADOPT PERMANENT RULES”; it is not proof that the repeal became effective. A targeted search did not retrieve a final/current official DHS 124.06 enactment or repeal instrument. Accordingly, the enforceable 2026 status of that particular state-rule right remains unresolved. C028. Wisconsin Department of Health Services+1

That evidence supports this bounded conclusion:

This pass establishes a strong federal §501(r) regime for qualifying charitable hospital facilities and identifies Wisconsin DHS assistance guidance plus a narrow DHS patient-rights publication. It does not establish a uniform Wisconsin statute requiring every hospital or medical provider to provide charity care at a fixed income threshold or discount.

G2. FAP, bill, notice, eligibility, and publicity requirements

3. What a qualifying FAP must contain

A covered hospital facility's written FAP must apply to all emergency and other medically necessary care provided by the facility, including covered care provided by a substantially related entity. It must state:

There is no federal percentage-of-FPL eligibility threshold in these provisions. The regulation's examples intentionally use variables such as “x% of FPL,” illustrating that the FAP must define its own threshold. No Wisconsin uniform FPL threshold was established either. C005. eCFR

4. Provider-list boundary

Notice 2015-46 confirms that the list may identify individual physicians, groups, or other entities using the name under which they contract or bill, and can distinguish covered from noncovered services of the same outside provider. A provider excluded from the hospital FAP might have a separate financial-assistance policy, but the hospital's list need not explain that separate program. C012. IRS

Thus:

“The emergency-room doctor treated me at a nonprofit hospital” does not, without more, establish that the physician's separate bill is governed by the hospital's FAP.

The hospital must disclose the coverage status of the outside provider under its own FAP; actual provider-specific status is a fact this assignment forbids looking up.

5. Publicity, paper copies, billing statements, and translations

The final regulations require the hospital facility to:

• post the FAP, application, and plain-language summary online;
• make paper copies free on request by mail and in public locations including the emergency room and admissions;
• notify the community in a manner reasonably calculated to reach likely assistance populations;
• offer the plain-language summary during intake or discharge;
• place a conspicuous FAP notice, contact number, and direct web address on billing statements;
• display conspicuous assistance notices in public locations; and
• provide translated FAP documents for each LEP language group meeting the regulation's threshold of the lesser of 1,000 persons or 5% of the relevant community/population. C010–C011. eCFR+1

Electronic provision can be used for specified documents when the individual indicates a preference for electronic access. C011. eCFR

6. Emergency care and FAP eligibility are separate

The hospital's written emergency policy must require nondiscriminatory emergency care regardless of FAP eligibility. It also must prohibit actions discouraging emergency care, including demanding advance payment for an emergency condition or permitting debt collection that interferes with emergency treatment. This is a §501(r) emergency-policy requirement, not a conclusion that all emergency care is free. C013. eCFR

The broader EMTALA treatment framework is deliberately not re-researched here.

7. Charges for FAP-eligible patients

For FAP-eligible emergency and medically necessary care, the patient's personally responsible amount may not exceed AGB. For other care covered under the FAP, charges must be less than gross charges. “Charged” is measured after deductions, FAP discounts, and insurance reimbursement. An insured FAP-eligible patient therefore can receive FAP protection even when insurer and patient payments together exceed the AGB amount, provided the individual's own responsibility does not exceed AGB. C006, C029. eCFR+1

The regulation allows a look-back method or prospective Medicare/Medicaid method. It does not supply one universal Wisconsin AGB percentage. C029.

G3. Billing and collection clocks

8. What qualifies as an extraordinary collection action

For a covered hospital facility, ECAs include specified actions against an individual to obtain payment, including:

A state-law lien against personal-injury judgment/settlement proceeds described in §1.501(r)-6(b)(3) and a bankruptcy proof of claim are expressly not ECAs under this regulation. C015. eCFR

Debt sale that is not treated as an ECA

A sale can avoid ECA classification only when a binding written agreement requires, among other things:

• purchaser cannot use ECAs;
• purchaser's interest cannot exceed the specified federal rate;
• debt is returnable/recallable if FAP eligibility is determined; and
• if not returned, hospital and purchaser procedures ensure the individual pays no more than the FAP-responsible amount. C016. eCFR

That exception does not create general collector authorization or displace Wisconsin collection law.

9. Ordinary notification route

A facility relying on the ordinary notification route makes reasonable efforts only if it:

1. refrains from initiating ECAs—apart from the special prior-care deferral/denial ECA—for at least 120 days from the first post-discharge billing statement;
2. at least 30 days before first initiating an ECA, gives written notice that assistance is available, identifies the intended ECA, and states a deadline no earlier than 30 days after that notice;
3. includes the FAP plain-language summary; and
4. makes a reasonable oral effort to notify the individual of the FAP and application assistance. C017–C018. eCFR

For multiple aggregated episodes, the 120-day period is measured from the first post-discharge statement for the most recent episode included in the aggregation. C018.

10. Application period

The “application period” starts on the care date. It ends on the later of:

• the 240th day after the first post-discharge billing statement; or
• the applicable later deadline under the ECA-notification or presumptive-eligibility branches identified in §1.501(r)-1(b)(3). C014. eCFR

Therefore “240 days” is a minimum structural endpoint in the ordinary case, not a universal statement that every application becomes untimely exactly on day 240.

11. Incomplete application

If a FAP application is incomplete during the application period, the facility must tell the applicant how to complete it and give a reasonable opportunity to do so. While a FAP application is pending, ECAs generally must be suspended; for an incomplete application, suspension can end after the individual fails to respond within the reasonable response period. C019–C020. eCFR

The facility cannot deny assistance merely because the person failed to provide information or documentation not required by the FAP/application instructions. C007. eCFR

12. Complete application

For a complete application submitted during the application period, reasonable efforts require the facility, in a timely manner, to:

• suspend applicable ECAs;
• determine FAP eligibility;
• give a written decision and basis;
• if assistance other than free care is awarded, issue a bill stating the FAP-responsible amount, calculation method, and AGB information/access;
• refund qualifying overpayments; and
• take all reasonably available measures to reverse applicable ECAs already taken. C021–C022. eCFR+1

Reasonably available reversal measures generally include seeking to vacate judgments, lifting non-exempt levies/liens, and removing adverse CRA information arising from the ECA. C022. eCFR

13. Refund rule

If the person is later determined FAP-eligible, the facility must refund payments exceeding the person's FAP responsibility unless the excess itself is less than $5, or another amount is later specified in governing IRS guidance. C023. eCFR

This is an overpayment-reconciliation rule, not an automatic statutory damages award.

14. Medicaid screening

If a complete FAP applicant is someone the hospital believes may qualify for Medicaid, the facility does not fail the reasonable-efforts standard merely by postponing the FAP decision until the Medicaid application has been completed, submitted, and decided. C024. eCFR

This does not establish that every applicant must apply for Medicaid, that Wisconsin BadgerCare eligibility is automatic, or that Medicaid denial is itself a FAP requirement unless the facility's compliant policy says so.

15. Referral or sale to a collector

Except for the specialized non-ECA debt-sale branch, a hospital that sells or refers an individual's debt to another party must first use and enforce a binding agreement reasonably designed to prevent ECAs before reasonable FAP efforts have occurred. The agreement must require suspension if a FAP application arrives during the application period, cap combined liability at the FAP amount if eligibility is granted, and require ECA reversals where the downstream party has authority. Further transfers during the application period require equivalent written protections. C016, C030. eCFR

This assistance rule is separate from whether the collector needs a Wisconsin license, complies with FDCPA/Reg F, or owns the debt.

G4. Worked Wisconsin classifications and calculations

These are invented arrangements. No actual hospital, patient, creditor, collector, or account is represented.

Example 1 — Uninsured person at a qualifying charitable hospital

Facts: Facility H is stipulated to be operated by a §501(c)(3) hospital organization and to be a Wisconsin-licensed hospital facility. Patient U is uninsured and receives medically necessary hospital care.

Result: §501(r) applies facility-by-facility. H must have a FAP stating its own eligibility criteria. U's uninsured status does not itself establish eligibility. If U qualifies under that policy, the personally responsible amount for emergency/medically necessary care cannot exceed AGB. C001, C005–C007, C029.

Required document: H's actual FAP and its current AGB method/percentage.

Adverse branch: If U's income/resources fall outside H's compliant criteria, federal law does not create eligibility merely from inability to pay.

Missing question: What are H's actual eligibility rules? This assignment prohibits named-policy lookup.

Example 2 — Insured person with an uncovered balance

Facts: Patient I has insurance but faces a hypothetical $6,000 patient-responsibility amount after insurer processing. H's applicable AGB for the care is hypothetically $4,100, and I is independently stipulated to qualify under H's FAP.

Calculation: Maximum personally responsible amount under the assumed AGB facts = $4,100, not $6,000.

Reason: The regulation measures what the FAP-eligible person personally must pay after insurance, even if insurer + patient payments together exceed AGB. C006, C029. eCFR

Adverse branch: If I is not FAP-eligible, the §501(r)(5) FAP charge cap does not apply merely because I has high cost sharing.

Missing evidence: Actual insurer adjudication, facility FAP eligibility, and real AGB calculation.

Example 3 — Independent emergency physician bill

Facts: Patient P receives emergency treatment inside covered Hospital H. Hospital H's own bill is FAP-covered, but a separately billing emergency group issues another bill.

Result: H's provider list must state whether that outside provider's emergency/medically necessary care is covered by H's FAP. It is not automatically covered simply because care occurred in H. C012.

Adverse branch: The group could have its own assistance policy, but Notice 2015-46 does not require H's list to describe that separate program.

Missing evidence: H's provider list and the group's legal relationship. Named lookup is forbidden.

Example 4 — Incomplete FAP application

Facts: First post-discharge statement: March 3, 2026. Applicant submits a FAP application within the application period but omits a document that the application instructions expressly require.

Result: Hospital must identify the missing information/documentation, give a reasonable opportunity to supply it, and generally suspend applicable ECAs while the application remains pending. C019–C020.

Calendar calculation: March 3, 2026 + 240 calendar days = October 29, 2026. March 3 was a Tuesday; October 29 is a Thursday. This is the ordinary 240-day reference point, but the legal application period can end later if one of the regulation's later-end branches applies. C014.

Adverse branch: If the applicant fails to respond within the reasonable completion period, the facility can satisfy the suspension rule without waiting forever.

Missing evidence: Actual FAP instructions, date of application receipt, missing-document request, response period, and any later deadline.

Example 5 — Complete application after collection activity began

Facts: Patient C files a complete FAP application during the application period after Hospital H already initiated an ECA.

Result: H or its authorized party must suspend applicable ECAs while eligibility is decided. A complete determination must be made timely and delivered in writing with the basis. If C is FAP-eligible, H must take reasonably available steps to reverse applicable ECAs. C021–C022.

Adverse branch: A debt sale itself and the care-deferral ECA have special treatment under the reversal provision; not every historical act is literally reversed by the same mechanism.

Missing evidence: ECA type, application completeness, decision, collector authority, and actual FAP level.

Example 6 — Later FAP approval and refund

Facts: Patient R has already paid $750. A timely completed FAP determination later establishes R's personal responsibility at $500.

Calculation: Excess payment = $750 − $500 = $250.

Because $250 is not less than the regulation's $5 de minimis threshold, the rule requires a $250 refund on these stipulated facts. C023.

Alternative branch: If R paid $503 and proper FAP responsibility were $500, the excess would be $3. Because $3 is less than $5, §1.501(r)-6(c)(6)(i)(C)(2) would not require the refund under that specific federal provision.

Important limit: This is refund arithmetic, not damages or an award.

Example 7 — Changed provider status / nonqualifying facility

Facts: Facility F was formerly operated by a qualifying charitable hospital organization but later is stipulated to be operated by an entity that does not satisfy the §501(c)(3) hospital-organization gateway for the later episode of care.

Result: §501(r) cannot simply be carried forward based on historical branding or former tax status. The applicable organization's status and facility operation during the relevant taxable period must be established. C001–C004, C031.

Adverse branch: If the operating organization remains a qualifying hospital organization, facility-specific §501(r) obligations continue even if ownership structures changed.

Missing evidence: Operative tax status, operating entity, effective date of change, and applicable FAP. No named entity research is authorized.

16. Calendar example — 120-day and 30-day ECA gates

Assume a qualifying hospital sends the first post-discharge statement on March 3, 2026 and later supplies the complete written ECA notice on June 1, 2026.

• March 3 + 120 calendar days = July 1, 2026.
• June 1 + 30 calendar days = July 1, 2026.
• The regulation's own structure means the stated ECA deadline cannot be earlier than July 1; the official Treasury example with the same March 3/June 1 relationship treats July 2 as the first day the ECA may begin after the July 1 deadline where all other required steps were satisfied.
• March 3 + 240 calendar days = October 29, 2026, subject to later-ending application-period branches.

No weekend or holiday extension was identified in these specific clauses; the calculations use ordinary calendar-day addition. Actual dates require actual statement provision, notice provision, application, and ECA facts. C014, C017–C018. eCFR

G5. Remedy, official routes, and boundaries

17. Federal consequence is principally tax-compliance enforcement

Treasury Regulation §1.501(r)-2 provides for tax-exemption consequences, correction of minor errors, excusable non-willful/non-egregious failures, and taxation of noncompliant facility income in specified multi-facility circumstances. IRS materials also describe possible loss of §501(c)(3) status and the separate §4959 CHNA excise tax. C031. eCFR+1

This pass did not establish from §501(r) or its regulations an express patient private damages cause of action. That does not mean no contractual, state-law, federal-consumer-law, equitable, or other private theory can ever exist. The private-enforcement question remains unresolved outside the tax-compliance structure researched here. C032.

A FAP violation does not automatically mean the medical debt is void.

18. Generic official routes

No complaint, form, referral, or contact was submitted.

19. Evidence-backed SettleADebt article/tool opportunities

Useful future content can safely be framed around classification and document retrieval, rather than telling readers they automatically qualify. For example, a Wisconsin hospital-bill page could ask whether the bill comes from the hospital facility or an outside physician; whether the facility is subject to §501(r); whether a FAP/provider list exists; date of the first post-discharge statement; whether a complete or incomplete FAP application was submitted; and whether an ECA has begun. Those questions map directly to C001–C024 without pretending every medical bill has the same assistance rights.

A useful calculator could compute only conditional federal deadlines after the user supplies the actual first post-discharge statement date and notice date, while warning that the application period may extend beyond day 240 and that a facility's own FAP controls eligibility. A separate AGB comparator can operate only after the user supplies the facility's actual published AGB method/percentage. It must not invent a Wisconsin charity percentage.

G6. Old-to-new disposition

Source register — S_WI-P07-S001 onward

All fresh reads below occurred on October 26, 2026 Pacific / October 27, 2026 UTC. No source-specific access times are claimed. “Printed page” and “zero-based PDF index” are given for PDFs actually used; HTML sources have no PDF page number.

Source-register count: 17.

Atomic claim register — S_WI-P07-C001 onward

Atomic claim count: 32.

Complete core coverage table

There are 40 core coverage rows below.

Explicit deferred-family coverage

There are 14 deferred rows.

Example coverage count

The 7 worked examples above are:

A separate calendar calculation illustrates C014/C017/C018 rather than adding an eighth classification.

Researcher self-check

Actually read in fresh public sources: current 26 U.S.C. §501(r); Treasury Regulations §§1.501(r)-1, -2, -4, -5 and -6; IRS FAP, provider-list, billing/collection, enforcement and exempt-organization complaint materials; Wisconsin DHS charity-care, hospital-regulation, complaint and inpatient-rights materials; Wisconsin's proposed DHS rule order; and DATCP's consumer complaint material. The relevant page of P-20195A and zero-based page 41 of the proposed Wisconsin rule order were visually inspected because they are PDFs.

Currentness limits: The current eCFR §1.501(r)-5 page displayed Title 26 up to date as of October 23, 2026 and last amended October 19, 2026. The §1.501(r)-2 page retrieved in this session displayed an older eCFR header—up to date October 14, 2026, last amended October 6. I therefore do not claim that every §1.501(r) page was served from an identical compilation snapshot. The OLRC §501 page states laws in effect through Public Law 119-121, October 9, 2026.

Wisconsin rule gap: A current official integrated DHS 124.06 body or final repeal/adoption instrument was not recovered. The 2023 DHS document is expressly a proposed rule. The October 2024 DHS client-rights publication continues to refer to DHS 124 and contains a financial-assistance-information statement, but that publication does not resolve the exact 2026 rule-enactment status. No conclusion of repeal, survival, or statewide applicability is invented.

Bounded negative result: Searching official Wisconsin legislative sources for “charity care,” hospital “financial assistance,” “uncompensated care,” and DHS 124.06 did not produce a current enacted general charity-care statute during this pass. That search failure is not proof that no narrower Wisconsin statute, reimbursement rule, public-hospital obligation, local ordinance, contract, Hill-Burton obligation, or case exists. DHS's own current consumer page supports only the narrower statement that some hospitals offer charity care and processes vary.

Calculations checked: March 3, 2026 + 120 days = July 1, 2026; March 3 + 240 days = October 29, 2026; June 1 + 30 days = July 1, 2026. The $750 − $500 = $250 and $503 − $500 = $3 refund examples are scalar arithmetic under stipulated FAP-responsibility assumptions. None validates an individual's eligibility, debt amount, damages, or claim.

Register reconciliation: 17 source rows; 32 atomic claim rows; 40 core coverage rows; 14 deferred rows; 7 classification examples; 3 old-to-new disposition rows. No hidden CSV, attachment, local file, or promised continuation substitutes for these visible registers.

No actions performed: No named hospital, provider, physician, collector, patient, account, license, policy, tax-exemption record, credit report, clinical record, case docket, or private document was searched. No application, complaint, referral, form, contact, filing, records request, payment, purchase, site change, or publication occurred.

This is the researcher's self-check, not independent review, operational approval, legal advice to an individual, or acceptance of Wisconsin PASS-07, the full state dossier, any parent dimension, or A066.

END S_WI PASS-07.