DHS 10.44(6)(c)12.g. g. Authorizing and making payment for services delivered.

DHS 10.44(6)(c)12.h. h. Setting the level of benefits, if any, to be provided in addition to requisite state and federal payroll benefits, such as vacation, sick leave or health insurance.

DHS 10.44(6)(c)12.i. i. Assistance in procuring additional optional employee benefits.

DHS 10.44(6)(c)12.j. j. Training workers.

DHS 10.44(6)(c)12.k. k. Assessing member liability.

DHS 10.44(6)(c)12.L. L. Supervising and disciplining workers.

DHS 10.44(6)(c)12.m. m. Arranging back-up workers or services.

DHS 10.44(6)(c)13. 13. The CMO has policies and procedures under which the CMO may restrict the level of self-management of service funding exercised by an enrollee or for increasing the level of involvement of the case management team where the team finds any of the following:

DHS 10.44(6)(c)13.a. a. The health and safety of the enrollee or another person is threatened.

DHS 10.44(6)(c)13.b. b. The enrollee’s expenditures are inconsistent with the budget established under subd. 5. and the plan established under subd. 6.

DHS 10.44(6)(c)13.c. c. The conflicting interests of another person are taking precedence over the desires and interests of the enrollee.

DHS 10.44(6)(c)13.d. d. Funds have been used for illegal purposes.

DHS 10.44(6)(c)13.e. e. Negative consequences have occurred under other policies approved by the department.

DHS 10.44(6)(c)14. 14. The CMO informs each enrollee whose level of self-management of service funding is restricted under subd. 13. about what actions by the enrollee will result in removal of the restrictions.

DHS 10.44(6)(c)15. 15. The CMO informs the enrollee whose level of self-management of service funding is restricted under subd. 13. about his or her right to file a grievance under s. DHS 10.53, request department review under s. DHS 10.54, or request a fair hearing under s. DHS 10.55 if he or she disagrees with any limit on the level of self-management.

DHS 10.44(6)(c)16. 16. The CMO has policies and procedures in place related to self-management of service funding of an enrollee under guardianship that include all of the following:

DHS 10.44(6)(c)16.a. a. Training for guardians to assist them in learning and respecting enrollees’ preferences and goals.

DHS 10.44(6)(c)16.b. b. Assistance to enrollees and their guardians in building the enrollees’ skills in the area of self-determination.

DHS 10.44(6)(c)16.c. c. Periodic re-assessment of enrollees’ competency to exercise rights directly and assistance to enrollees in attaining or regaining rights the CMO believes they are competent to exercise.

DHS 10.44 History History: Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 04-040: am. (4) (c) 5. Register November 2004 No. 587, eff. 12-1-04; EmR2121: am. (2) (e), eff. 8-5-21; CR 21-081: am. (2) (e) (intro.) Register May 2022 No. 797, eff. 6-1-22, am. (2) (e) (intro.) eff. upon the termination of the Appendix K: Emergency Preparedness and Response and COVID-19 Addendum to the 1915 (c) Family Care program waiver.

DHS 10.45 DHS 10.45 Operational requirements for CMOs.

DHS 10.45(1) (1) Governing board. A care management organization shall have a governing board that reflects the ethnic and economic diversity of the geographic area served by the CMO. At least one-fourth of the members of the governing board shall be older persons or persons with physical or developmental disabilities or their family members, guardians or other advocates who are representative of the CMO’s enrollees.

DHS 10.45(2) (2) Open enrollment.

DHS 10.45(2)(a) (a) Except as provided in s. DHS 10.36 (2), a CMO shall conduct a continuous open enrollment period, accepting enrollment of any member of its target population who is enrolled by an aging and disability resource center serving the area of the CMO, without regard to life situation, health or disability status or cost sharing requirements.

DHS 10.45(2)(b) (b) A CMO may not disenroll any enrollee except under circumstances specified in its contract with the department and the express approval of the department, unless the enrollee has requested to be disenrolled. When a CMO requests department approval to disenroll an enrollee, the CMO shall refer the enrollee to the resource center for counseling under s. DHS 10.23 (2) (j). A CMO may not encourage any enrollee to disenroll.

DHS 10.45(3) (3) Service to private pay individuals. The CMO shall provide, on a fee-for-service basis, case management and other services to private pay individuals as necessary to meet the requirements specified in s. DHS 10.37.

DHS 10.45(4) (4) Reporting and records.

DHS 10.45(4)(a) (a) The department shall require each CMO to report information as the department determines necessary, including information needed for all of the following:

DHS 10.45(4)(a)1. 1. Determination of whether the CMO is meeting minimum quality standards, including adequate long-term care outcomes for its enrollees.