DHS 10.55(1g)(d)2.2. The reduced, suspended or terminated service or support was only authorized for a limited amount or duration and that amount or duration has been completed. DHS 10.55(1g)(g)(g) Denial of an enrollee’s request to dispute financial liability, including copayments, premiums, deductibles, coinsurance, other cost sharing, and other enrollee financial liabilities. DHS 10.55(1g)(h)(h) Denial of an enrollee, who is a resident of a rural area with only one CMO, to obtain services outside the CMO’s network of contracted providers. DHS 10.55(1g)(i)(i) An individualized service plan that is unacceptable to the enrollee because any of the following apply: DHS 10.55(1g)(i)1.1. The plan is contrary to an enrollee’s wishes insofar as it requires the enrollee to live in a place that is unacceptable to the enrollee. DHS 10.55(1g)(i)2.2. The plan does not provide sufficient care, treatment or support to meet the enrollee’s needs and identified family care outcomes. DHS 10.55(1g)(i)3.3. The plan requires the enrollee to accept care, treatment or support items that are unnecessarily restrictive or unwanted by the enrollee. DHS 10.55 NoteNote: The rights guaranteed to persons receiving treatment or services for developmental disability, mental illness or substance abuse under ch. 51, Stats., and ch. DHS 94 are also guaranteed under par. (f), and enrollees may request a fair hearing related to such matters in accordance with this section and ch. HA 3, or may choose the grievance resolution procedure under Subchapter III of ch. DHS 94 to grieve a violation of those rights, and if necessary may choose to appeal a provider or CMO grievance decision to the department of health services as specified in ss. DHS 94.42 and 94.44. DHS 10.55(1g)(k)(k) Determinations of protection of income and resources of a couple for maintenance of a community spouse under s. DHS 10.35 to the extent a hearing would be available under s. 49.455 (8) (a), Stats. DHS 10.55(1m)(1m) Exception to right to fair hearing. An enrollee does not have a right to a fair hearing under sub. (1g), if the sole issue is a federal or state law requiring an automatic change adversely affecting some or all enrollees and the enrollee does not dispute that they fall within the category of enrollees to be affected by the change. DHS 10.55(2)(2) Grievances. An enrollee may contest any decision, omission or action of a CMO other than those specified under sub. (1g) by filing a grievance with the CMO under s. DHS 10.53 (2). If the enrollee is not satisfied with the CMO’s grievance decision, or if the CMO fails to issue a grievance decision within the timeframes specified under s. DHS 10.53 (2) (d), the enrollee may request a department review under s. DHS 10.54. DHS 10.55(3)(3) Requesting a fair hearing. Receipt of notice is presumed within 5 days of the date the notice was mailed. A client shall file their request for a fair hearing in writing within the timeframes specified under subs. (1) and (1g) with the division of hearings and appeals in the department of administration. A hearing request shall be considered filed on the date of actual receipt by the division of hearings and appeals, or the date of the postmark, whichever is earlier. A request filed by facsimile is complete upon transmission. If the request is filed by facsimile transmission and such transmission is completed between 5 p.m. and midnight, one day shall be added to the prescribed period. If a client asks the department, a county agency, a resource center or CMO for assistance in writing a fair hearing request, the department, resource center or CMO shall provide that assistance. DHS 10.55 NoteNote: A hearing request can be submitted by mail or hand-delivered to the Division of Hearings and Appeals, at 4822 Madison Yards Way, 5th Floor North, Madison, WI 53705-5400, faxed to the Division at (608) 264-9885, or emailed to the Division at DHAMail@wisconsin.gov. The Division’s telephone number is (608) 266-3096. DHS 10.55(4)(a)(a) When the division of hearings and appeals receives a request for a fair hearing under this chapter, it shall set the date for the hearing in accordance with ch. HA 3 and notify the department that it has received the request. DHS 10.55(4)(b)(b) When an enrollee has requested a fair hearing under sub. (3), the department shall conduct an informal review to identify, and, as appropriate, intervene in, fair hearing requests related to member health and safety, contract non-compliance and complex situations, if it appears to the department that informal resolution of the matter may be appropriate. DHS 10.55(5)(a)(a) The division of hearings and appeals shall conduct a fair hearing pursuant to this section in accordance with ch. HA 3, in response to each fair hearing requested unless, prior to the scheduled hearing date, any of the following occurs: DHS 10.55(5)(a)3.3. In the case of an enrollee appealing a CMO decision, the person voluntarily disenrolls from the CMO. DHS 10.55(5)(a)4.4. The petitioner has abandoned the hearing request. The division of hearings and appeals shall determine that abandonment has occurred when the petitioner, without good cause, fails to appear personally or by representative at the time and place set for the hearing. Abandonment may also be deemed to have occurred when the petitioner or the authorized representative fails to respond within a reasonable time to correspondence from the division regarding the hearing. DHS 10.55(5)(a)5.5. An informal resolution is proposed that is acceptable to the client, and the client agrees, in writing, to the resolution or withdraws the request for fair hearing.