DHS 10.56(1)(1) Request for continuation of services pending outcome of cmo appeal. Prior to reducing, suspending or terminating services under the family care benefit, a CMO shall provide to the enrollee prior notification of its intent to reduce, suspend or terminate the services in accordance with s. DHS 10.52 (3). If an enrollee who has received a notice that services will be reduced, suspend or terminated files an appeal with the CMO under s. DHS 10.53 (2) before the effective date of the reduction, suspension or termination, the enrollee may request that the CMO continue to provide the services pending the outcome of the appeal. DHS 10.56(1m)(1m) Request for continuation of services pending outcome of dha fair hearing. An enrollee is entitled to continuation of services pending the outcome of a fair hearing if all of the following apply: DHS 10.56(1m)(a)(a) The CMO’s decision on appeal under s. DHS 10.53 (2) is to proceed with reducing, suspending, or terminating the enrollee’s service. DHS 10.56(1m)(b)(b) The enrollee’s services were continued pending the outcome of the CMO appeal decision. DHS 10.56(1m)(c)(c) The enrollee requests a fair hearing on the CMO’s appeal decision before the effective date of the CMO’s appeal decision. DHS 10.56(1m)(d)(d) The enrollee requests continuation of services before the effective date of the CMO’s appeal decision. DHS 10.56(2)(2) Requirement for continuation. Except as provided in sub. (2m), a CMO may not reduce, suspend or terminate services under dispute pending the outcome of the enrollee’s appeal under s. DHS 10.53 (2) or fair hearing under s. DHS 10.55 if a request for continued benefits was made under sub. (1) or (1m). DHS 10.56(2m)(2m) Exemption from right to continuation. 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 he or she falls within the category of enrollees to be affected by the change, the enrollee does not have the right to continuation of services pending the outcome of the enrollee’s appeal under s. DHS 10.53 (2) or fair hearing under s. DHS 10.55. A CMO will not receive a monthly capitated payment for such an individual and is not required to continue services in such circumstances. DHS 10.56(3)(3) Liability for continuation of services. The enrollee shall be liable for the cost of services provided during the period in which services have been continued under this section if the outcome of the appeal or fair hearing is unfavorable to the enrollee. The CMO shall notify in writing an enrollee who requests continuation of services under this section of the potential for liability under this subsection and the time period during which the enrollee will be liable. If the department or its designee determines that the person would incur a significant and substantial financial hardship as a result of repaying the cost of the services provided, the department may waive or reduce the enrollee’s liability under this subsection. DHS 10.56 HistoryHistory: Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 09-003: am. (2), cr. (2m) Register November 2009 No. 647, eff. 12-1-09; CR 22-026: am. (1), cr. (1m), am. (2) to (3) Register May 2023 No. 809, eff. 6-1-23. DHS 10.57DHS 10.57 Cooperation with advocates. DHS 10.57(1)(a)(a) “Advocate” means an individual or organization whom a client has chosen to assist him or her in articulating the client’s preferences, needs and decisions. DHS 10.57(1)(b)1.1. To provide any information related to the client’s eligibility, entitlement, cost sharing, care planning, care management, services or service providers to the extent that the information is pertinent to matters in which the client has requested the advocate’s assistance. DHS 10.57(1)(b)2.2. To assure that a client who requests assistance from an advocate is not subject to any form of retribution for doing so. DHS 10.57(2)(2) Cooperation with advocates. The department and each resource center and CMO shall cooperate with any advocate selected by a client. Nothing in this section allows the unauthorized release of client information or abridges a client’s right to confidentiality. DHS 10.57 HistoryHistory: Cr. Register, October, 2000, No. 538, eff. 11-1-00. DHS 10.61DHS 10.61 Recovery of incorrectly paid benefits. County agencies, on behalf of the department, shall recover benefits incorrectly paid under the family care benefit, whether paid on behalf of individuals eligible for medical assistance or not, according to provisions of s. 49.497, Stats., s. DHS 108.03 (3) and policies established by the department or by the department of workforce development. The amount to be recovered is the amount actually paid by a CMO on behalf of a family care enrollee. DHS 10.61 HistoryHistory: Cr. Register, October, 2000, No. 538, eff. 11-1-00; correction made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635. DHS 10.62DHS 10.62 Recovery of correctly paid benefits. DHS 10.62(1)(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. DHS 10.62(1)(a)(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. DHS 10.62 NoteNote: Paragraph (a) was inadvertently left in by rule CR 23-046 and will be removed in future rulemaking. DHS 10.62(2)(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. DHS 10.62(3)(3) Use of funds. The department shall deposit amounts recovered under this section to the appropriation under s. 20.435 (4) (im), Stats.