DHS 10.44(2)(f)5.b. b. Would not have a significant, long-term negative impact on the enrollee’s long-term care outcomes identified under par. (e) 2.

DHS 10.44(2)(f)5.c. c. Balances the needs and outcomes identified by the comprehensive assessment with reasonable cost, immediate availability of services and ability of the CMO to develop alternative services and living arrangements.

DHS 10.44(2)(f)5.d. d. Was developed after active negotiation between the CMO and the enrollee, during which the CMO offered to find or develop alternatives that would be more acceptable to both parties.

DHS 10.44(2)(g) (g) The CMO shall reassess each enrollee’s needs and strengths as specified under par. (e) 1. and long-term care outcomes as specified under par. (e) 2. and adjust the individual service plan based on the findings of the re-assessment, as specified in par. (j) 5.

DHS 10.44(2)(h) (h) The CMO shall provide, arrange, coordinate and monitor services as required by its contract with the department and as specified in the enrollee’s individual service plan. The CMO shall provide opportunity for each enrollee to be involved, to the extent that he or she is able and willing, in all of the following:

DHS 10.44(2)(h)1. 1. The selection of service providers from within the CMO’s network of providers.

DHS 10.44(2)(h)2. 2. The recruiting, interviewing, hiring, training and supervision of individuals providing personal care and household assistance in the enrollee’s home.

DHS 10.44(2)(i) (i) The CMO shall provide assistance to enrollees in arranging for and coordinating services that are outside the direct responsibility of the CMO.

DHS 10.44(2)(j) (j) The CMO shall meet timeliness standards as specified in its contract with the department, that shall include all of the following:

DHS 10.44(2)(j)1. 1. Immediately upon enrollment, the CMO shall provide services to preserve the health and safety of the enrollee. Within 5 days of enrollment, the CMO shall develop and implement an initial service plan based on information received from the resource center and the CMO’s initial assessment of the enrollee’s needs.

DHS 10.44(2)(j)2. 2. The CMO shall complete a comprehensive assessment, as specified under par. (e) not later than 30 days after enrollment.

DHS 10.44(2)(j)3. 3. Within 60 days of enrollment, the CMO shall, jointly with the enrollee and any other individual identified by the enrollee, develop an individualized service plan as specified under par. (f).

DHS 10.44(2)(j)4. 4. The CMO shall provide services and support items in accordance with the time frames specified in each enrollee’s individualized service plan.

DHS 10.44(2)(j)5. 5. The CMO shall review each enrollee’s service plan and adjust services if indicated by the review, as follows:

DHS 10.44(2)(j)5.a. a. Whenever a significant change occurs in the enrollee’s health, functional capacity or other circumstances.

DHS 10.44(2)(j)5.b. b. When requested by the enrollee, the enrollee’s representative, the enrollee’s primary medical provider, or an agency providing services to the enrollee.

DHS 10.44(2)(j)5.c. c. As often as necessary in relation to the stability of the enrollee’s health and circumstances, but not less than every 180 days.

DHS 10.44(2)(j)6. 6. The CMO shall provide required reports in a timely manner as specified in its contract with the department.

DHS 10.44(3) (3) Service monitoring. A CMO shall do all the following:

DHS 10.44(3)(a) (a) Develop and implement standards for CMO service provider qualifications and written procedures and protocols for assessing whether providers meet the standards. Provider qualification standards established by a CMO shall meet or exceed standards that are specified in its contract with the department.

DHS 10.44(3)(b) (b) Develop and implement written procedures and protocols that assure that services furnished are consistent with the needs and strengths identified under sub. (2) (e) 1., the long-term care outcomes identified under sub. (2) (e) 2. and the individual service plan under sub. (2) (f) for each enrollee.

DHS 10.44(3)(c) (c) Develop and implement written procedures and protocols that assure that enrollee problems related to services are detected and promptly addressed.

DHS 10.44(3)(d) (d) Maintain a process to consider an enrollee’s request to receive services from a provider who does not have an agreement with the CMO for providing services to the CMO’s enrollees. The CMO shall arrange for services with non-CMO providers if the enrollee’s request is authorized by the CMO. Instances where the enrollee’s request for a non-CMO provider is warranted include all of the following:

DHS 10.44(3)(d)1. 1. When the CMO does not have the capacity to meet the identified needs of its enrollees.

DHS 10.44(3)(d)2. 2. When the CMO does not have the specialized expertise, specialized knowledge or appropriate cultural diversity in its network of providers.

DHS 10.44(3)(d)3. 3. When the CMO cannot meet the enrollee’s need on a timely basis.

DHS 10.44(3)(d)4. 4. When transportation or physical access to the CMO providers causes an undue hardship to the enrollee.

DHS 10.44(3)(e) (e) Offer each enrollee the opportunity to participate in the monitoring and improvement of services in the enrollee’s care plan.

DHS 10.44(4) (4) Internal quality assurance and quality improvement. The CMO shall implement an internal quality assurance and quality improvement program that [meets] the requirements of its contract with the department. As part of the program, the CMO shall do all of the following: