DHS 10.52 DHS 10.52 Required notifications.

DHS 10.52(1) (1) Notification of general client rights and responsibilities. Each resource center, county agency and CMO shall provide clients with written notification of their rights and responsibilities in accordance with timelines and other requirements established in its contract with the department in every instance in which:

DHS 10.52(1)(a) (a) The client applies for the family care benefit and is initially counseled by a resource center about the family care benefit or enrollment in a specific care management organization.

DHS 10.52(1)(b) (b) The client enrolls in a care management organization.

DHS 10.52(2) (2) Notification of eligibility or entitlement. Every applicant for the family care benefit shall be notified in writing of decisions regarding eligibility, entitlement and cost sharing requirements as required under s. DHS 10.31 (6) (b).

DHS 10.52(3) (3) Notification of intended adverse benefit determination. Clients shall be given written notice of any intended adverse benefit determination at least 10 days prior to the date of the intended adverse benefit determination in accordance with all of the following:

DHS 10.52(3)(a) (a) Notification shall be provided as follows:

DHS 10.52(3)(a)1. 1. By the county agency in every instance in which a client’s eligibility or entitlement for family care will be discontinued, terminated, suspended or reduced, or in which the client’s maximum cost sharing requirement will be increased.

DHS 10.52(3)(a)2. 2. By the CMO in every instance in which the CMO makes an adverse benefit determination under s. DHS 10.13 (1) (b).

DHS 10.52(3)(b) (b) The notification of intended adverse benefit determination shall include an explanation of all the following, as applicable:

DHS 10.52(3)(b)1. 1. The adverse benefit determination the county agency, resource center or CMO intends to take, including how the adverse benefit determination will affect any services that the applicant or enrollee currently receives.

DHS 10.52(3)(b)1m. 1m. The effective date of the adverse benefit determination.

DHS 10.52(3)(b)2. 2. The reasons for the adverse benefit determination.

DHS 10.52(3)(b)3. 3. Any laws that support the adverse benefit determination.

DHS 10.52(3)(b)4. 4. The applicant’s or enrollee’s right to file an appeal with the CMO or request a fair hearing with the resource center or county agency.

DHS 10.52(3)(b)5. 5. How to file an appeal or a fair hearing and the timelines for doing so.

DHS 10.52(3)(b)5m. 5m. The circumstances under which expedited resolution of an appeal is available and how to request it.

DHS 10.52(3)(b)6. 6. That if the applicant or enrollee files an appeal, he or she has a right to appear in person before the CMO personnel assigned to resolve the appeal.

DHS 10.52(3)(b)7. 7. If the adverse benefit determination will affect any services that the enrollee currently receives through the family care benefit, the circumstances in which the enrollee’s services will be continued under s. DHS 10.56 pending the outcome of an appeal, how the enrollee can request that the services be continued, and the circumstances in which the enrollee may be required to repay the costs of the continued services.

DHS 10.52(3)(b)8. 8. The availability of independent advocacy services and other local organizations that might assist an applicant or enrollee with an appeal or fair hearing.

DHS 10.52(3)(b)9. 9. That the applicant or enrollee may obtain, free of charge, copies of client records relevant to the appeal or fair hearing, and how to obtain the copies.

DHS 10.52 History History: Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 04-040: am. (3) (b) 4. and (4) (a) and (e), cr. (3) (b) 5m. Register November 2004 No. 587, eff. 12-1-04; CR 22-026: am. (1) (intro.), (3) (intro.), (a) 2., (b) (intro.), 1., cr. (3) (b) 1m., am. (3) (b) 2. to 9., r. (4) Register May 2023 No. 809, eff. 6-1-23; correction in (3) (b) 8. made under s. 35.17, Stats., Register May 2023 No. 809.

DHS 10.53 DHS 10.53 Grievances and appeals.

DHS 10.53(1) (1) Grievance process in resource centers.

DHS 10.53(1)(a) (a) The governing board of each resource center shall approve and effectively operate a process for reviewing and resolving client grievances. The board may delegate, in writing, its responsibility for reviewing and resolving grievances to a committee of the resource center’s senior management, provided the process ensures that the board is made aware of grievances and requests for department review and fair hearings.

DHS 10.53(1)(b) (b) The department shall review and approve a resource center’s grievance process as part of its contracting with the resource center.

DHS 10.53(1)(c) (c) A resource center shall inform clients of all of the following:

DHS 10.53(1)(c)1. 1. The circumstances under which expedited resolution of a grievance is available and how to request it.

DHS 10.53(1)(c)2. 2. The client has the right to appear in person before the resource center personnel assigned to resolve a grievance filed, if the enrollee files the grievance.