Section DHS 10.52 - Required notifications(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: (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.(b) The client enrolls in a care management organization.(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).(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: (a) Notification shall be provided as follows: 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.2. By the CMO in every instance in which the CMO makes an adverse benefit determination under s. DHS 10.13 (1) (b).(b) The notification of intended adverse benefit determination shall include an explanation of all the following, as applicable: 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.1m. The effective date of the adverse benefit determination.2. The reasons for the adverse benefit determination.3. Any laws that support the adverse benefit determination.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.5. How to file an appeal or a fair hearing and the timelines for doing so.5m. The circumstances under which expedited resolution of an appeal is available and how to request it.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.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.8. The availability of independent advocacy services and other local organizations that might assist an applicant or enrollee with an appeal or fair hearing.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.Wis. Admin. Code Department of Health Services DHS 10.52
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.Amended by, 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, eff. 6/1/2023