Section DHS 10.54 - Department reviews(1) DEPARTMENT REVIEW PROCESS FOR GRIEVANCES FILED WITH A RESOURCE CENTER. The department shall review, investigate, and analyze the facts surrounding client grievances in an attempt to resolve concerns and problems informally, whenever either of the following occurs: (a) A client makes a grievance directly to the department.(b) A client requests department review of a decision arrived at through a county agency or resource center grievance process.(2) TIMELINESS OF REVIEW. The department shall complete its review under sub.(1) within 20 days of receiving a request for review from a client, unless the client and the department agree to an extension for a specified period of time.(2e) DEPARTMENT REVIEW PROCESS FOR GRIEVANCES FILED WITH A CMO. The department shall review and resolve enrollee grievances whenever either of the following occurs: (a) An enrollee requests department review of a decision arrived at through a care management organization grievance process under s. DHS 10.53 (2).(b) An enrollee requests department review of a grievance request that the CMO has failed to act on within the timeframe specified under s. DHS 10.53 (2) (d).(2j) TIMEFRAME FOR REQUESTING DEPARTMENT REVIEW. An enrollee must file the request for grievance review within 45 days of the receipt of the CMO's written decision regarding the enrollee's grievance or, if the CMO fails to issue a written grievance decision to the enrollee within the timeframe specified under s. DHS 10.53 (2) (d), within 45 days of the date that timeframe expires.(2o) TIMELINESS OF REVIEW. The department shall complete its review under sub. (2e) within 30 days of receiving a request for review from an enrollee, unless the enrollee and the department agree to an extension for a specified period of time.(2v) TIMELINESS OF DECISION. The department shall mail or hand deliver to the enrollee and the CMO a written decision resolving the grievance within 7 days of the completion of the grievance review. This decision is final and binding on both the enrollee and CMO. Department review is the final process in resolving enrollee grievances.(3) DEPARTMENT REVIEW PROCESS FOR FAIR HEARINGS. Whenever the department receives notice from the department of administration's division of hearings and appeals that it has received a fair hearing request under s. DHS 10.55 (3), the department shall conduct an informal review in accordance with s. DHS 10.55 (4).Wis. Admin. Code Department of Health Services DHS 10.54
Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 04-040: am. (1) (intro.) (a) and (3) Register November 2004 No. 587, eff. 12-1-04.Amended by, CR 22-026: am. (1), (2) (title), cr. (2e) to (2v), am. (3) Register May 2023 No. 809, eff. 6/1/2023