DHS 10.42 NoteNote: Until July 1, 2001, the Wisconsin Legislature has authorized the Department to establish Family Care pilots in areas of the state in which not more than 29% of the state’s eligible population lives. After that date, if specifically authorized and funded by the Legislature, the Department may contract with additional entities certified as meeting requirements for a CMO. The Department is required to submit, prior to November 1, 2000, a report to the Governor that describes the implementation and outcomes of the pilots and makes recommendations about further development of Family Care.

DHS 10.42(5)(5) The department’s contracts with CMOs shall specify a range of remedies that may be taken in the event of noncompliance by the CMO with contract requirements. The remedies may include the following:

DHS 10.42(6)(6) Except as provided in this subsection, the department shall use standard contract provisions for contracting with CMOs. The provisions of the standard contract shall comply with all applicable state and federal laws and may be modified only in accordance with those laws and after consideration of the advice of the secretary’s council on long-term care.

DHS 10.42(7)(7) The department shall annually provide to the members of the secretary’s council on long-term care copies of the standard CMO contract the department proposes to use in the next contract period and seek the advice of the council regarding the contract’s provisions. The department shall consider any recommendations of the council and may make revisions, as appropriate, based on those recommendations. If the department proposes to modify the terms of the standard contract, including adding or deleting provisions, in contracting with one or more organizations, the department shall seek the advice of the council and consider any recommendations of the council before making the modifications.

DHS 10.42(9)(9) Prior to receiving funds to provide the family care benefit, an organization shall agree to the terms of the standard CMO contract.

DHS 10.42 HistoryHistory: Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 04-040: am. (6) (a) and (7) Register November 2004 No. 587, eff. 12-1-04; corrections in (2) (a), (3) (a), (b), (c), (d) 1., (4), (6) (b) and (8) made under s. 13.92 (4) (b) 7., Stats., Register November 2009 No. 647; CR 22-026: r. (3) (a), cons. (6) (intro.) and (a) and renum. to (6) and am., r. (6) (b) Register May 2023 No. 809, eff. 6-1-23; CR 23-046: cr. (2) (am) Register April 2024 No. 820, eff. 5-1-24; CR 24-087: am. (2) (a), r. (3) (b), am. (3) (c), cons. (3) (d) (intro.) and 2. and renum. to (3) (d) and am., r. (3) (d) 1., am (3) (e) 1., (4), r. (8) Register February 2025 No. 830, eff. 3-1-25.

DHS 10.43DHS 10.43 CMO certification standards. If an organization applies for a contract to operate a CMO, the department shall determine whether the organization meets the requirements of s. 46.284 (2) and (3), Stats., and all of the following standards:

DHS 10.43(1)(1) Case management capability. Each organization applying to operate a CMO shall demonstrate to the department that it has expertise in determining and arranging for services and supports to meet the needs of its target population. Demonstration of this expertise includes evidence that the organization, a subcontractor, or both, has all of the following:

DHS 10.43(1)(c)(c) Thorough knowledge of methods for maximizing informal caregivers and community resources and integrating them into individual service plans.

DHS 10.43(1)(d)(d) Strong linkages with systems and services that are not directly within the scope of the CMO’s responsibility but that are important to the organization’s target population, including primary and acute health care services, and the capacity to arrange for those services to be made available to its enrollees.

DHS 10.43(1)(e)(e) Mechanisms to coordinate services internally and with services available from community organizations and other social programs.

DHS 10.43(1)(g)(g) Thorough knowledge of methods for promoting and supporting the use of mechanisms under which individuals direct and manage their own service funding.

DHS 10.43(2)(2) Adequate availability of providers. Each organization applying to operate a CMO shall demonstrate to the department that it has adequate availability of qualified providers with the expertise and ability to serve its target population in a timely manner. To demonstrate an adequate availability of qualified providers, an organization shall assure the department that it has all of the following:

DHS 10.43(2)(b)(b) Appropriate provider connections to qualify providers, on a timely basis, as needed to directly reflect the specific needs and preferences of particular enrollees in its target population.

DHS 10.43(2)(c)(c) Agreements with a broad array of providers representing diverse programmatic philosophies and cultural orientations to accommodate a variety of enrollee preferences and needs within its target population.

DHS 10.43(2)(e)(e) The ability to provide an appropriate range of residential and day services that are geographically accessible to proposed enrollees’ homes, families, guardians or friends.

DHS 10.43(2)(f)(f) Supported living arrangements of the types and sizes that meet its target population’s preferences and needs and staff to coordinate residential placements who have shown capability in recruiting, establishing and facilitating placements with appropriate matching to enrollee needs.

DHS 10.43(2)(g)(g) The ability to recruit, select and train new service providers, including in-home providers, in a timely fashion and a program designed to retain individual providers.