DHS 10.44(2)(e)2.e. e. Respect.

DHS 10.44(2)(e)2.f. f. Independence.

DHS 10.44(2)(e)2.g. g. Social roles and ties to family, friends and community.

DHS 10.44(2)(e)2.h. h. Educational and vocational activities.

DHS 10.44(2)(e)2.i. i. Desired level and type of participation in community life.

DHS 10.44(2)(e)2.j. j. Spiritual needs and desired participation in religious activities.

DHS 10.44(2)(f) (f) The CMO, in partnership with the enrollee, shall develop an individual service plan for each enrollee, with the full participation of the enrollee and any family members or other representatives that the enrollee wishes to participate. The CMO shall provide support, as needed, to enable the enrollee, family members or other representatives to make informed service plan decisions, and for the enrollee to participate as a full partner in the entire assessment and individual service plan development process. The service plan shall meet all of the following conditions:

DHS 10.44(2)(f)1. 1. Reasonably and effectively addresses all of the long-term care needs and utilizes all enrollee strengths and informal supports identified in the comprehensive assessment under par. (e) 1.

DHS 10.44(2)(f)2. 2. Reasonably and effectively addresses all of the enrollee’s long-term care outcomes identified in the comprehensive assessment under par. (e) 2. and assists the enrollee to be as self-reliant and autonomous as possible and desired by the enrollee.

DHS 10.44(2)(f)3. 3. Is cost-effective compared to alternative services or supports that could meet the same needs and achieve similar outcomes.

DHS 10.44(2)(f)4. 4. Is agreed to by the enrollee, except as provided in subd. 5.

DHS 10.44(2)(f)5. 5. If the enrollee and the CMO do not agree on a service plan, provide a method for the enrollee to file a grievance under s. DHS 10.53, request department review under s. DHS 10.54, or request a fair hearing under s. DHS 10.55. Pending the outcome of the grievance, review or fair hearing, the CMO shall offer its service plan for the enrollee, continue negotiating with the enrollee and document that the service plan meets all of the following conditions:

DHS 10.44(2)(f)5.a. a. Meets the conditions specified under subds. 1. to 3.

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.