DHS 10.55(1g)(k) (k) Determinations of protection of income and resources of a couple for maintenance of a community spouse under s. DHS 10.35 to the extent a hearing would be available under s. 49.455 (8) (a), Stats.

DHS 10.55(1g)(L) (L) Recovery of incorrectly paid family care benefit payments as provided under s. DHS 108.03 (3).

DHS 10.55(1g)(m) (m) Hardship waivers, as provided in s. DHS 108.02 (12) (e), and placement of liens as provided in ch. HA 3.

DHS 10.55(1g)(n) (n) Determination of temporary ineligibility for the family care benefit resulting from divestment of assets under s. DHS 10.32 (1) (i).

DHS 10.55(1m) (1m) Exception to right to fair hearing. An enrollee does not have a right to a fair hearing under sub. (1g), if the sole issue is a federal or state law requiring an automatic change adversely affecting some or all enrollees and the enrollee does not dispute that they fall within the category of enrollees to be affected by the change.

DHS 10.55(2) (2) Grievances. An enrollee may contest any decision, omission or action of a CMO other than those specified under sub. (1g) by filing a grievance with the CMO under s. DHS 10.53 (2). If the enrollee is not satisfied with the CMO’s grievance decision, or if the CMO fails to issue a grievance decision within the timeframes specified under s. DHS 10.53 (2) (d), the enrollee may request a department review under s. DHS 10.54.

DHS 10.55(3) (3) Requesting a fair hearing. Receipt of notice is presumed within 5 days of the date the notice was mailed. A client shall file their request for a fair hearing in writing within the timeframes specified under subs. (1) and (1g) with the division of hearings and appeals in the department of administration. A hearing request shall be considered filed on the date of actual receipt by the division of hearings and appeals, or the date of the postmark, whichever is earlier. A request filed by facsimile is complete upon transmission. If the request is filed by facsimile transmission and such transmission is completed between 5 p.m. and midnight, one day shall be added to the prescribed period. If a client asks the department, a county agency, a resource center or CMO for assistance in writing a fair hearing request, the department, resource center or CMO shall provide that assistance.

DHS 10.55 Note Note: A hearing request can be submitted by mail or hand-delivered to the Division of Hearings and Appeals, at 4822 Madison Yards Way, 5th Floor North, Madison, WI 53705-5400, faxed to the Division at [phone], or emailed to the Division at [e-mail]. The Division’s telephone number is [phone].

DHS 10.55(4) (4) Department review of fair hearing requests.

DHS 10.55(4)(a) (a) When the division of hearings and appeals receives a request for a fair hearing under this chapter, it shall set the date for the hearing in accordance with ch. HA 3 and notify the department that it has received the request.

DHS 10.55(4)(b) (b) When an enrollee has requested a fair hearing under sub. (3), the department shall conduct an informal review to identify, and, as appropriate, intervene in, fair hearing requests related to member health and safety, contract non-compliance and complex situations, if it appears to the department that informal resolution of the matter may be appropriate.

DHS 10.55(5) (5) Fair hearing procedures.

DHS 10.55(5)(a) (a) The division of hearings and appeals shall conduct a fair hearing pursuant to this section in accordance with ch. HA 3, in response to each fair hearing requested unless, prior to the scheduled hearing date, any of the following occurs:

DHS 10.55(5)(a)1. 1. The client withdraws the request in writing.

DHS 10.55(5)(a)2. 2. The contested matter is resolved under sub. (4).

DHS 10.55(5)(a)3. 3. In the case of an enrollee appealing a CMO decision, the person voluntarily disenrolls from the CMO.

DHS 10.55(5)(a)4. 4. The petitioner has abandoned the hearing request. The division of hearings and appeals shall determine that abandonment has occurred when the petitioner, without good cause, fails to appear personally or by representative at the time and place set for the hearing. Abandonment may also be deemed to have occurred when the petitioner or the authorized representative fails to respond within a reasonable time to correspondence from the division regarding the hearing.

DHS 10.55(5)(a)5. 5. An informal resolution is proposed that is acceptable to the client, and the client agrees, in writing, to the resolution or withdraws the request for fair hearing.

DHS 10.55(5)(a)6. 6. An informal resolution acceptable to the client appears imminent to all parties, and the client requests rescheduling of the fair hearing. If the informal resolution that was anticipated is, in fact, not acceptable to the client, a new hearing date shall be set promptly.

DHS 10.55(5)(b) (b) In accordance with ch. HA 3, the division of hearings and appeals:

DHS 10.55(5)(b)1. 1. Shall consider and apply all standards and requirements of this chapter.

DHS 10.55(5)(b)2. 2. Shall issue a decision within 90 days of the date of receipt of the request for fair hearing.

DHS 10.55(5)(b)3. 3. May dismiss the petition if the client does not appear at a scheduled hearing and does not contact the division of hearings and appeals with good cause for postponement.

DHS 10.55(5)(c) (c) An applicant for or recipient of medical assistance is not entitled to a hearing concerning the identical dispute or matter under both this section and 42 CFR 431.200 to 431.246.

DHS 10.55 History History: Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 04-040: am. (1) (a), (2), and (4) (b) Register November 2004 No. 587, eff. 12-1-04; corrections in (1) (i) and (j) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; CR 09-003: am. (1), cr. (1m) Register November 2009 No. 647, eff. 12-1-09; CR 22-026: am. (1), renum. (1) (d) to (1g) (b), r. (1) (e), renum. (1) (f) to (1g) (i), renum. (1) (g) to (1g) (j) and am., renum. (1) (h) to (k) to (1g) (k) to (n), cr. (1g) (intro.) (a), (c), (d) to (h), am. (1m) to (3), (4) (title), (b), (5) (a) 3. Register May 2023 No. 809, eff. 6-1-23; correction in (1g) (title) made under s. 13.92 (4) (b) 2., Stats., Register May 2023 No. 809.

DHS 10.56 DHS 10.56 Continuation of services.

DHS 10.56(1) (1) Request for continuation of services pending outcome of cmo appeal. Prior to reducing, suspending or terminating services under the family care benefit, a CMO shall provide to the enrollee prior notification of its intent to reduce, suspend or terminate the services in accordance with s. DHS 10.52 (3). If an enrollee who has received a notice that services will be reduced, suspend or terminated files an appeal with the CMO under s. DHS 10.53 (2) before the effective date of the reduction, suspension or termination, the enrollee may request that the CMO continue to provide the services pending the outcome of the appeal.

DHS 10.56(1m) (1m) Request for continuation of services pending outcome of dha fair hearing. An enrollee is entitled to continuation of services pending the outcome of a fair hearing if all of the following apply:

DHS 10.56(1m)(a) (a) The CMO’s decision on appeal under s. DHS 10.53 (2) is to proceed with reducing, suspending, or terminating the enrollee’s service.