Section 10.51. Client rights.

  Clients shall have the rights in family care that are outlined in the applicant information materials they receive when contacting a resource center and in the member handbook they receive prior to enrollment in a care management organization. The department shall review and approve the statement of client rights and responsibilities in each resource center's applicant information materials and in each CMO's member handbook. Client rights shall, at a minimum, include an explanation of client rights in the following areas:

(1)   Rights of clients. Clients have the right to all of the following:

(a) Freedom from unlawful discrimination in applying for or receiving the family care benefit.

(b) Accuracy and confidentiality of client information.

(c) Prompt eligibility, entitlement and cost-sharing decisions and assistance.

(d) Access to personal, program and service system information.

(e) Choice to enroll in a CMO, if eligible, and to disenroll at any time.

(f) Information about and access to all services of resource centers and CMOs within standards established under this chapter to the extent that the client is eligible for such services.

(g) Support for all clients in understanding their rights and responsibilities related to family care, including due process procedures, and in providing their comments about resource centers, CMOs and services, including through grievances, appeals and requests for department review and fair hearings. Resource centers, CMOs and county agencies under contract with the department shall assist clients to identify all rights to which they are entitled and, if multiple grievance, review or fair hearing mechanisms are available, which mechanism will best meet client needs.

(h) Support for all clients in the exercise of any rights and available grievance and appeal procedures beyond those specified in this chapter.

(2)   Rights of enrollees. Enrollees have the right to all of the following:

(a) Support from the CMO in all of the following:

1. Self-identifying long-term care needs and appropriate family care outcomes.

2. Securing information regarding all services and supports potentially available to the enrollee through the family care benefit.

3. Actively participating in planning individualized services and making reasonable service and provider choices for achieving identified outcomes.

(b) Receipt of services identified in the individualized service plan.

(3)   Application of other rules and regulations. Nothing in this chapter shall limit or adversely affect the rights afforded to clients in accordance with other state or federal laws or regulations. To the extent that provisions in this chapter differ from provisions affording a client rights under other state or federal laws or regulations, the provision that does most to promote the rights of the client shall be controlling.

History: Cr. Register, October, 2000, No. 538 , eff. 11-1-00; CR 04-040 : am. (1) (g) and (2) (b), cr. (1) (h) and (3), Register November 2004 No. 587 , eff. 12-1-04.

Note

Examples of other rights and procedures available to clients include those afforded to persons who receive treatment or services for developmental disability, mental illness or substance abuse under ch. 51 , Stats. and ch. DHS 94 , and those afforded to persons who reside in a nursing home, community-based residential facility, adult family home or residential care apartment complex, or who receive services from a home health agency under statutes and rules of those programs. Microsoft Windows NT 6.1.7601 Service Pack 1