Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 104 - Recipient Rights And Duties › Section DHS 104.01 - Recipient rights

Current through June 24, 2024
(1) CIVIL RIGHTS. No applicant for or
				recipient of medical assistance (MA) may be excluded from participation in MA
				or denied benefits or otherwise be subjected to discrimination under MA for
				reasons which violate Title VI of the civil rights act of 1964, as amended,
				42 USC
				200d et seq., and the implementing
				regulations, 45 CFR Part 80.
(2)
				RIGHTS OF INDIVIDUALS WITH DISABILITIES. No otherwise qualified individual with
				a disability may, solely by reason of disability, be excluded from the
				participation in MA, be denied benefits of MA or be subjected to discrimination
				under MA.
Note:
See s. 504 of the rehabilitation act of
				  1973, as amended, 29 USC
				  794, and the implementing regulations, 45 CFR
				  Part 84.
(3) CONFIDENTIALITY
				OF MEDICAL INFORMATION. Information about recipients shall be confidential and
				only disclosable in accordance with 42 CFR pt. 2 and ss.
				146.81 to
				146.83, Stats. No privilege
				exists under MA regarding communications or disclosures of information
				requested by appropriate federal or state agencies or their authorized agents
				concerning the extent or kind of services provided recipients under the
				program. The disclosure by a provider of these communications or medical
				records, made in good faith under the requirements of this program, shall not
				create any civil liability or provide any basis for criminal actions for
				unprofessional conduct.
(4) FREE
				CHOICE OF PROVIDER.
(a)
Selection of a
				provider.
The department or agency shall maintain a current list of
				certified providers and shall assist eligible persons in securing appropriate
				care.
(b)
Limitations.
A recipient may request service from any
				certified provider, subject to ss.
				DHS 104.02
				(1),
				104.03,
				and
				104.05,
				except as provided in pars. (d), (f) and (g).
(c)
Right to fair hearing.
A
				recipient who believes the recipient's freedom of choice of provider has been
				denied or impaired unfairly may request a fair hearing within 45 days of the
				department's action.
(d)
Nursing home admission.
Free choice of a skilled nursing or
				intermediate care facility shall be limited so as to provide only care which is
				necessary to meet the medical and nursing needs of the recipient. A
				pre-admission screening assessment shall take place to determine appropriate
				service needs.
(e)
Non-covered services.
A recipient's participation in MA does
				not preclude the recipient's right to seek and pay for services not covered by
				the program.
(f)
Case
				management services.
Only recipients in the target populations
				designated by the department in s.
				DHS 107.32 (1) (a)
				2 may choose case management services.
				Receipt of case management services does not restrict a recipient's right to
				receive other MA services from any certified provider.
(g)
Presumptive eligibility
				determination.
A recipient who requests a determination of presumptive
				eligibility to receive MA services shall file an application only with a
				qualified provider designated by the department and certified under s.
				DHS
				103.11.