CRO Frequently Asked Questions (FAQ)
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If you are receiving services for mental illness, developmental disabilities or substance abuse in Wisconsin:
- What do I do if I just want to get my concern resolved quickly?
- What if I am not satisfied with informal resolution or reluctant to try it and I want to follow the formal complaint process?
- What can I expect as an outcome of the grievance process?
- What if I am seeing a private psychiatrist or psychologist who has a solo practice?
- What if I am on Medicaid and my services are denied or reduced?
- Do I have patient rights if I am receiving services at a Methadone clinic?
- What if I want to see my treatment records?
- What if I think parts of my treatment records are wrong?
- What if I need a legal advocate to assist me in assuring my client rights?
- What if I want to go directly to court over a client rights violation?
For other types of complaints or services:
- What if I have a complaint about a caregiver, agency or regulated facility?
- What if I am having problems at a nursing home or other long-term care facility?
- What if I have a concern about an adult at risk?
- What if I am concerned about the welfare of a child?
- What if I am in the Family Care program?
Your best chance of resolving conflicts or concerns quickly is to raise it directly with the staff person involved or with their supervisor. Many agencies also have a designated Client Rights Specialist who can help informally resolve concerns or complaints. It is natural to feel some reluctance to approach a person or an agency with a complaint. However, if the complaint is one that may be resolved by some action by the person or agency then this might be the most efficient course of action to follow. If you would like assistance raising your concern, ask if there is a Client Rights Specialist, an Ombudsman, a Member Rights Specialist (if you receive services through Family Care) or some other advocate who could assist you.
You may file a formal complaint if you believe your rights were violated by the agency providing you services. As required in DHS 94, Wisconsin Administrative Code, the agency must have designated a Client Rights Specialist to receive complaints. This is someone who can conduct an investigation to determine if your rights have been violated and make recommendations for changes to the agency. If you disagree with the agency’s decision, you may appeal the decision for review at the county or MCO level and then at the state level. This process is resolution focused and is geared towards making improvements in the implementation of client rights in the service delivery system. (See the rest of the Client Rights Office website for more information about your rights and the grievance process.)
The outcome you will receive is an impartial review of the facts and a decision as to whether or not your rights were violated. Whether or not there is a finding of a rights violation, recommendations may be made to prevent future violations. The DHS 94 grievance procedure does not award money “damages” and does not recommend staff discipline. Damages can only be awarded by a court. Any potential Staff disciplinary action is up to the employer, not the grievance process. (See the rest of the Client Rights Office website for more information about your rights and the grievance process.)
Independent practitioners are specifically excluded from the provisions of the DHS 94 grievance resolution procedure. They would have no one to act as their Client Rights Specialist. So if you have a complaint about their conduct or the treatment they provided for you, you have to contact the State of Wisconsin, Department of Safety and Professional Services (formerly the Department of Regulation and Licensing). DSPS is the state agency responsible for credentialing and regulating various professions in the State of Wisconsin. Regulation of the professions is accomplished through various licensing boards as well as directly by the department in some circumstances. If you believe a licensed professional has done something unethical or unprofessional, you may file a complaint with DSPS. Please note that it can take time (possibly up to two or three years) for them to see an investigation to its conclusion. The Director of the Bureau of Health Professions in the Department of Regulation and Licensing may be reached at telephone: (608) 267-7223. Information on how to file a complaint and the forms for doing so can be found on the DSPS webpage: Complaints.
The state Division of Hearings and Appeals (DHA) holds Fair Hearings regarding denials of requests for assessments, program eligibility, terminations of program eligibility or covered Medicaid funded services, or reductions in covered services. The Fair Hearings process may also be used to address a lack of choices in covered services, or to challenge the decision to deny or limit coverage of a requested service or item for any reason. If your provider agency, or case manager, makes a decision regarding one of the above topics and you disagree, you may have the right to a Fair Hearing with DHA. The DHA webpage: Information About the Administrative Hearing Process has additional information. (Exit DHS)
Yes, you do. Patients receiving services for substance abuse have the same rights as anyone receiving services for mental illness or developmental disabilities, including the right to file complaints. Like any other service provider, the clinic must have a grievance procedure that ties into the DHS 94 process. However, you should be aware that Methadone is a highly regulated controlled substance. The clinic has strict rules about its use that you must follow to ensure your safety as well as the safety of others in the community. If you violate those rules and are dismissed from the program, the client rights grievance process cannot help you get back into the program. You may file a grievance about being dismissed, but the only issues will be whether or not you should have been aware of the rules and if you violated those rules, regardless of your reasons for the violations. If you are having any difficulties following the strict rules about Methadone use, you are encouraged to discuss them with clinic staff before you are dismissed from the program.
During treatment, access to your treatment records may be restricted by the treatment facility under ss. 51.30(4)(d), Wis. Stats. However, DHS 92.05(1)(b), Wis. Admin. Code, states that your access to records during treatment may only be restricted if there is reason to believe that the benefits of access to those records is outweighed by the disadvantages. The reasons for the restriction must also be entered into your records. Access to records about your health treatment or medications cannot be restricted at any time. After your discharge, you may see all your records and may obtain copies of all or part of the records, if you follow the agencies’ records request policy and are willing to pay for them.
You have the right to challenge the “accuracy, completeness, timeliness or relevancy” of factual information in your records under ss. 51.30(4)(f), Wis. Stats. You can only challenge “facts” in your records, not opinions or diagnoses made by professionals. Your treatment agency will have a process to follow to challenge your records. That process must comply with state laws and rules and also the federal Health Insurance Portability and Accountability Act (HIPAA). They should have a form for you to fill out to begin the challenge to your records. If your records challenge is denied, you will have the opportunity to insert your own version of the facts in your record. Your version will have to be released along with the rest of your records to anyone you authorize to see your records or who has access to your records without your consent under the exceptions provisions of the records confidentiality law.
You can contact Disability Rights Wisconsin (DRW). DRW is the state’s designated
“protection and advocacy agency” for persons who have a mental illness or developmental disabilities. DRW may be able to assist you, depending
on the nature of your services and needs. DRW is located at:
131 W. Wilson St., Suite 700
Madison, WI 53703
Telephone: (608) 267-0214
Fax: (608) 267-0368
Toll Free: 1-800-928-8778
Website: Disability Rights Wisconsin
The Wisconsin “patient rights” law is the only similar law that does not require the client to “exhaust their administrative remedies” before filing a lawsuit. In other words, you can take a “patient rights” issue directly to court without having to go through the grievance procedure first. (See ss. 51.61(7), Wis. Stats.) You are advised to seek competent legal advice if you wish to bring such a lawsuit.
You may file a complaint with the Department of Health Services, Division of Quality Assurance (DQA). DQA is responsible for assuring the health, safety, and welfare of the citizens of Wisconsin. If you belief that a caregiver, agency, or DQA regulated facility has violated State or Federal laws pertaining to regulated entities, you may file a complaint with DQA. Toll free number: 1-800-642-6552. There is also an online complaint intake process available on the DQA website at: Complaints about Health Care in Wisconsin
The Long Term Care ombudsman responds to complaints and problems of residents or recipients of long term care, such as care in nursing homes, community-based residential facilities, and services of the Community Options Program and managed long-term care programs. The Board on Aging and Long Term Care can be reached toll-free at 1-800-815-0015 or at the The Long Term Care Ombudsman webpage.
Contact your county’s Adult Protective Services agency. “Adult at risk” means any adult who has a physical or mental condition that substantially impairs his or her ability to care for his or her needs and who has experienced, is currently experiencing, or is at risk of experiencing abuse, neglect, self-neglect, or financial exploitation. If the person in question is an adult-at-risk the county can investigate allegations immediately. These Protective Service units try to help resolve issues so that clients are no longer at risk. If appropriate, these Protective Service units may contact law enforcement officers for a separate investigation regarding potential criminal conduct. See the DHS webpage: Wisconsin Elder Adults-at-Risk Help Lines.
Contact your county’s Child Protective Services agency. Those agencies are required to review, investigate, and/or intervene in responding to allegations of child abuse, exploitation, or neglect. These Protective Service units try to help resolve issues so that clients are no longer at risk. If appropriate, these Protective Service units may contact law enforcement officers for a separate investigation regarding potential criminal conduct.
If you are receiving services or the payment of your services is administered via a Managed Care Organization (MCO) under Family Care, you may file a complaint with the MCO. Please contact the Member Rights Specialist at the MCO for more information about this option. The document has additional information: Rights of Family Care Clients (PDF, kb)