Module #10: Functional Eligibility Results

Contents

10.1 Information Available on the Eligibility Results Page
10.2 What Do These Results Mean?
10.3 Confirm the Functional Eligibility Results
10.4 Sharing Functional Eligibility Results with Others
10.5 Functional Eligibility Results Affecting Eligibility for Other Programs
10.6 Completed CLTS Functional Screen Summary Reports  


10.1 Information Available on the Eligibility Results Page

Once the screener has selected "CALCULATE ELIGIBILITY" a new screen will appear with important information. At the top of the page will be the following information that helps identify who produced this screen and when it was completed. Included is:

  • Screen Begin Date
  • Screener Name
  • Screen Entered By
  • Eligibility calculated by Agency

The page will then display the following chart:

Eligibility Program

Eligibility Results

Pending Results

Comprehensive Community Service

   
Community Recovery Services    

Community Options Program

   

Family Support Program

   

Children's Waivers

   

Katie Beckett Medicaid Program

   

MH Wrap Around

   

For Comprehensive Community Service, the following Eligibility Results are possible:

  • Functionally eligible to need services
  • Not functionally determined to need services

For Community Recovery Services, the following Eligibility Results are possible:

  • Functionally eligible to need services
  • Not functionally determined to need services

For the Community Options Program, the following Eligibility Results are possible:

  • Functionally eligible
  • Not functionally eligible
  • Not eligible due to living situation
  • For an individual of this age, refer to the adult functional screen

For the Family Support Program, the following Eligibility Results are possible:

  • Functionally eligible
  • Not functionally eligible
  • Not eligible due to adjudicated delinquent status
  • Not eligible due to living situation
  • For individuals over 22 years, please contact BLTS

For the Children's Waivers, the following Eligibility Results are possible:

  • Mental Health Target Group (Psych Hospital LOC)
  • Physical Disability Target Group (Nursing Home LOC)
  • Physical Disability Target Group (Hospital LOC)
  • DD Target Group (ICF-MR/DD1 LOC)
  • DD Target Group (ICF-MR/DD2 LOC)
  • Not eligible due to living situation
  • This screen should not be used for an individual of this age
  • Not functionally eligible

Note: The Children's Waivers Functional Eligibility Results will list all the target groups for which the child meets the functional eligibility requirements. The decision of which specific target group to select for any particular child is the responsibility of the agency/county using the Children's Waivers.

For the Katie Beckett Medicaid Program, the following Eligibility Results are possible:

  • Psychiatric Hospital Level of Care
  • Hospital Level of Care
  • Nursing Home Level of Care
  • ICF-MR/DD1 Level of Care
  • ICF-MR/DD2 Level of Care
  • Functionally eligible but is in an ineligible living situation
  • Not eligible due to age
  • Not functionally eligible

For the MH Wrap Around, the following Eligibility Results are possible:

  • Functionally eligible
  • Not functionally eligible
  • Not eligible due to age

Pending Results may include:

  • Not eligible due to lack of U.S. Citizenship documentation and verification. Services cannot be provided through this program without required documentation.
  • Pending U.S. Bureau of Citizenship and Immigration Services verification.
  • Pending Identity verification.
  • Requires a disability determination
  • Living Situation
  • Adjudicated Delinquent Status
  • N/A
  • None

If a CLTS FS indicates that there are Pending Results for a child's functional eligibility, then only when those issues are resolved can one determine that a child actually meets the functional eligibility requirement for that particular program. However, meeting the functional eligibility for a program does not automatically make the child eligible for that program because there may be additional criteria that must be met prior to program eligibility.

Two exceptions to Pending Results:

  • If a child has a pending result that reads, "Pending U.S. Bureau of Citizenship and Immigration Services verification" then the screener must indicate in the note section when this verification has been made. This pending result will continue to display on future screens for this child but with the accompanying note, screeners can proceed with service provision.

  • If a child has a pending result that reads, "Requires a disability determination" but the child is applying for a locally matched waiver slot, the application can proceed. This pending result will continue to display for state funded waiver requirements.

At the bottom of the page is the reminder that "This does not include FINANCIAL eligibility." This is important to keep in mind because Financial Eligibility is of significant importance to certain programs.

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10.2 What do These Results Mean?

The results only indicate that the child meets (or does not meet) functional eligibility for certain programs. It does not mean that they meet program eligibility. Some programs have additional criteria including financial eligibility that need to be determined for program eligibility. The CLTS FS only determines functional eligibility.

If the functional eligibility is pending anything, than the child is not considered functionally eligible for that program until the pending issues are addressed. The Level of Care (LOC) or Target Group that the child will meet once the pending issues are addressed is listed so that plans for their eventual functional eligibility can be made accordingly.

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10.3 Confirm the Functional Eligibility Results

Screeners, as knowledgeable professionals in the field who have met the child and reviewed valuable information about the child, are responsible for confirming that the results of the CLTS FS meet with their professional judgment. If the outcome is not what the screener expected, the screener should complete a thorough review of the screen. If the results are the same following this initial review, they should conduct an internal review with someone else from the same agency. If the results are still in question, the screener should contact the CLTS FS Coordinator for assistance.

If the result is that the child is Not Functionally Eligible, the screener should always request an internal review by their agency/entity. Each agency/entity is responsible for screen/screener quality assurance at a local level. The CLTS FS Coordinator may be consulted when specific questions arise but cannot verify eligibility results for any child.

Screeners should not attempt to change their answer choices on the screen to get the results they anticipated. If the screener finds that they unintentionally checked something incorrectly on the screen, they can use the Edit button to make small changes to their answer choices and recalculate eligibility. If the Calculate Eligibility button is selected multiple times on a single child, the screener will be asked by State Clinical Staff to provide an explanation for their repeated eligibility calculations.

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10.4 Sharing Functional Eligibility Results with Others

Naturally the functional eligibility results are to be kept confidential. This page is not to be shared in total with a family. If requested, the screener can share the results for the program the family requested a screen for, but do not share the results for other programs.

If the screener sees from the results that the child has met the functional eligibility for another program, the screener can refer the family to that program. Screeners are not required to make such referrals. The CLTS FS does not determine program eligibility so being found functionally eligible for a program does not guarantee program eligibility. Screeners should never tell a family that they are eligible for any program other than the program the screener is offering.

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10.5 Functional Eligibility Results Affecting Eligibility for Other Programs

The CLTS FS determines functional eligibility for multiple programs. Therefore, it may find children ineligible for multiple programs as well. When the functional eligibility results indicate that a child is no longer functionally eligible for a program that they are currently receiving services from, it is the screener’s responsibility to inform that program of their results. For example, if a screener is completing a CLTS FS for the Family Support Program and the results indicate that the child is no longer eligible for the Katie Beckett Program, the Family Support Program has a responsibility to inform the Katie Beckett Program of this change immediately.

As long as the CLTS FS is completed accurately, it does not matter who completed it or which program it is being completed for. The functional eligibility results are binding for all programs listed. It is important that the CLTS FS be completed based on fact and not subjectively as the results impact many programs for which the child may be functionally eligible.

This applies when ALL of the following conditions are met:

  1. You are a certified screener doing a Children’s Long-Term Support Functional Screen (CLTS FS) for a child.
  2. You have obtained a Functional Screen Informed Consent form from the child’s parent/guardian.
  3. You have followed existing procedure to have the screen transferred to you, if necessary.
  4. You have determined that a previous screen(s) exists for the child.
  5. You have completed the screen and calculated results with which you are in agreement. Per the CLTS FS Instructions, if you disagree with your results, you are responsible for using your agency’s internal CLTS FS review process and if necessary, contacting CLTS FS Coordinator, Becky Burns, at Becky.Burns@Wisconsin.gov.
  6. Your calculated results show that the child’s eligibility has changed to Not Eligible or Not Functionally Eligible for a program(s) other than the one for which you were completing the screen. Note: the child may or may not be a participant in the other program(s).

When the situation meets all of the above conditions, follow the procedure outlined below:

Step 1 If the screen results change the child’s functional eligibility for Katie Beckett Program - Medicaid from Functionally Eligible to Not Functionally Eligible:

  1. Send an e-mail to the KBP Central Office at DHSKatieBeckett@Wisconsin.gov.
    a. In the ‘Subject’ heading state: Change in FS Results.
    b. In the ‘Message’ of the e-mail indicate the first and last name of the child, spelled correctly, and describe the change in his/her functional eligibility results.
    c. Be sure your email includes your full name, title and phone number.

2. Administrative staff at the KBP Central Office will forward your email to the assigned Katie Beckett Nurse Consultant. The Nurse Consultant will call you to discuss the screen results.

Step 2 If the screen results change the child’s eligibility for any other program (other than Katie Beckett) to Not Eligible or Not Functionally Eligible, then you must also contact all screeners for whom your screen changed eligibility results.

The screeners you contact must reply to you with the needed information within ten (10) business days. If the previous screener does not reply to your original request for their telephone and FAX numbers within 10 business days, then continue with your customary process for finalizing and communicating to the family the eligibility results for your program.

Step 3 If the child is currently active on BOTH Katie Beckett Program – Medicaid and a
CLTS Waiver, the screener for the CLTS Waiver takes the lead in the discussion regarding the change in the CLTS-FS results. The Katie Beckett Program staff are not involved at this point because they have had no recent contact with the children for review of eligibility. Refer to Termination of CLTS-Waiver Participation policy for further information as needed.

Step 4 You and the previous certified screener(s) will have a dialogue about the child’s needs and functional eligibility upon the exchange. Remember that there are many reasons why eligibility results may have changed, including a change in the child’s condition, a change in the child’s age or the family represented the child’s needs differently. You will discuss the need for any further information with the other screener(s) and agree on a method to collect this. If appropriate, you will make edits to the screen using the new or expanded information gathered during this process and recalculate eligibility.

Step 5 If you and the previous screener agree that the results of the most current finalized screen are accurate and reflect your experience with the child and family, then each screener will proceed with the actions appropriate to the program with which they work.

Note: The final agreed upon screen may have changed functional eligibility back to functionally eligible.

If the result of this process is that you and the previous screener are unable to reach an agreement about the screen results, you must refer this situation to the CLTS-FS Team for a final decision. Send an email to the CLTS FS Coordinator, Becky Burns, at Becky.Burns@Wisconsin.gov.

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10.6 Completed CLTS Functional Screen Summary Reports

There are summary report options available for a completed individual CLTS FS. These reports can be viewed at the web site and can also be printed. The reports have been developed based on feedback from screeners and managers who operate the programs for which the CLTS FS determines functional eligibility. There are three (3) report formats to choose from. The three reports are titled:

  • FS report w/eligibility
  • Family FS report w/notes
  • Family FS report

FS report w/eligibility
This report is a complete report of everything the screener entered in the CLTS Functional Screen. This is the report that is used to determine functional eligibility for various programs and is used internally for review of completed screens. This is the only report that displays the functional eligibility results.

Family FS report w/notes
This report is designed to be shared with parents. It does not include some of the sections found in the FS report w/eligibility. It does not include the Screen Time or Eligibility Results pages. It does include all the notes the screener entered on the most recent screen. This report can be shared with parents who request a copy of the completed screen.

Family FS report
This report is designed to be shared with parents. It does not include some of the sections found in the FS report w/eligibility. It does not include the Screen Time or Eligibility Results pages. In addition, it does not include any of the notes the screener entered. This report can be shared with parents who request a copy of the completed screen.

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Last Revised: February 28, 2014
Wisconsin Department of Health Services
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