Summary of Revisions to the Medicaid Home and Community-Based Services Waiver Manual for the Children’s Long-Term Support Waiver Program

The 38 updates included in the most recent (April 2021) version of the Medicaid Home and Community-Based Services (HCBS) Waiver Manual for the CLTS Waiver Program, P-02256, are summarized below. 

Changes Occurring in All Chapters

  1. Re-numbering chapter sections and subsections.
  2. Changing the standard for referring to participants:

At the beginning of chapters, it is noted that “participant” refers to a child or youth and their parent(s) and/or legal guardian(s) who apply to and/or participate in the CLTS Waiver Program.

  1. Adding the names of online systems (for example, PPS, EES) and hyperlinks.

Specific Changes, Ordered by Chapter

Each change is described as “removed,” “added,” or “changed to read.” 

  • For changes described as “removed” or “added,” the extent of the removal or addition is specified (for example., “removed all,”  “added bullet point,” “second bullet point removed).
  • For changes described as “changed to read,” the updated text in P-02256 is shown in its entirety.

Chapter 1–Overview and Administration

  1. 1.04 Registering Potentially Eligible Applicants

Removed all.

  1. 1.4 Waitlist

Section 1.4.1 Waitlist Policy
Changed to read:

DHS administers a single, statewide waitlist to facilitate consistency for participants to access and enroll in the CLTS Waiver Program. All participants are placed on the waitlist. CWAs may not create or adopt a waitlist policy or prescribe and enforce waitlist priorities that deviate from this policy.

  1. 1.4 Waitlist

Section 1.4.2 Placing Participants on the Waitlist
Changed to read:

CWAs must use the following procedures when placing a participant’s information on the CLTS waitlist:

  1. Complete the participant’s functional eligibility determination via the CLTS Functional Screen. (Refer to Chapter 2, Waiver Eligibility, for more information.)
  2. Check the participant’s enrollment status in Wisconsin Medicaid. Enrollment in a qualifying source of Medicaid is not required for placement on the waitlist; however, the time of placement on the waitlist is an opportunity for the CWA to assist participants who are not enrolled in a qualifying Medicaid program. (Refer to Chapter 3, Financial Eligibility, for more information.)
  3. Document contact with the participant or other referral source and enter the participant on the CLTS Waitlist if functionally eligible. CWAs enter functionally eligible participants in the CLTS Waitlist module in the online Wisconsin Department of Health Services Program Participation System (PPS). Refer to the Children’s Long-Term Supports (CLTS) Waitlist in Program Participation System (PPS) Step-by-Step Training Guide (P-00697).
  4. Explore options that may be available through other programs (such as CCOP), schools, community resources, and the participant’s natural support systems (for example, friends, family, and community).
  1. 1.4 Waitlist

Section 1.4.3 Enrolling Participants from the Waitlist
Changed to read:

When CLTS Waiver Program resources become available, enrollment and service planning processes must occur for participants that DHS has determined are enrollable and who wish to enroll. DHS places a predetermined number of participants in enrollable status each month according to the first-come, first-served policy for the CLTS Waiver Program. All participants in enrollable status are fully funded and enrollment and service planning processes must begin immediately. 

First‐Come, First‐Served Policy

In order to ensure participants are enrolled in the CLTS Waiver Program according to the order in which they are placed on the waitlist, participants are assigned a statewide enrollment position according to their referral date. This date is entered and documented in the PPS online system. The only exception to the “first come, first served” standard are participants who meet crisis criteria. Refer to the next section for additional information about crisis needs.

Enrollable

DHS has determined the eligible participant fully funded and CWAs must move to enroll and begin service planning immediately. 

Fully Funded

All allowable services, authorized and claimed in compliance with CLTS Waiver Program requirements, will be paid by DHS to the CLTS service provider through the third party administrator (TPA).

CWAs are responsible to use the county‐specific Children’s Wait List Report in the PPS online system to identify participants newly placed in enrollable status. Once a participant is placed in enrollable status the participant no longer has a statewide enrollment position, and funding the participant according to first come, first served policy has been satisfied. CWAs may initiate enrollment activities for several participants in enrollable status at a time and are not required to follow any particular order for enrolling participants once they are in enrollable status.

The date the participant is enrollable starts the timelines for the CWA to contact the participant, verify the participant’s eligibility, complete the individualized service plan, and schedule and authorize services. (Refer to Chapter 2 and P-02049 for additional information.) Service planning includes coordinating all of the supports and services that the SSC and participant agree will benefit the participant, build on the participant’s strengths, and maximize the participant’s independence and community participation.

  1. 1.4 Waitlist

Section 1.4.5 Determining a Variance to the Waitlist Policy
Changed to read:

CWAs determine when a variance to the waitlist policy is justified based on the criteria listed above. When it is determined that a participant meets crisis need criteria, the CWA completes a variance to the waitlist policy. A variance may be determined prior to or as part of the application process.

The CWA is required to use the PPS online system to submit a variance to the waitlist for the participant by completing the Variance Request checkbox and corresponding Variance Request Information Section. The completed variance includes a narrative summary, clearly describing the specific nature of the crisis situation for the participant involved, for the requested exception. Refer to the Children’s Long-Term Supports (CLTS) Waitlist in Program Participation System (PPS) Step-by-Step Training Guide (P-00697) for operational guidance.

The CWA must maintain documentation of the variance request. Adherence to the DHS waitlist variance policy is subject to monitoring by state quality assurance record review and program audit processes.

Chapter 2–Eligibility

  1.  2.3 Target Groups

Section 2.3.3 Severe Emotional Disturbance
Paragraph 2 changed to read:

Additional information regarding target groups and levels of care can be found in the Clinical Instructions for the CLTS Functional Screen (P-00936).

  1. 2.4 Functional Eligibility

Paragraphs 2-3 changed to read:

A child’s functional eligibility determination is completed once every 12 months. The CWA must notify the child of the results of the determination within 15 calendar days of the determination.

When a child or youth meets functional eligibility criteria, financial eligibility criteria (refer to Chapter 3, Financial Eligibility), and DHS has determined the eligible child fully funded, enrollment is completed through the Wisconsin Department of Health Services Eligibility and Enrollment Streamlining (EES) online system. Refer to Chapter 6, Enrollment and Recertification, for enrollment requirements and timelines.

  1. 2.4 Functional Eligibility

Section 2.4.1 Initial Eligibility Determination
Changed to read:

Within 45 days from the child’s or youth’s (hereafter referred to as “participants”) referral date to the CLTS Waiver Program the county waiver agency (CWA) must ensure a CLTS FS (F-00367) has been completed for the participant’s initial eligibility determination. A CLTS FS completed by any program within the previous 12 months meets this requirement; when a CLTS FS has been completed within the previous 12 months, the CWA must not complete another CLTS FS.  

Referral Date
The date the initial inquiry or contact was made by a parent, legal guardian, or another person acting in the interest of the child or youth indicating he or she has a child with a disability or exceptional need, which the family is seeking assistance from the CWA in meeting.

When the CLTS FS (F-00367) completed for an initial eligibility determination shows a qualifying LOC, CWAs must document the participant’s eligibility in the Wisconsin Department of Health Services Program Participation System (PPS) online system within five calendar days of the CLTS FS calculation date. Refer to the Children’s Long-Term Supports (CLTS) Waitlist in Program Participation System (PPS) Step-by-Step Training Guide (P-00697).

  1. 2.4 Functional Eligibility

Section 2.4.2 Eligibility Determination for Recertification
Changed to read:

After a child’s or youth’s initial eligibility determination, functional eligibility is completed annually using the CLTS FS (F-00367), generally at recertification.

  1. 2.4 Functional Eligibility

Section 2.4.3 Not Functionally Eligible
Changed to read:

When a CLTS FS indicates a participant is not functionally eligible (NFE), it is the CWA’s responsibility to ensure the determination is accurate prior to taking action that will result in denial of enrollment or disenrollment, through the following activities:

  • The CWA will not transfer the CLTS FS results to the EES online enrollment system.
  • When a CLTS FS results in an NFE determination, the CWA will have a second screener review the screen within 10 calendar days.
  • CWAs must work with DHS and follow the state’s guidance to resolve any functional screen issues or errors.
  • The CWA will delay disenrolling the participant until the NFE determination is confirmed by both the second screener and DHS.
  • When NFE is confirmed for an initial application, the CWA will notify the participant of denial within 15 calendar days of the determination, along with a description of the participant’s state appeal and county grievance rights. 

DHS will review all NFE screen results for the CLTS Waiver Program and may contact a CWA with questions or further instructions. After 31 days, an NFE result for an enrolled participant will automatically be transferred to the EES online enrollment system, and the CWA must enter an end date into EES.

  1. 2.7 Participant County Moves

Changed to read:

A CLTS Waiver Program participant has a right to continuity of services and freedom of movement while residing in Wisconsin. This means that the participant’s CLTS Waiver Program eligibility and services may not be reduced or terminated solely because they have moved to a different county. CLTS Waiver Program policy for participant moves does not extend to other funding sources which are governed by other statutes, policies, and rules (for example, the Children’s Community Options Program (CCOP), Community Aids, etc.). 

All participants enrolled in the CLTS Waiver Program maintain enrollment when moving from one county to another. All enrolled participants are fully funded at the state level and remain fully funded when moving from one county to another.

For a participant enrolled in a Wisconsin MA subprogram (refer to the MEH, Section 21.2, Full-Benefit Medicaid) managed by an IM, any discussion of potential moves from one county to another must, at a timely point, involve the IM. It is the responsibility of the CWA to ensure that IM workers (IMWs) are informed so that necessary transfers can occur and MA eligibility is not interrupted.

2.7.1 CWA Responsibilities for Participant County Moves

This section outlines CWA responsibilities when a participant voluntarily moves and establishes legal residence (physical presence and intent to remain) in a different county. In this section, the “sending county” is the original county from which the participant moved, and the “receiving county” is the county to which the participant moved.

2.7.1.1 Sending County Responsibilities

When a CLTS Waiver Program participant voluntarily moves to a different county, the sending county must maintain primary program responsibility until all transition activities are complete. To ensure continuity of services, the sending county is responsible for the following transition activities:

Notify the receiving county. 

The sending county or the participant must notify the receiving county with as much advance notice as possible, of their plans to move.  

Notify the local Income Maintenance Consortia (IM).

For a participant enrolled in a Wisconsin MA subprogram (refer to the MEH, Section 21.2, Full-Benefit Medicaid) managed by an IM, the sending county must ensure that IM workers (IMWs) are informed so that necessary transfers can occur and MA eligibility is not interrupted. 

Maintain primary program responsibility until all transition activities are complete.

Services in the participant’s ISP may not be reduced or terminated due to the participant’s move. When the participant has an approved Tier 2 exceptional expense ISP, the sending county must communicate this to the receiving county and share any associated documentation. 

Additionally, if the participant’s move is of significant distance (either more than a two-hour drive or further than 100 miles from the location of the support and service coordinator (SSC)), the sending county must update the ISP with information that addresses how the participant’s health and safety will be monitored and assured during the transition of CWA responsibility. All SSC contact requirements continue to apply during the transition of CWA responsibility and cannot be waived because of travel time, distance, or cost. The sending county may arrange for the transfer of SSC responsibilities to the receiving county until all transition activities are complete.

Update information in the PPS online system, as applicable.

If the participant is on the CLTS Waiver Program waitlist at the time of their move, the sending county must maintain their information in the PPS online system until the receiving county completes all required transition activities. 

2.7.1.2 Receiving County Responsibilities

To ensure continuity of services, the receiving county must complete all of the following transition activities and assume primary program responsibility for the participant within 30 calendar days of receiving notice of the their move, or within 30 calendar days of their move, whichever is later. 

Verify functional eligibility.

The receiving county must verify that the participant’s functional eligibility has been determined within the last 12 months, and does not complete a CLTS FS based solely on the participant’s move; functional eligibility determinations are only completed once every 12 months.

Verify enrollment in a Wisconsin MA subprogram.

When the participant is enrolled in a Wisconsin MA subprogram (refer to the MEH, Section 21.2, Full-Benefit Medicaid) managed by an IM, the receiving county must ensure that IM workers (IMWs) are informed so that necessary transfers can occur and MA eligibility is not interrupted.

Update the ISP with the participant and their family.

The receiving county must continue CLTS Waiver Program services with no unnecessary interruptions; services may not be reduced or terminated due to a participant’s move. If a participant has an approved Tier 2 exceptional expense ISP (refer to Ch. 4.05, Authorization for Exceptional Expense, and 7.04, Requirements and Procedures for Developing Outcomes and an ISP), the receiving county is not required to submit an additional exceptional expense notification.

Update information in the PPS online system, as applicable.

If the participant is on the CLTS Waiver Program waitlist at the time of their move, the receiving county re-enters the participant’s information in the PPS online system only after completing all other required transition activities.

When all required transition activities have been completed, the receiving county assumes primary program responsibility for the participant by maintaining their ongoing services and addressing any new or increased needs. 

2.7.2 Primary Program Responsibility for Participants in Foster Care

For a participant in foster care, CWA primary program responsibility transitions only when the county of residence of their custodial parent(s) or their court appointed guardian changes, or when the court order ends. The county in which the participant’s custodial parent(s) or court appointed guardian reside is the participant’s residential county (Wis. Stat. §§ 48.185(2) and 48.64(4)(c)), and the CWA for the participant’s residential county assumes primary program responsibility. If the participant in foster care temporarily resides in another county, the county of residence may request courtesy supervision from the county in which the participant is temporarily residing, and primary program responsibility does not transition.

Chapter 4–Provider Requirements and Allowable Services

  1. 4.3 Ensuring Access

Section 4.3.2 Remote Waiver Services
Added section:

Remote waiver services are a resource for participants to access CLTS programs services, in combination with all other available resources, to build a complete individual service plan (ISP). Remote waiver services must be considered when participants develop their ISP with their support and service coordinator. They should be used in combination with other supports and services in the amounts and frequencies that best address the participant’s identified outcomes.

4.3.2.1 Remote Waiver Services Definition and Requirements

Remote waiver services are waiver services delivered using multimedia that includes both video and audio communication technology that permits two-way, real-time, interactive communication between a provider and a participant. Remote waiver services do not include communications delivered solely by audio-only telephone, electronic mail, or facsimile (fax) machine.

Services can be provided remotely when all of the following criteria are met:

  • Service can be provided with functional equivalency. That is, the service is amenable to virtual delivery (the provider of the service attests that quality and effectiveness is not significantly compromised and transmission of voices is clear and audible), and of sufficient audio and visual fidelity and clarity as to be functionally equivalent to an in-person visit.
  • Participant gives informed consent to the service provider. Providers must develop and implement their own methods of informed consent to verify that a participant agrees to receive services remotely. These methods must comply with all federal and state regulations and guidelines. Providers must maintain documentation of the informed consent.
  • Participant has the equipment and access to technology needed to participate in services remotely.

Health Insurance Portability and Accountability Act (HIPAA) confidentiality requirements apply to remote waiver services. When a CLTS provider uses remote waiver services that involve protected health information (PHI), the provider must conduct an accurate and thorough assessment of the potential risks and vulnerabilities to PHI confidentiality, integrity, and availability. Each provider must assess and implement the reasonable and appropriate security measures for their situation.

4.3.2.2 Allowable Remote Waiver Services

CLTS Waiver Program services that may be delivered remotely are outlined in DMS Numbered Memo 2021-02, Remote Waiver Services for the Children’s Long-Term Support Waiver Program and Children’s Community Options Program. Refer to DMS Numbered Memo 2021-02 and Chapter 4.6 for additional information about using remote waiver services for an individual service.  

Rates for CLTS programs remote waiver services are the same as services delivered in-person. Refer to the CLTS Waiver Program Rate Schedule (P-02184).

 
Allowable Remote Waiver Services
Adaptive Aids Mentoring
Assistive Technology and Communication Aids     Personal Emergency Response  System (PERS)
Community Integration Services   Respite
Consumer Education and Training     Specialized Medical and Therapeutic Supplies
Counseling and Therapeutic Services  Support and Service Coordination
Daily Living Skills Training Supported Employment - Individual
Day Services   Supported Employment – Small Group
Financial Management Services Supportive Home Care
Home Modifications Training for Parents and/or Guardians and Families of Children with Disabilities (Training for Unpaid Caregivers)
Housing Counseling

 

  1. 4.4 Medicaid Waivers: General Limitations

Section 4.4.5 Services During an Institutional Stay
Changed to read:

If a participant enters a Medicaid-certified institution, hospital, nursing home, intermediate care facility for individuals with intellectual disabilities, or State Center, the CLTS Waiver Program may not cover services provided to the participant on the day they are admitted to the institution or during the time they are in the institution. The CLTS Waiver Program may cover services on the day the participant is discharged from the institution.

There are a few exceptions when waiver services may continue to be authorized during an institutional stay:

  • Services billed on a monthly basis that are impractical and more costly to discontinue rather than to maintain:
    • Personal emergency response system.
    • Waiver-allowable foster care expenses.
    • Financial management services.
  • Discharge-related support and service coordination. 

Transitional support and service coordination may be provided for a participant relocating to the community from an institution beginning up to 90 days prior to discharge and completed on the date of relocation. (Up to 180 days prior to discharge may be allowed with DHS approval.) Transitional services may include associated tasks such as locating appropriate housing, completing lease or housing subsidy applications, assistance in processing changes in Social Security or Medicaid benefits, and meetings with families and potential formal and informal caregivers. Transitional support and service coordination is covered as an aggregate total on the date of discharge.

  • Institutional respite that has been approved by DHS prior to service delivery.
  1. 4.5 Service Authorization

Section 4.5.1 Authorization for Exceptional Expense
Added section:

CWAs must complete a CLTS Exceptional Expense Notification (F-02749) when the CLTS Waiver Program services on a participant’s ISP, excluding high-cost supports and services, are expected to meet or exceed $56,000 annually or $154.71 per day. CWAs are responsible for completing and submitting CLTS Exceptional Expense Notifications (F-02749) according to the tiered threshold review process:

4.5.1.1 Low Threshold (Tier 1) for Exceptional Expense ISPs

  • The low threshold is met when the waiver services cost on the participant’s ISP is greater than or equal to $56,000/annually or $154.71/day.
  • The CLTS cost is calculated, using the CLTS Waiver Program Rate Schedule (P-02184) when applicable, for items being authorized and totaled in Box 15 (Total Waiver Cost/Day) of the participant’s ISP.
  • CWAs complete only the Tier 1 portions of Children’s Long-Term Support (CLTS) Exceptional Expense Notification (F-02749) and submit to DHS via dhscltshighcost@dhs.wisconsin.gov, with the subject “Attention: Regional TA Lead, Tier 1 EE ISP.”
  • Tier 1 notifications are for DHS budget monitoring purposes only.
  • CWAs will not receive a response from DHS and should move forward with service authorizations for Tier 1 exceptional expense ISPs.
  • Exceptional expense ISPs are submitted upon initially meeting the Tier 1 threshold only. Exceptional expense ISPs that continue to meet the Tier 1 threshold upon ongoing ISP review and updates should not be submitted to DHS.
  • If during an ISP review and update, the CLTS costs increase and result in an exceptional expense ISP moving from the Tier 1 threshold to the Tier 2 threshold, CWAs must resubmit F-02749 and await DHS review prior to authorization.
  • If during an ISP review and update, the CLTS costs drop below the Tier 1 threshold, no further notification to DHS is required. 

4.5.1.2 High Threshold (Tier 2) for Exceptional Expense ISPs

  • The high threshold is met when the CLTS cost on the participant’s ISP is greater than or equal to $100,000/annually or $273.97/day.
  • The CLTS cost is calculated, using the CLTS Waiver Program Rate Schedule (P-02184) when applicable, for items being authorized and totaled in Box 15 (Total Waiver Cost/Day) of the participant’s ISP.
  • CWAs complete Children’s Long-Term Support (CLTS) Exceptional Expense Notification (F-02749) in its entirety, attach the child’s exceptional expense ISP, and submit to DHS at dhscltshighcost@dhs.wisconsin.gov, with the subject “Attention: Regional TA Lead, Tier 2 EE ISP.”
  • Tier 2 notifications require DHS review prior to service authorization. The CWA may not move forward with service authorization until a response has been received from DHS.
  • The DHS Exceptional Expense Panel will review F-02749 and the exceptional expense ISP for:
    • The ISP services and supports meet the identified outcomes.
    • Services are allowed through the CLTS Waiver Program.
    • The deciding together process (Deciding Together Guide [P-02246] and instructions [P-02246i]) was used to ensure family partnership and appropriateness of ISP development.
    • Coordination of benefits for all funding sources.
  • DHS will review and provide a response to the CWA within 14 calendar days of submission of a complete F-02749.
  • Exceptional expense ISPs are submitted only upon initially meeting the Tier 2 threshold. CWAs do not submit Exceptional expense ISPs that continue to meet the Tier 2 threshold during ongoing ISP review and updates to DHS.
  • If during an ISP review and update the CLTS costs drop below the Tier 2 threshold, no further notification to DHS is required.

If a participant has an approved Tier 2 exceptional expense ISP and moves to another county, no additional submission of CLTS Exceptional Expense Notification (F-02749) is required by the receiving county. The sending county must communicate to the receiving county that the participant has an approved Tier 2 exceptional expense ISP and provide documentation of it to the receiving county.

  1. 4.5 Service Authorization

Section 4.5.2 Authorization for High Cost Items
Added section:

CWAs must complete a Children's Long-Term Support Waiver High-Cost Notification (F-21353) for all adaptive aids, consumer education and training, and home modifications that are anticipated to have a CLTS Waiver Program cost equal to or greater than $2,000. CWAs are responsible for completing and submitting a Children's Long-Term Support Waiver High-Cost Notification (F-21353) for these supports and services according to the tiered threshold review process: 

4.5.2.1 Low Threshold (Tier 1) for a High-Cost Item

4.5.2.2 High Threshold (Tier 2) for a High-Cost Item

  • The high threshold is met when the high-cost item is equal to or greater than $2,000 and is over the typical range as indicated on Children’s Long-Term Support Waiver High-Cost Request Instructions and Typical Ranges (F-21353i) or does not have an established typical range.
  • CWAs complete Children’s Long-Term Support Waiver High-Cost Request (F-21353) in its entirety, attach the bids and diagrams, and submit to DHS via: dhscltshighcost@dhs.wisconsin.gov, with the subject “Attention: Regional TA Lead, Tier 2 HC item.”
  • Tier 2 notifications require DHS review and approval prior to service authorization. The CWA may not move forward with service authorization until a response has been received from DHS.
  • The High-Cost Panel will review F-21353 and the bids and diagrams to ensure:
    • The item meets the identified outcomes.
    • The item is allowed through the CLTS Waiver Program.
    • The deciding together process (Deciding Together Guide (P-02246) and instructions (P-02246i)) was used to ensure family partnership and appropriateness of the item.
    • Coordination of benefits for all funding sources.
  • DHS will review and provide a response to the CWA within 14 calendar days of submission of a complete F-21353.
  • If the anticipated year of completion changes, please notify DHS at dhscltshighcost@dhs.wisconsin.gov, with the subject “Attention: Regional TA Lead, Tier 2 HC modification.”
  • Notification to DHS is not required if, upon or near completion, the high-cost item cost drops below the Tier 2 threshold.
  1. 4.6 Allowable Services

Service definitions for every service included in remote waiver services
Sections 4.6.1.1, 4.6.3.1, 4.6.6.1, 4.6.7.1, 4.6.8.1, 4.6.9.1, 4.6.10.1, 4.6.11.1, 4.6.12.1, 4.6.13.1, 4.6.14.1, 4.6.15.1, 4.6.17.1, 4.6.18.1, 4.6.19.1, 4.6.20.1, 4.6.21.1, 4.6.22.1, 4.6.23.1
Added paragraph:

[Service Name] may be delivered by remote waiver services (refer to Chapter 4.3.2 Remote Waiver Services), as applicable and agreed upon by the child or youth and their family. Refer to DMS Numbered Memo 2021-02, Remote Waiver Services for the Children’s Long-Term Support Waiver Program and Children’s Community Options Program for the specific components of [Service Name] that may be delivered remotely.

  1. 4.6 Allowable Services

Service limitations for every service included in remote waiver services
Sections 4.6.1.3, 4.6.3.3, 4.6.6.3, 4.6.7.3, 4.6.8.3, 4.6.9.3, 4.6.10.3, 4.6.11.3, 4.6.12.3, 4.6.13.3, 4.6.14.3, 4.6.15.3, 4.6.17.3, 4.6.18.3, 4.6.19.3, 4.6.20.3, 4.6.21.3, 4.6.22.3, 4.6.23.3
Added bullet point:

  1. 4.6 Allowable Services

Service limitations for every service included in authorization for high-cost items
Sections 4.6.1.3, 4.6.7.3, 4.6.12.3
Added bullet point:

  1. 4.6 Allowable Services

Section 4.6.7.3 Consumer Education and Training Service Limitations
Second bullet point removed.

  1. 4.6 Allowable Services

Section 4.6.12.2 Home Modifications Service Requirements
First bullet point removed.

  1. 4.6 Allowable Services

Section 4.6.17.5 Respite Care Provider Standards and Documentation, General Provider Standards
First bullet point changed to read:

  • Respite care providers must maintain documentation to demonstrate providers and staff meet the training standards as described in the applicable Provider Types and Qualifications below.
  1. 4.6 Allowable Services

Section 4.6.17.5 Respite Care Provider Standards and Documentation, Provider Types and Qualifications, Respite agency (agency provider)
Paragraph 1 changed to read:

The provider is required to receive training specific for the child’s or youth’s support and care needs. The provider must complete the required training within six months of beginning employment, unless the child’s or youth’s individual service plan specifies that training is needed before providing services. Persons providing respite care are required to meet the DHS training requirements below. This includes training on at least the following subjects pertaining to the child or youth served: …

  1. 4.6 Allowable Services

Section 4.6.19.2 Support and Service Coordination Service Requirements
Fourth bullet point changed to read:

  • Every child or youth and his or her family require varying levels of engagement with the SSC. At a minimum, the SSC is required to make the following contacts:
    • Monthly collateral contact
    • Direct contact with the family every three months 
    • In-person contact at least every six months (with the child or youth) 
    • Annually, at least one of the in-person contacts is required to take place at the child and family’s place of residence.

The determination of the type and frequency of contacts with the child or youth, their caregivers, and their providers is based on the following variables as applicable:

  • The child’s or youth’s health 
  • The capacity of the child or youth and their family to direct the child’s individual service plan 
  • The strength of in-home supports and the child’s or youth’s informal support network. 
  • The stability of provider staffing (frequency and reliability of staffing, turnover, and availability of emergency backup staff)
  • The stability of the child’s or youth’s individual service plan (for example, history of and/or anticipated frequency of change or adjustment to the plan) 
  • The frequency and types of critical incidents
  • The amount and types of involvement with other systems 

Direct contact with the family includes remote contact using audio and visual communication technology (under remote waiver services), written or email exchanges, telephone conversations, or in-person contact. A collateral contact includes remote contact using audio and visual communication technology (under remote waiver services), written or email exchange, telephone conversation, or in-person contact with the child’s or youth’s family member, medical or social services provider, or other person with knowledge of the child’s or youth’s long-term support needs.

  1. 4.6 Allowable Services

Section 4.6.19.5 Support and Service Coordination Provider Standards and Documentation, General Provider Standards
Fifth bullet point changed to read:

  • SSCs are subject to required licensing and credentialing verification, caregiver background checks, and hiring prohibitions described in Chapter 4. Refer to Section 4.2, Provider Qualification Process and Requirements, for additional information.
  1. 4.6 Allowable Services

Section 4.6.22.5 Provider Standards and Documentation, Provider Types and Qualifications, Other person appropriately qualified as approved by the county waiver agency (CWA) and as related to the unique service being provided to the child (individual provider)
Changed to read:

For caregivers delivering SHC, see qualification description for supportive home care agency above. For individuals delivering SHC that are not caregivers, the CWA must approve the individual is qualified as related to the unique service they are delivering to the participant.

Chapter 5–Use of Funding in Substitute Care

  1. 5.4 Payment for Children’s Foster Care during an Institutional Stay

Paragraph 1 changed to read:

The costs of children’s foster care that are allowable through the CLTS Waiver Program may continue to be covered when a child or youth enrolled in the program and residing in a foster home enters a Medicaid-certified institution (hospital, nursing home, intermediate care facility for people with intellectual disabilities, or State Center) on a short-term basis and their enrollment in the CLTS Waiver Program is temporarily suspended. Refer to Chapter 4 for additional information about CLTS Waiver Program services and institutional stays.

Chapter 6–Enrollment and Recertification

  1. 6.1 Enrollment

Paragraph 2 changed to read:

When all enrollment criteria are met and DHS has determined the eligible participant enrollable (fully funded), the county waiver agency (CWA) enrolls the participant in the DHS Eligibility and Enrollment Streamlining (EES) online system without delay.

  1. 6.1 Enrollment

Section 6.1.1 Requirements and Timelines for Enrollment
Paragraph 1 changed to read:

Enrollment timelines have been established to ensure a participant has timely access to support and service coordination and other CLTS Waiver Program services that will help them reach their goals. The enrollment process and timelines begin on the date of the participant’s referral to the CLTS Waiver Program and must be complete within 60 calendar days of the Department determining the participant is enrollable. The sections below outline requirements and timelines for the three main components of the enrollment process: …

  1. 6.1 Enrollment

Section 6.1.1.1 Referral
Paragraphs 1-3 changed to read:

The CWA must contact the participant within 10 calendar days of their referral date to schedule a date and time to meet with them. The CWA is responsible for documenting the date of this contact with the participant. 

Referral Date
The referral date is the date the initial inquiry or contact was made by a parent, legal guardian, or another person acting in the interest of the child or youth indicating he or she has a child with a disability or exceptional need, which the family is seeking assistance from the CWA in meeting. 

A participant has one referral date; when an agency receives a referral, that referral date will be the date the CWA uses when they are notified of an eligible child. Additionally, CWAs must enter the referral date as the participant’s start date in the online Wisconsin Department of Health Services Program Participation System (PPS). This documentation ensures enrollment in the CLTS Waiver Program according to the first‐come, first‐served policy.

  1. 6.1 Enrollment

Section 6.1.1.2 Eligibility
Changed to read:

The CWA is responsible for completing an eligibility determination for the participant within 45 calendar days from the referral date and then issuing results and notification of rights to the participant. CWAs must document all eligible participants by entering each participant’s eligibility determination in the PPS online system within five calendar days of the calculation date of their Functional Eligibility Screen for Children's Long-Term Support Programs (F-00367) (CLTS FS). This process occurs one time only for each participant, and establishes the participant on the CLTS Waiver Program waitlist. CWAs must also notify the participant of the results of the determination within 15 calendar days of the functional eligibility determination.

Once a start date has been entered for a participant in the PPS online system, the CWA may also document a crisis variance as applicable, by completing the Variance Request checkbox and corresponding Variance Request Information Section (Refer to Chapter 1.4.4 for waitlist variance policy, and the Children’s Long-Term Supports (CLTS) Waitlist in Program Participation System (PPS) Step-by-Step Training Guide (P-00697) for operational guidance).

The CWA determines a participant’s eligibility for the CLTS Waiver Program by verifying that the participant meets all of the following program eligibility criteria. (Refer to Chapter 2–Eligibility and Chapter 3–Financial Eligibility for additional information about CLTS Waiver Program eligibility criteria.)

To determine that a participant meets the nonfinancial and financial eligibility criteria for a full-benefit category of MA, the CWA must check the participant’s enrollment status in Wisconsin Medicaid. If the participant is not enrolled in a full-benefit Medicaid subprogram, the CWA is responsible for assisting them to enroll. (Refer to Chapter 2–Eligibility and Chapter 3–Financial Eligibility.) The CWA also completes the Medicaid Waiver Eligibility and Cost Sharing Worksheet (F-20919) and the Worksheet for Determination of Parental Payment Limit for Children's Long-Term Supports (F-01337) at this time. 

The SSC talks with the participant about pursuing home and community-based services and explains the options available to them through the CLTS Waiver Program. Additionally, the SSC provides a copy of the Participant Rights and Responsibilities Notification (F-20985) to the participant, discusses the content of the document, and addresses any questions they have. The document is completed by gaining signatures from the parent(s) or guardian(s) and the participant (if 14 years old or older). (Refer to Chapter 8–Participant Rights and Appeal and Grievance Processes for additional information about notifying program applicants and participants of their rights.)

CLTS Waiver Program functional institutional LOC requirements are determined by the CLTS FS (F-00367). A CLTS FS done by a certified screener within the last 12 months is to be used to verify these requirements. When a CLTS FS has been completed within the last 12 months, the CWA must apply the existing eligibility results and does not complete another CLTS FS. When a CLTS FS has not been completed within 12 months, the CWA must complete a CLTS FS. 

  1. 6.1 Enrollment

Section 6.1.1.3 Enrollment
Changed to read:

Within 30 calendar days of the date DHS determined the participant is enrollable, the CWA is responsible for enrolling the participant in the CLTS Waiver Program using the DHS Eligibility and Enrollment Streamlining (EES) online system. The CWA must close the participant’s profile on the state-level waitlist in the PPS online system. The CWA has a maximum of 60 calendar days from the date the participant is determined enrollable to complete the participant’s enrollment in the CLTS Waiver Program.

Enrollment Effective Date
A participant’s enrollment effective date is the first date that CLTS Waiver Program supports and services can be authorized for them. This date is also referred to as the program start date and must occur within 30 calendar days of the date DHS has determined the participant is enrollable. It is the earliest date when all requirements outlined above for referral and eligibility have been met and the CWA completes a participant’s enrollment in the EES online system.

When CLTS Waiver Program resources become available, enrollment and service planning processes must occur for participants that DHS has determined are enrollable and who wish to enroll. All participants in enrollable status are fully funded and enrollment and service planning processes must begin immediately. CWAs are responsible to use the county‐specific Children’s Wait List Report in the PPS online system to identify participants newly placed in enrollable status. CWAs may initiate enrollment activities for several participants in enrollable status at a time and are not required to follow any particular order for enrolling participants once they are in enrollable status. Refer to Chapter 1.4.3 Waitlist, Enrolling Children from the Waitlist.

CLTS Waiver Program supports and services can be authorized on or after the enrollment effective date and not earlier. Activities that an SSC conducts to determine eligibility and enroll a participant that take place up to 90 days prior to the program start date can be covered in aggregate as of the enrollment effective date. No other supports or services can be authorized prior to the participant’s enrollment. 

When a participant chooses to enroll in the CLTS Waiver Program, the SSC is responsible for initiating the development of an ISP. An ISP is initiated by the participant and SSC when they preliminarily identify some supports and services that may be authorized through the CLTS Waiver Program to address the participant’s needs. Support and service coordination may be the only service authorized through the CLTS Waiver Program for the participant while the SSC and participant continue to develop a full range of services to address the participant’s goals.

A participant’s ISP must be completed within 60 days of the date of being placed in enrollable status by DHS. Working together, the SSC and participant complete the ISP by assessing the participant’s needs, talking about the participant’s goals, or outcomes, and the supports and services that are needed for them to reach their goals. The SSC documents the participant’s outcomes for the CLTS Waiver Program on the outcomes form (F-20445A) and CLTS Waiver Program services to address those outcomes on the ISP form (F-20445). (Refer to Chapter 7–Individual Service Plan for requirements and additional information for developing outcomes and an ISP.) Additionally, the SSC schedules and authorizes the CLTS Waiver Program services on the ISP.

  1. 6.1 Enrollment

Section 6.1.2 Policy and Operational Requirements for Deferring Enrollment
Added section:

Deferring CLTS Waiver Program enrollment is a participant’s choice and may only be made by them after they are placed in enrollable status. 

Deferred Services
The participant has been placed in enrollable status and is not ready to accept services. Deferrals are participant-requested and participant-driven. 

When a participant chooses to defer enrollment in the CLTS Waiver Program, the CWA must do the following:

Chapter 7–Individual Service Plan

  1. 7.3 Assessment for Supports and Services

Paragraph 3 changed to read:

The participant-focused assessment provides a comprehensive illustration of their circumstances, preferences, and needs, including a review of pertinent records and related information obtained from medical, educational, and other service providers. The SSC must gather the following information for the assessment (the Functional Eligibility Screen for Children's Long-Term Support Programs (F-00367) is not an appropriate tool for the ISP assessment): …

  1. 7.4 Requirements and Procedures for Developing Outcomes and an ISP

Paragraph 4, added bullet point:

ISP content must include:

Chapter 8–Participant Rights and Appeal and Grievance Processes

  1. 8.2 Informing Participants of Their Rights and Adverse Actions

Section 8.2.2 Notice of Adverse Action (NOA)
Paragraph 10 (Roles and Responsibilities for Issuing NOA for Service Denial), second bullet point changed to read:

Last Revised: April 19, 2021