Glossary of Acronyms

Implements statewide policy for children with developmental disabilities, physical disabilities, and developmental delays.

Provides services for children under 22 with severe physical, mental, or emotional disabilities.

Supports children who are living at home or in the community and who have substantial limitations due to developmental, emotional, and/or physical disabilities.

Part of the Department of Health & Human Services that administers many programs including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.

Aids children who have been abused, neglected, or exploited.

Wisconsin has five Children’s Resource Centers devoted to supporting families with children and youth with special health care needs and the providers who serve them. CRCs are staffed by helpers who often have personal experience having a child or family member with special health care needs. CRCs provide free and confidential services and have up to date information on a variety of topics, including:

• Communicating with schools.
• Facilitating parent-to-parent support.
• Providing information on specific diagnoses.
• Identifying services in the community or state.
• Locating doctors and dental care.
• Transitioning to adult settings.
• Understanding health benefits.

Agency of a Wisconsin county that is delegated the responsibility for implementing the CLTS Program according to procedures and guidelines created by DHS.

Part of the Wisconsin Department of Administration. It conducts fair hearings for appeals in the CLTS Program and other state benefit programs.

Provides high-quality, affordable health care coverage and public health services to Wisconsin residents; ensures that the care provided to Wisconsin residents is high quality and provided in accordance with state and federal law; ensures that Wisconsin taxpayer dollars are being utilized effectively and efficiently by preventing and detecting waste, fraud, and abuse; and works to continue Wisconsin’s long tradition of strong health outcomes and innovation.

Administers the Medicaid programs to medically needy and low-income individuals and families, as well as long-term support and services for older adults and services for people of all ages with disabilities.

Enables providers to receive and deposit ForwardHealth payments directly into an authorized EFT settlement account at the provider’s designated financial institution in lieu of receiving paper checks.

Helps families manage the funding for CLTS Program supports and services. Sometimes called FMS providers, they are required when a family wishes to use a family-hired provider who neither owns nor is employed by an agency.

An agreement between the waiver program agency and the participant as to how the program will meet the assessed needs of the person and in doing so, help the participant reach their individual outcomes.

A unique identifier assigned to health care providers who participate in the Medicaid program. It helps state Medicaid agencies track, verify, and process claims efficiently.

The Administrative Simplification requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates that health care providers acquire and use an NPI. NPIs are 10-digit numbers that uniquely identify health care providers. Providers use NPIs to identify themselves to any health insurance company in the United States.

If you are a health care provider, as defined by the federal Centers for Medicare & Medicaid Services (CMS), you must have an NPI.

Federal Office of the Inspector General – Office with the mission to protect the integrity of DHHS programs as well as the health and welfare of program beneficiaries.

State of Wisconsin Office of the Inspector General – Office charged with protecting the taxpayers of Wisconsin by preventing and detecting waste, fraud, and abuse of public assistance programs such as Medicaid, FoodShare, and Family Care. Consolidates all DHS program integrity, audit, and fraud investigation activities within one office.

A formal approval required before a provider can deliver services funded through the CLTS Program. It specifies the service, rate, and frequency approved for a participant. Without a PA, providers cannot submit claims for services rendered under the CLTS Program.

A CMS program that measures improper payments in Medicaid, ensuring federal funds are used correctly and identifying areas for program improvement.

A point of contact for families and providers in the CLTS Program. SSCs are assigned by the county waiver agency responsible for the geographical location in which the family resides. See Section 6 of this handbook for more information about the role of SSCs.