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Children’s Long-Term Support (CLTS) Provider Handbook

Section 3: Provider Qualifications and Caregiver Standards

Agencies

An agency CLTS provider is an organization that employs and supervises staff who provide CLTS program services to enrolled participants. As an agency provider in the CLTS Program, you must meet the program requirements outlined in section 4 of the Children's Long-Term Support (CLTS) Waiver Program Provider Agreement and Acknowledgement of Terms of Participation, F-03344 (PDF), ensure staff are qualified to perform the skills required in their position description prior to performing work, ensure direct staff have caregiver background checks, and submit the appropriate documentation for the services your agency offers.

Agencies are also responsible for maintaining a training plan for each staff member who provides or will provide direct care to participants and has a way to ensure all necessary training has been completed prior to performing work, maintaining documentation that staff are trained annually on compliance, fraud, waste, and abuse.

Financial management service (FMS)

A financial management service is an entity that hires family-selected caregivers and performs financial transactions on behalf of the participant for the delivery of CLTS Program services. The FMS, sometimes referred to as an FMS provider, is also responsible for handling employment-related tasks associated with the supports and services in the participant’s authorized Individual Service Plan.

FMS providers are required to verify that a caregiver has the qualifications needed to provide quality services to the CLTS participant. FMS providers can find the qualifications a caregiver needs for any service in Chapter 4.6, Allowable Services, of the Medicaid Home and Community-Based Services Waiver Manual for the CLTS Waiver Program, P-02256 (PDF).

If a caregiver needs participant-specific training, the FMS provider should keep documentation that shows the caregiver has received this training from the participant’s family.

If a caregiver needs a certification, license, education, or experience, the FMS provider is required to make sure it is up to date and keep records of their submission.

FMS services may be provided at one of two levels: basic or enhanced. The service level is determined by the county waiver agency (CWA).

Basic level requirements

FMS providers are required to train caregivers on the service requirements, limitations, and exclusions for the CLTS service(s) the caregiver will directly provide. DHS expects these trainings to highlight the requirements, limitations, and exclusions of the CLTS service(s) the caregiver will directly provide. Appropriate training methods include:

  • Live training sessions.
  • Service description packets.
  • Training pamphlets.

Additionally, county waiver agencies must run background checks for caregivers delivering services through a basic level FMS provider.

For more information, reference the Service section in the Medicaid Home and Community-Based Services Waiver Manual for the CLTS Waiver Program, P-02256 (PDF).

Enhanced level of care requirements

Includes all basic level activities in addition to:

  • Ensuring sufficient participant-authorized units.
  • Verifying caregiver qualifications.
  • Maintaining a list of qualified and available caregivers.
  • Maintaining documentation stating caregivers have received required participant-specific training.
  • Completing caregiver screening activities at the caregiver’s time of hire, and at minimum, in alignment with the FMS provider’s Medicaid Waiver Agreement renewal.

Additionally, under enhanced level, FMS providers must maintain documentation that the caregiver has received required participant-specific training. FMS providers are not responsible for delivering the participant-specific training but are required to maintain the documentation that it was completed.​

FMS providers must verify and confirm that the caregiver has any certification, license, education, or experience required for the applicable service(s) the caregiver will provide to the participant.​ CLTS Program funds may not pay for services provided by a caregiver who has had their professional license or certification denied, suspended, or revoked.​

Sole proprietors

A sole proprietor is a single individual who is also the provider of the service. Do not register as a sole proprietor if you have employees who provide direct services. To be a sole proprietor in the CLTS Program, you must meet the program requirements outlined in section 4 of the Children's Long-Term Support (CLTS) Waiver Program Provider Agreement and Acknowledgement of Terms of Participation, F-03344, show that you have the qualifications needed to provide quality services to the CLTS participant, complete a background check with DHS if enrolling as a caregiver, and submit the appropriate documentation for the services you provide.

Caregiver background checks

Caregiver background checks are part of assuring the health and safety of CLTS Waiver Program participants. DHS must ensure a Wisconsin caregiver background check is completed for all caregivers. This requirement applies to all service providers, paid or unpaid, who deliver services listed on the Individual Service Plan (ISP) and meet the definition of a caregiver. Caregivers are defined as individuals who have regular, direct contact with a CLTS Program participant.

  • “Regular” means contact that is scheduled, planned, expected, or otherwise periodic.
  • “Direct” means face-to-face physical proximity to a participant that allows the opportunity to commit abuse or neglect or to misappropriate their property.

Each CLTS Program provider type (agency, FMS, and sole proprietor) has background check responsibilities:

  • Agencies are responsible for background checks on their staff, contractors, and volunteers who meet the caregiver definition. Agencies must also require, through written policy and procedures, that employees and contractors report criminal convictions or investigations to their immediate supervisor as soon as possible, but no later than the next working day.
  • FMS are required to complete background checks on participant-selected caregivers.
  • DHS completes background checks on sole proprietors.

Find Background Information Disclosure (BID), F-82064, forms.

DHS may request submission of the caregiver background check results for provider agency employees and FMS participant-selected caregivers for quality assurance or auditing purposes.

CLTS Program service providers cannot employ, subcontract with, or accept volunteer services from individuals convicted of:

Participants may not employ individuals to deliver CLTS Waiver Program services whose background check results reveal conviction of a barring offense, serious crime, or substantially related crime as outlined in Chapter 4.2.3.1, Background Check Results, in Medicaid Home and Community-Based Services Waiver Manual for the CLTS Waiver Program, P-02256 (PDF).

If the prospective caregiver’s background check reveals no record of conviction or substantiated finding by a governmental agency of a barring offense, serious crime, or substantially related crime but does contain a negative finding, the background check results must be thoroughly reviewed with the participant. If the participant is fully informed of any negative finding and continues to express a preference to employ the caregiver, the CWA respects the choice of the participant unless there is compelling justification not to do so.

The agency retains the F-82064 form and submits a Wisconsin Criminal History Single Name Record Request form (DJ-LE-250 [PDF] or DJ-LE-250A [PDF]) to the Department of Justice, Crime Information Bureau.

What providers are considered “essential service providers”?

Essential service providers deliver waiver-funded services and have regular, direct contact with participants and therefore are expected to sign and receive the ISP.

“Regular” means contact that is scheduled, planned, expected, or otherwise periodic.

“Direct” means face-to-face physical proximity to a participant.

The following services fit the essential service provider definition:

  • Adult family home
  • Children’s foster care
  • Communication assistance for community inclusion*
  • Community/competitive integrated employment – individual
  • Community/competitive integrated employment – small group
  • Community integration services
  • Counseling and therapeutic services
  • Daily living skills training
  • Day services
  • Discovery and career planning*
  • Grief and bereavement counseling
  • Health and wellness*
  • Mentoring
  • Participant and family-directed broker services
  • Personal supports (supervision services only, and not routine home care, chore services, or pest control)
  • Respite care
  • Safety planning and prevention*

*Components of this service may have providers who meet the definition of an essential service provider.

For more information and frequently asked questions, visit the Children’s Long-Term Support Program: Provider Medicaid (MA) Agreement and Qualification Process.

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