Registering with the Department of Health Services (DHS) is the first step in becoming an approved provider of CLTS waiver services.
Below is information about how to register, who to contact, and other resources.
To learn more about the program and service descriptions, see the Medicaid Home and Community-Based Services (HCBS) Waiver Manual for the CLTS Waiver Program, P-02256 (PDF).
How to Register
All new and current CLTS waiver providers must complete the steps below to register. DHS requires providers to re-register every four years.
Note: If you are a direct care employee of a provider agency or submit time sheets to a fiscal agent, do not complete this registration process.
Step 1: Complete, sign, and scan the appropriate CLTS Medicaid Waiver Provider Agreement (see the Program Resources tab). You will upload this form during the online registration process.
Step 2: Gather your business information (business name as reported to the IRS, tax ID number, and national provider identifier (NPI) if you are a county waiver agency or deliver medical services.
Step 3: Fill out the online Children's Long-Term Support Waiver Provider Registration, F-02341A. You will receive a confirmation email upon successful registration.
Step 4: After your successful registration, DHS will share your information with the county waiver agency in the area you wish to provide services.
Step 5: Contact the county waiver agency(ies) where you are interesting in delivering services. They will manage the rest of the provider approval process, including conducting screening activities, verifying your credentials, issuing any contracts or agreements, claims processing forms, and authorizing services.
Note: Filling out the CLTS Waiver Provider Registry does not mean you are approved as a qualified provider authorized to deliver services. The county waiver agency must approve your provider qualification status before you are authorized to deliver services.
Questions? Email us.
Who to Contact
CLTS Waiver Resources
CLTS Waiver Provider Agreement forms
When you register, you will need to upload a completed CLTS Medicaid Waiver Provider Agreement form to the Provider Registry. Choose the appropriate form from the list below.
- Service provider agencies
- Complete the Children's Long-Term Support Waiver Program Provider Agreement and Acknowledgement of Terms of Participation for Service Provider Agencies, F-02363.
- Examples include (but are not limited to) corporations, partnerships, limited liability companies (LLCs), such as child care agencies, supportive home care agencies, and respite agencies.
- Individual, sole proprietors unaffiliated with an agency or service organization
- Complete the Children's Long-Term Support Waiver Program Provider Agreement and Acknowledgement of Terms of Participation for Sole Proprietor or Individual Waiver Service Providers, F-02364.
- Self-employed individual who delivers services and does not employ staff for service delivery
- Examples include an individual music therapist, carpenter, or child care provider.
- Fiscal agents or fiscal intermediaries
- Complete the Children's Long-Term Support Waiver Program Provider Agreement and Acknowledgement of Terms of Participation for Fiscal Agents Managing Self-Directed Waiver Supports, F-02365.
- Providers who deliver financial management services and issue payments to self-directed workers
- County waiver agencies complete the CLTS Waiver Program Provider Agreement and Acknowledgement of Terms of Participation for County Waiver Agencies, F-02349 for their role in delivering support and service coordination and other services to CLTS participants.
CLTS Claims Payment Information
DHS contracts with Wisconsin Physicians Service (WPS) as the CLTS third-party administrator (TPA) claims processing vendor. WPS processes and issues payments to providers, reports claim data to DHS, and recovers overpayments per federal regulations. Once you have been approved as a provider and authorized to deliver services, you will submit claims to WPS for payment.
DHS is currently developing statewide payment rates for most CLTS waiver services. Providers will be paid based on these rates starting in January 2019. You can find out more at the CLTS Waiver Service Rates Initiative page.