Children's Long-Term Support: Provider Quality for Counties
What to know
The Children’s Long-Term Support (CLTS) Program relies on local county waiver agencies (CWAs) to ensure quality care and services for program participants. That means ensuring enrolled providers are delivering quality services. It also means addressing concerns and reaching solutions.
CWA role in provider quality
CWAs are responsible for:
- Monitoring providers to make sure they follow program standards and service provision protocols, and deliver quality services.
- Supporting participants and their families when a provider is not meeting program policies and expectations.
- Responding to feedback from families, participants, and support and service coordinators (SSCs) about unprofessional conduct, inadequate training, and service effectiveness.
- Reporting health and safety concerns or failure to comply with signed Medicaid Agreements to the Wisconsin Department of Health Services (DHS).
How quality assurance and oversight works
Providers enroll to deliver specific CLTS Program services. Each service requires unique qualifications. Providers submit evidence to DHS to show they’re qualified to deliver each service they’re enrolling for.
DHS reviews this evidence to decide if a provider is qualified. DHS:
- Reviews and verifies basic information providers submit.
- Ensures they completed and signed the CLTS Medicaid Waiver Provider Agreement, F-02349 (PDF).
- Verifies they have the right certification, license, education, or experience.
DHS notifies a provider when they’re deemed qualified. DHS then adds them to the public CLTS Provider Directory. Participants and families can then find and choose them as a provider.
Learn more about CLTS Program provider qualifications and requirements in the CLTS Program Waiver Manual, P-02256 (PDF).
The CWA authorizes a provider’s services once a participant or family chooses them to deliver services. Learn more about service delivery in the CLTS Program Waiver Manual, P-02256 (PDF).
CWAs are required to monitor for provider quality.
Issues with service delivery
CWAs are responsible for ensuring participants and families are getting good service. Here are some examples of concerns that might be reported to CWAs about service delivery:
- Unprofessional conduct
- My provider is often late for our appointments.
- I can never get in contact with my provider.
- Our child’s caregiver uses inappropriate language.
- Inadequate training
- I don’t always know what my child will be working on each day, it seems to change every time we meet.
- My provider doesn’t understand my child’s needs.
- I’m not sure if my caregiver knows how to provide respite.
- Service effectiveness
- The support I get from this CLTS Program provider is not helping me anymore.
- My child has not progressed toward their goals since getting this service.
- I think my child should be getting a different service.
Issues with standards and contracts
CWAs are responsible for maintaining program standards and identifying widespread issues that may need DHS enforcement. Here are some examples of issues with standards that a CWA should monitor for:
- Fraudulent behavior, such as billing for services that a child didn’t get.
- Violation of participant rights, such as the use of restrictive measures.
- Health and safety violations, such as facility hazards that can cause serious injury to a participant.
- Service misalignment, such as providing services not covered by the CLTS Waiver Program.
Issues with health and safety
CWAs are responsible for reporting any incidents that could harm a child. Find examples and protocols on the CLTS Incident Management for Counties webpage.
Solve problems together
The SSC and CWA should work together to help resolve concerns with CLTS Program providers. Use the Deciding Together approach. CWAs can help solve problems by repairing relationships, defining expectations, and reaching solutions.
Switch providers
If a provider’s services are not meeting a child’s needs, the family might request a new caregiver or agency. The CWA must work with families to resolve any issues with service quality.
Report health and safety concerns
CWAs must report health and safety incidents to DHS. Visit the CLTS Incident Management for Counties webpage for more information.
Contact DHS
If an issue is ongoing or cannot be resolved, CWAs should contact DHS CLTS Provider Relations at dhscltsproviderrelations@dhs.wisconsin.gov. They will work with policy, billing, and legal experts to look into and resolve widespread issues.
If a provider’s actions violate program requirements or are not correctable, DHS may remove them from the CLTS Program network. Termination can happen when the issue meets the criteria defined in Wis. Admin. Code § DHS 106.06.
Terminated providers will:
- Get an official notice.
- Become inactive and removed from the CLTS Program Directory.
- Have their Medicaid enrollment ended on the date of termination.
DHS will notify the CWA in the provider’s service delivery area(s). If they have active authorizations, CWAs must help affected families find new providers.