Children’s Long-Term Support: Waiver Basics Training for Support and Service Coordinators

CLTS Program description

• The purpose of the CLTS Program is to help kids with disabilities and their families. We aim to support kids with substantial developmental, mental health, and/or physical disabilities who are living at home or in the community. Our goal is to help them live their best life.
• Review: Children’s Long-Term Support: Information for Counties webpage.

Medicaid Home and Community-Based Waiver (HCBW) Program history

• Wisconsin began Medicaid home and community-based waiver programs in 1983.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 1, §1.1, paragraphs 1–3.

State assurances to CMS

• If states don’t meet CMS requirements, CMS may not grant or may end a waiver. Waiver approval lets us offer the CLTS Program.
• Review: Measuring and Improving Quality in HCBS webpage.

More resources

These are helpful resources, but they won’t be on the exam.

• Application for 1915(c) Home and Community-Based Services Waiver (PDF)—The Social Security Act authorizes the HCBS waiver program. This allows the state to give services that support people getting Medicaid. Services are meant to keep people in their community instead of in an institution.
• 1915(b)(4) Waiver Application—This waiver allows DHS to limit the delivery of CLTS support and service coordination to qualified persons who are employed by a county waiver agency or their sub-contracted case management entities.

Eligibility requirements

• All kids and young adults in the CLTS Program must meet certain requirements.
• We use the Wisconsin Functional Screen system to determine eligibility. The Functional Screen is a web-based application. It collects details about a person’s functioning status, health, and disabilities.
• To enroll a child in the CLTS Program, the SSC enters enrollment data into the online Eligibility and Enrollment Streamlining (EES) system.
• Review: Who is Eligible? webpage.

Eligible living arrangements

• A child must live in an eligible living situation to enroll in the CLTS Program.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 2, §2.6.

Changing counties

• If a child in the CLTS Program moves from one county to another, both counties must ensure services continue.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 2, §2.7.

Typical and atypical development training

• The University of Wisconsin-Madison helped create training modules. They explore the stages of child development for typically and atypically developing children.
• This training takes four to six hours. You must complete it in your first six months as an SSC. You need to register to use Cornerstone to access this training.
• Keep a copy of the certificate when you complete the training.
• Complete: Typical and Atypical Child Development Modules.

More resources

These are helpful resources, but they won’t be on the exam.

• Clinical Instructions: Wisconsin’s Functional Eligibility Screen for Children’s Long-Term Supports, P-00936 (Word)—We use the Wisconsin Functional Screen system to determine functional eligibility. The Functional Screen is a web-based application. It collects details about the needs of a child in a variety of developmental, behavioral, health, and daily living activities.
• Resources for CLTS Screeners—To become a screener, you must complete the CLTS Functional Screen Certification Course. You also must pass the exam. If you complete the training, keep proof of completion for your records.

Medicaid enrollment requirements

• Kids who participate in the CLTS Program must have already enrolled in Wisconsin Medicaid.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 3.
• Read: CLTS Waiver Program EES Implementation Interim Guidance Update, P-02277 (PDF).

Parental payment limit

• When a child enrolls in the CLTS Program, the family may have to pay for part of the cost of CLTS services. We call this a parental payment limit. 
• Review: Waiver Program Costs for Families webpage.
• Read: CLTS Parental Payment Limit User’s Guide for the Automated Worksheet and the Printed Reference Tables, F-01337A (PDF).
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)— Chapter 3, §3.4.
• Read: CLTS Parental Payment Limit (PPL) System Frequently Asked Questions, F-01377B (PDF).
• Reference: Worksheet for Determination of Parental Payment Limits for CLTS, F-01337 (Exc el) .

More resources

These are helpful resources, but they won’t be on the exam.

• Katie Beckett Medicaid—This program is a special eligibility process. It helps people get a Wisconsin ForwardHealth Medicaid card. The program is for kids with long-term disabilities, mental illness, or complex health needs. They must live at home with their family.
• Medicaid Eligibility Handbook History, §28.14.2—CLTS uses the CARES (Client Assistance for Re-employment and Economic Support System) process to see if a child and family qualify for BadgerCare Plus and the Group A Waiver or Group B or B Plus Waiver. This is based on the child’s income.
• Supplemental Security Income (SSI)—SSI is a monthly cash benefit. The federal Social Security Administration and DHS pay this to people in financial need. It’s for either:
  • Wisconsin residents who are 65 or older.
  • Wisconsin residents of any age who are blind or have a disability.
• Medicaid and Medicare for Those with Disabilities—Social Security Disability Income (SSDI) benefits are for adults or kids who have a disability. They must meet income, resource, and living condition requirements. When someone qualifies, they also qualify for Medicaid.

Support and service coordination

• The CLTS Program includes helping families get access to services and support they need. These services can be formal or informal. The SSC helps coordinate services to meet the family’s outcomes.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 4, §4.6.29.

Available services

• CLTS offers a range of services for kids and families.
• We updated service descriptions to reflect the five-year renewal of 1915(c) and 1915(b)(4) waiver applications. Some services are subject to rate-setting. Others are not.
• Review: CLTS Covered Services for Families webpage.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)— Chapter 4, §4.6.

Provider registration 

DHS and CWAs share joint responsibility for deeming providers willing and qualified to deliver CLTS Waiver Program services.
•    Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF) —Chapter 4, §4.1-4.2.
•    Review: CLTS Provider Registry webpage.

Remote services

• We define remote services as CLTS services that providers give either by multimedia (using both video and audio technology) or by using only audio technology. They use both video and audio technology. There must be two-way, real-time, interactive communication between the provider and child/family.
• Reference: CLTS Program Benefit Code Crosswalk, P-02283. It shows which services can be remote.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF) —Chapter 4, §4.3.2.

Service codes

• Reference: CLTS Program Benefit Code Crosswalk, P-02283 for HIPAA (Health Insurance Portability and Accountability Act) codes.

Service rate-setting

• Some CLTS services have set rates. Other services use the market rate.
• The rate schedule shows the maximum amount that can be paid for each service unit.
• Review: CLTS Program Service Rates webpage.
• Reference: CLTS Waiver Program Rate Schedule, P-02184.

CCOP and CLTS funds

• You may be able to use funds from CCOP for services that aren’t allowed under CLTS.
• Read: CCOP Procedures Guide for Administering Agencies, P-01780 (PDF)— §CCOP and CLTS Waiver.

More resources

These are helpful resources, but they won’t be on the exam.

• Final Rule Medicaid HCBS (PDF)—The HCBS Settings Rule ensures that people getting long-term services through HCBS waiver programs have access to the benefits of community living. They must be able to get services in the most integrated settings.
• HCBS Settings Rule FAQs
• Regulatory Requirements for Home and Community-Based Settings (PDF)—This CMS document summarizes the key points in the HCBS Settings Rule.
• Steps to Creating a Statewide Person-Centered Service Planning System (PDF)—CMS set up this tool to help clarify how to use “person-centered planning” as part of the HCBS Settings Rule. The PowerPoint takes about 15-30 minutes to review.

Allowed costs

• CLTS covers care and supervision costs for kids in foster care homes or adult family homes. It does not cover room and board.
• For children’s foster care, CLTS covers services for intensive support and supervision. This goes beyond the maintenance payment for foster families. It helps foster parents get extra emotional, behavioral, physical, or personal care needs in a family setting.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 4, §4.6.4.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF))—Chapter 5.

More resources

These are helpful resources, but they won’t be on the exam.

• Approved CLTS Treatment Foster Care Administrative Rates, P-00700 (PDF)—This sheet summarizes administrative rates for CWAs to use to find costs for foster care treatment. DHS and the Department of Children and Families work each year to make updates.
• Calculating Expenses for a CLTS Foster Home Using Actual Expenses, F-01715 (Excel)—SSCs can use this worksheet to assess costs for a CLTS foster home.
• Calculating Expenses for a CLTS Foster Home Using Uniform Foster Care Brochure, F-01716 (Excel)—SSCs can use this worksheet to assess costs for a CLTS foster home.
• Instructions for Calculating CLTS Foster Care Room and Board Expenses, F-01721 (PDF)—This guide tells you how to use F-01715 and F-01716.
• Level of Care Certification Information—Wisconsin Department of Children and Families defines each Level of Care for foster care and its certification requirements.
• Level 5 Exceptional Treatment Foster Home: Guide to Certification and Placement (PDF)—This guide gives an overview of Level 5 Exceptional Treatment Foster Homes. It outlines resources for agencies who want to license a Level 5 Foster Home or put a child into a current home.

Enrollment criteria

• To enroll a child in CLTS, the SSC enters enrollment data into the EES system.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 6.

State-level budget and enrollment administration

• As of Aug. 01, 2021, kids receive CLTS funding as soon as they are functionally eligible. All kids who are eligible are fully funded. CWAs must enroll the child and start service planning right away.
• Kids who meet the definition of a “vulnerable child” need immediate attention. CWAs should prioritize their enrollment. CWAs must enter the crisis criteria in the Program Participation System (PPS).
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 6, §6.1.2.
• Review: Enrollment Information for Counties webpage.
• Review: CLTS Enrollment Dashboard.

Support and service timeline requirements

• There are timelines and standards for eligibility and Individual Service Plan (ISP) development. These are to help SSCs.
• Reference: Support and Service Coordination Eligibility and Enrollment Diagram, P-02049 (PDF).

Deciding Together process

• Deciding Together helps create a team approach between SSCs and CLTS families. Tools help with dialogue and use a family-centered, collaborative decision-making framework.
• Deciding Together results in a full outcome-based support plan. It also recognizes and increases capacities, resiliency, and unique abilities of the child and their family. It promotes self-determination and inclusion.
• Read: Deciding Together Guide, P-02246 (PDF)
• Read: Deciding Together Guide Instructions, P-02246I (PDF)
• Read: Deciding Together Guide: What It Is and What It Isn’t, P-02245C (PDF)
• Read: DMS Memo, 2019-01—Release of Deciding Together Guidance (PDF)

ISP forms and instructions

• SSCs should use a person-centered approach when working with kids and their families. Each child gets an ISP.
• SSCs must also complete an ISP Individual Outcomes Form.
• Review: ISP—CLTS Programs, F-02245.
• Review: ISP—Outcomes—CLTS Programs, F-20445A.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 7.

More resources

These are helpful resources, but they won’t be on the exam.

• 42 Code of Federal Regulations, §441.301(b)(1-6) (PDF)—SSCs must complete a written plan of care for each child in CLTS.
• CLTS Waiver Program Eligibility and Enrollment User Guide, P-01991 (PDF)—Instructions for the Enrollment Wizard.
• EES webpage.
• EES Reports webpage—Many reports are available to help CWAs manage their caseloads in EES.
• PPS webpage—PPS is a web-based system that helps streamline program functions and tasks.
• PPS Step-by-Step Training Guide for CLTS Program, P-00697 (PDF)—Reviews PPS functionality and aligns it with CLTS eligibility and enrollment policies. PPS is only for functionally eligible kids not yet enrolled in CLTS.
• What you need to know about Early and Periodic Screening, Diagnostic, and Treatment Services (EPST) (PDF)—The Medicaid program benefit for kids. In Wisconsin, it’s called HealthCheck “Other Services.”
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)—A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents (PDF).
• Introduction to HealthCheck and HealthCheck “Other Services”, P-02413 (PDF).

Requirements

• The SSC completes a recertification, ISP review, and update for each child in CLTS.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 7.

Think Possible! Employment Webinar Series

• Think Possible! is a four-part employment training series. It’s for SSCs who work with programs like Birth to 3, CLTS, and CCOP. The goal of this training is to help SSCs support kids and families, so they can grow and work in the community.
• SSCs must complete this training within the first six months of employment.
• Keep a copy of the completion certificate.
• Complete: Think Possible! Employment Webinar Series.

Transitioning CLTS kids to adult services

• When working with participants and families on transition issues, SSCs are expected to:
  • Maintain a working relationship with the child, the child’s family, adult long-term care programs, and other community supports to ensure a smooth transition from one program to another.
  • Take reasonable steps to help families know what to expect with regard to adult services.
  • Support the transition planning process with participants and the family throughout their enrollment in the program and documenting identified services and outcomes in the ISP.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 10.

More resources

These are helpful resources, but they won’t be on the exam.

• Youth in Transition—What is Transition Planning?

Rights and processes

• CLTS participants have the right to access appeal and grievance processes.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 8.
• Reference: Forms
  • Participant Rights and Responsibilities Notification, F-20985—Provided to each participant before the first eligibility determination. Also provided at least once each year after the first eligibility determination.
  • Informed Consent—CLTS Functional Screen, F-21076. Kids (14 and older who can sign) or another person legally authorized must sign this form to consent to the CLTS Functional Screen.

Health and safety assurance

• Assuring health, safety, and welfare of all CLTS participants is a vital part of the program.
• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 9.

Incident reporting

• If a reportable incident happens, SSCs must complete an incident report.
• Review: Incident Management for Counties webpage.
• Watch: CITR Systems Training: Connections to Policy and Practice.

Restrictive measures

• Read: Medicaid HCBS Waiver Manual for the CLTS Waiver Program, P-02256 (PDF)—Chapter 9, §9.4.
• Read: Instructions and Requirements for the Use of Protective Equipment and Mechanical Restrains in CLTS Programs, P-00216 (PDF).

Mandated Reporter Online Training

• SSCs are mandated reporters for child abuse and neglect. As part of the county human, social, and community service infrastructure, SSCs must make referrals to county child protection and child welfare services when needed.
• SSCs must take training from the Wisconsin Child Welfare Development System. Training takes 30–60 minutes.
• Keep a copy of the completion certificate.
• Complete: Mandated Reporter Online Training.

More resources

This is a helpful resource, but it won’t be on the exam.

• Children with Disabilities: Preventing Abuse and Neglect (PDF)—Talks about increased risk for abuse and neglect for kids with disabilities and how to support them.
• LTCare Information Exchange System Login—Connects to the Children’s Incident Tracking and Reporting system to report an incident to DHS, track and manage incidents, and view incident history.

These are helpful resources, but they won’t be on the exam.

Systems

• Program Participation System (PPS)—Web-based system that helps streamline functions and tasks.
• Wisconsin Web Access Management System (WAMS)—Allows authorized users to access state internet applications. You need a Web Access Management System ID to access PPS.

Forms and memos libraries

• CLTS Waiver Forms and Publications Library
• DHS Forms Library
• DMS Information Memos—Explain long-term care information that DHS shares with partners and providers.
• DMS Numbered Memos—Detail actions that partners and providers could or should take with long-term care programs.

DHS communication tools

• CLTS teleconferences—Held on the third Thursday of every month. To receive regular information about the CLTS Teleconference, email dhsclts@dhs.wisconsin.gov.
• Email updates—Register to get routine communication from DHS.

Waiver applications

• Application for a §1915(c) HCBS Waiver (PDF)—Submitted every five years for the CLTS program.
• Application for Section 1915(b)(4) Waiver Fee-for-Service Selective Contracting Program (PDF)—Submitted every five years for the CLTS program.

External resources

• ABC for Health, Inc.
• Community Resources for Families and Children
• Disability Rights Wisconsin—Children with Disabilities
• Family Voices of Wisconsin fact sheets

1. Introduction and Overview
2. Is my Child Eligible for the CLTS Program?
3. Completing a Functional Screen
4. What to Expect After a Child is Determined Eligible
5. Developing Your Child’s Individual Service Plan
6. Your Child’s Service Plan: Creating Outcomes
7. What Services Might Be Covered?
8. Appealing a Denial

• Regional Centers for Children and Youth with Special Health Care Needs (CYSHCN)