COVID-19: Children's Long-Term Support (CLTS) Program Operations Questions and Answers

Eligibility, Enrollment, and Disenrollment

Are there changes to the required timelines for enrollment and recertification?

Enrollment timelines remain unchanged. The Wisconsin Department of Health Services (DHS) expects that these activities will continue, using telephone or electronic methods to contact the family and gather information. Refer to the Signature Requirements section below for additional information.

Maintaining enrollment timelines is essential for children to access critical Medicaid programs during this time.

UPDATED Are there changes to the required annual CLTS Functional Screen (FS) reevaluation?

Yes, the timeline for completing the annual CLTS FS reevaluation is extended one year past the due date per Wisconsin’s § 1915(c) Appendix K, WI.0414.R03.03. This applies to all children and youth enrolled in the CLTS Waiver Program with a level of care (LOC) end date between 3/1/2020–2/28/2021.

Changes reflecting this extension will be made in the Eligibility and Enrollment Streamlining (EES) system. For example, if a child’s LOC end date was 8/31/2020, it will be changed to 8/31/2021. No county waiver agency (CWA) action is needed for this change. CWAs do not complete the annual CLTS FS reevaluation for affected children and youth until the extended LOC end date.

This extension also applies to children and youth for whom a CLTS FS was completed after 3/1/2020 and were found not functionally eligible (NFE) but remained enrolled in the CLTS Waiver Program per DHS guidance. Changes reflecting this extension will be made in the EES system by reverting to the previous eligible screen and extending the LOC end date by one year. CWAs do not complete the annual CLTS FS reevaluation for affected children and youth until the extended LOC end date. 

For children and youth for whom a CLTS FS was completed after 3/1/2020 and were found eligible, there is no change to their LOC end date. These participants currently have a LOC end date beyond 2/28/2021 and will not be impacted. 

NEW Does the one-year extension of the CLTS FS reevaluation apply to the Children’s Community Options Program (CCOP) participants?

Yes, the timeline for completing the annual CLTS FS reevaluation for CCOP is extended one year past the due date, to align with guidelines for the CLTS Waiver Program. This applies to all children and youth dually enrolled in CCOP and the CLTS Waiver Program and those enrolled only in CCOP, with a CLTS FS due date between 3/1/2020–2/28/2021.

For children and youth dually enrolled in CCOP and the CLTS Waiver Program, CWAs must follow the guidance outlined for the question “Are there changes to the required annual CLTS Functional Screen (FS) reevaluation?”

For children and youth enrolled only in CCOP:

  • No CWA action is needed to extend the due date of the annual CLTS FS reevaluation.
  • When a reevaluation is required between 3/1/2020–2/28/2021, the CWA does not complete the annual CLTS FS reevaluation for affected children and youth until the date of the next annual reevaluation. For example, when a child’s CLTS FS due date is 9/30/20, the CWA does not reevaluate until 9/30/21. 
  • If a CLTS FS was completed after 3/1/2020 and found a child or youth eligible, there is no change to their CLTS FS due date. These children and youth currently have a CLTS FS due date beyond 2/28/2021 and will not be impacted.
  • If a CLTS FS was completed after 3/1/2020 and found a child or youth not functionally eligible (NFE), no CWA action is required. The requirement to extend the CLTS FS reevaluation is not retroactive and previous CLTS FS reevaluations with NFE findings require no CWA action. 

How will Medicaid renewals be handled during this period?

DHS will maintain Medicaid eligibility for people who were enrolled on March 18, 2020, or after, in accordance with section 6008 of the Families First Coronavirus Response Act, and in anticipation that these members will need Medicaid-provided testing and treatment. 

Should certain disenrollments be delayed?

Yes, delay all CLTS disenrollments during the pandemic with the following exceptions:

  • A participant’s change of residence to an out-of-state location.
  • A participant’s request to terminate their enrollment.
    • In this circumstance, the CWA will need to submit comprehensive documentation that the family has requested to terminate their enrollment.
  • A participant has died.
  • A child is found eligible to transition to an adult long-term care program

The Families First Coronavirus Response Act includes a provision that requires states to suspend Medicaid disenrollments in order to qualify for a 6.2% Federal Medical Assistance Percentage (FMAP) increase. Under this provision states may not disenroll any individual who is enrolled as of March 18, 2020 (the date of enactment), or who newly enrolls during the COVID-19 pandemic period for any reason unless the individual is no longer a resident of the state or requests voluntary termination.

Disenrollments will be monitored to ensure compliance with this federal direction. 

Should a youth be disenrolled if they exceed maximum age limits?

Yes, youth should transition from the CLTS Waiver Program to an adult long-term care program per permanent policy in the CLTS Waiver Program Manual (P-02256), Chapter 4.05, Support and Service Coordination service definition, when the youth is eligible for an adult long-term care program. Contact your CLTS technical assistance (TA) lead to discuss youth-specific questions about a transition.

Should children on the waitlist for the CLTS Waiver Program be removed from the waitlist during the pandemic?

No, in accordance with the guidance for program disenrollments during the COVID-19 pandemic, children and youth who are on the waitlist for the CLTS Waiver Program must remain on the waitlist during the COVID-19 pandemic with the following exceptions:

  • A child’s or youth’s change of residence to an out-of-state location.
  • A child’s or youth’s request to terminate their enrollment process.
    • In this circumstance, the CWA will need to submit comprehensive documentation that the family has requested to terminate their enrollment.
  • A child or youth has died.
  • A child is found eligible to transition to an adult long-term care program

Refer to “Should certain disenrollments be delayed?” for the federal and state authorities for this guidance.

Should a participant be disenrolled if they are temporarily staying in an ineligible setting for more than 90 days?

No, maintain the child’s enrollment in suspend status for the duration of the pandemic via the Eligibility and Enrollment Streamlining (EES) System.

If a child is approaching (or has passed) the end date of the suspension in EES, the CWA should use the Update/End option to extend the end date of the suspended segment. The user may get a warning message indicating that a suspension should only last for 90 days. If this error message pops up, the user must check the box “Ignore” and click on the word “Continue” in red text; do not click the Next button. The user may also get a message indicating the child does not have functional eligibility. In this case, please contact the SOS Help Desk to extend the child’s level of care.

Refer to the Children’s Long-Term Support Waiver Program Eligibility and Enrollment User Guide (P-01991) (PDF) for additional guidance about entering information in EES.

Support and Service Coordination and CLTS Functional Screens

What is the required frequency of contacts for participants and support and service coordinators?

Contact with families is essential during this pandemic. Heightened support and service coordination (SSC) requirements are necessitated by the need to maintain quality services during the global pandemic, and the serious threat that the COVID-19 virus poses to the health of everyone, especially those with serious underlying medical issues. Contacts must be completed by telephone or electronic communication during the pandemic.

Effective April 2, 2020, CWAs must implement support and service coordination contacts in accordance with Numbered Memo 2020-04, (PDF) Minimum Contact Standards for Support and Service Coordination: New Requirements Necessitated by the Novel Coronavirus (COVID-19) Pandemic. These requirements include:

  • Initial contact with each participant.
  • At minimum, direct contact every month (unless the family specifically requests less frequent contact).
  • A child-specific SSC contact plan during the pandemic that is maintained in the child’s record.
  • Rigorous child-specific SSC contact plans for vulnerable and high-risk participants that is maintained in the child’s record.
  • Processes for tracking and substantiating SSC contacts outlined in child-specific plans; documentation of SSC contacts made is maintained in the child’s record.

Refer to Numbered Memo 2020-04 for full details about the requirements for SSC contacts during the pandemic.

What type of documentation is needed to verify support and service coordination contacts meet the requirements in Numbered Memo 2020-04, Minimum Contact Standards for Support and Service Coordination: New Requirements Necessitated by the Novel Coronavirus (COVID-19) Pandemic? 

Case note documentation is sufficient as long as it clearly illustrates that all requirements in Numbered Memo 2020-04, Minimum Contact Standards for Support and Service Coordination: New Requirements Necessitated by the Novel Coronavirus (COVID-19) Pandemic(PDF) are met.

Contact your technical assistance lead with questions about documenting support and service coordination contacts during the pandemic.

Are support and service coordination face‐to‐face visit requirements suspended?

No. effective May 13, 2020, all support and service coordination contacts may be completed either face-to-face or remotely, by phone or alternate electronic or virtual method. In-person service coordination contacts required by the CLTS Waiver Program Manual (P-02256) may be completed either face-to face or remotely, including:

  • In‐person contacts and assessments required by policy
  • Initial or recertification CLTS Functional Screens required by policy

Wisconsin has experienced a drastic rise in COVID-19 cases throughout the state, which has led the Governor to declare a public health emergency (Executive Order #90). As the lead agency designated by the Governor to respond to this public health emergency, DHS is committed to reducing the risk of COVID-19 exposure to program participants and staff. It is imperative to take measures to protect populations at an elevated risk of becoming seriously ill should they become infected. 

CWAs must follow the requirements established in Emergency Order #1 regarding the use of face coverings in indoor and enclosed spaces when providing in-person (face-to-face) services to CLTS Waiver Program participants. CWAs should also  review available information from their local public health department authorities and align their practices for face-to-face service delivery with the guidance from those local authorities. CWA practice must be consistent and applied to all participants served by the CWA.

CWAs must work with families to affirm their acceptance of face-to-face or remote support and service coordination during this health pandemic. Discussion with the family must include information about available options and risks associated with each option. The family leads this decision and the CWA ensures the family’s decision is authorized in compliance with program requirements. 

We need additional support and service coordination resources. Are there any resources to help with this?

Yes, paraprofessionals who are on staff at the CWA but do not meet all of the requirements of the support and service coordination service description may deliver and be reimbursed for this service. Paraprofessional support and service coordinators (SSCs) must possess any combination of four years of post-secondary education and/or work experience working directly with children and families who have long-term support needs. Paraprofessional SSCs do not need to complete the CLTS Waiver Program Support and Service Coordinator Training: CLTS Waiver Basics and the Mandated Reporter Online Training prior to being authorized as a qualified support and service coordination provider.

Paraprofessional SSCs may not complete CLTS Functional Screens unless they are a certified CLTS screener.

Are any functional screen requirements being modified during this time?

It is important that the lack of a face‐to‐face screening visit not delay the child’s or youth’s eligibility for a long‐term support program and their access to critical Medicaid programs during this time.

For an initial CLTS FS: 

  • Secondary sources are acceptable for a mental health diagnosis (non-diagnosing provider, MyChart notes, After Visit Summaries). 
  • Parent report or existing documentation is acceptable for developmental or physical disability. Existing documentation is documentation the family may already have or can be easily accessed during this time.
  • Parent report or existing information is sufficient for all other areas of the functional screen.

Initial eligibility must not be delayed due to the barriers that may be in place as clinics and providers are unavailable during this public health crisis. If you have questions about a specific case, contact the CLTS FS Inbox.

For every initial CLTS FS performed without a face‐to‐face meeting, the screener should include a note in the Screen Information Notes box of the online functional screen describing the method by which the information for the screen was gathered.

For an annual CLTS FS reevaluation:
Annual CLTS FS reevaluations are extended. 

  • The timeline for completing an annual CLTS FS reevaluation is extended one year past the due date per Wisconsin’s § 1915(c) Appendix K, WI.0414.R03.03. This applies to all children and youth enrolled in the CLTS Waiver Program with a level of care (LOC) end date between 3/1/2020 – 2/28/2021.
  • Changes reflecting this extension will be made in the EES system. 
  • CWAs do not complete an annual CLTS FS reevaluation for affected children and youth until the extended LOC end date.

Services

Are face-to-face services prohibited?

No, we are not prohibiting one-on-one services. Providers and CWAs must work with families to decide the best mode of service for the family.

CWAs and service providers must work with families to affirm their acceptance of face-to-face service during this pandemic. Discussion should address available options for service delivery and risks associated with each option, in conjunction with the need for the service. The family leads this decision, the CWA assures the family’s decision is authorized in compliance with program requirements, and the provider assures they are able to provide the service in the mode identified by family.

What happens when a family requests services to continue to be provided in-person but their current provider is not delivering in-person services during the pandemic?

Policy and CWA actions for handling this situation during the pandemic remain the same:

  • Notice of adverse action (NOA) does not need to be issued to a participant when authorized services on an ISP are reduced due to COVID-19-related provider changes. In this case, the service is not available, and has not been changed as a result of a decision made by the program to reduce, deny, or terminate the service. The CWA must maintain documentation via a case note for a provider’s temporary reduced capacity to deliver services as authorized on an ISP.
  • If the family wants another provider to address this outcome, the CWA will assist them with finding a provider who will deliver in-person services.
  • If another provider is not available to deliver these services, other supports and services should be explored to address the outcome.
  • The CWA will continue to review the status of these decisions with both the family and provider to verify any changes in status.

Can any CLTS Waiver Program service be provided remotely? 

Some CLTS Waiver Program services have an existing allowance to be provided remotely. Refer to “What services with an existing allowance can be provided remotely?”

Effective March 13, 2020, some additional CLTS Waiver Program services can be provided remotely to support participants and their families during the pandemic. This includes camps authorized through federal procedure codes T2036 and T2037. This measure will be reassessed at the conclusion of the pandemic. Refer to "What additional services can be provided remotely as of March 13, 2020, due to the COVID-19-pandemic?” 

“Remotely” means provision by telephone or an alternate electronic or virtual method. Remote provision of services must be done in real-time, or live, with the exception of support and service coordination (SSC). SSC may be provided remotely either live or by the exchange of telephone or electronic messages.

CWAs and service providers must work with families to affirm their acceptance of remote service during this public health emergency. Discussion should include information about available options and any risks to confidentiality associated with each option. The family leads this decision, the CWA assures the family’s decision is authorized in compliance with program requirements, and the provider assures they are able to provide the service in the mode identified by the family. 

The CWA must document remote service provision in a case note in the participant’s records.

There is a small group of services for which remote service provision is prohibited because they cannot be delivered remotely with the functional equivalence of in-person delivery. Refer to “For which services is remote provision prohibited?” These services should be provided during the pandemic, using a delivery method other than remote provision.

There is a small group of services for which remote service provision is not applicable because they are limited to only items and goods. Refer to "For which services is remote provision not applicable?” These services should be provided during the pandemic, using a delivery method other than remote provision.

What services with an existing allowance can be provided remotely? 

  • Assistive technology and communication aids
  • Consumer education and training
  • Training for parents and/or guardians and families of children with disabilities

What additional services can be provided remotely as of March 13, 2020, due to the COVID-19 pandemic?

  • Community integration services
  • Counseling and therapeutic services for which the desired outcome can be accomplished via verbal and visual cueing
    • Including camps authorized through federal procedure codes T2036 and T2037
  • Daily living skills training (DLST)
  • Day services
  • Home modifications
  • Housing counseling
  • Mentoring
  • Relocation services
  • Support and service coordination
  • Supported employment–Individual
  • Supported employment–small group
  • Supportive home care

For which services is remote provision prohibited?  

  • Adult family home
  • Child care
  • Children’s foster care
  • Respite
    • Excluding camps authorized through federal procedure codes T2036 and T2037
  • Transportation

For which services is remote provision not applicable?

  • Adaptive aids
  • Financial management services
  • Personal emergency response services (PERS) 
  • Relocation services 
  • Specialized medical and therapeutic supplies

What are some considerations for how services can be provided remotely?

Be resourceful and creative when thinking about how services can be provided remotely or without direct face-to-face contact, with these considerations:

  • Can observation and cueing be done remotely (including when it requires assistance from an unpaid caregiver who is physically present with the child) with the functional equivalence of in-person provision?
  • What aspects of a service do not need direct face-to-face contact to address the child’s outcome?
  • Have the child’s outcomes changed due to changes in the child’s circumstances during the Safer at Home order? For example, does the child and their family have different needs for CLTS services that will help them remotely access natural community services and resources such as the library, food delivery (from grocery stores or restaurants), delivery of medications and/or other goods or items that would otherwise be accessed by in-person visits to stores? 

Are resources available to help participants access services that are provided remotely?

Yes, equipment participants need to access remote services should be identified and can be considered for coverage under the CLTS Waiver Program or CCOP. Services that may cover these resources include, but are not limited, to adaptive aids and assistive technology and communication aids.

Can the CLTS Waiver Program cover personal protective equipment (PPE) to help participants access in-person services?

Yes, PPE, including cloth face coverings, for a participant should be identified and can be considered for coverage under the CLTS Waiver Program or Children's Community Options Program (CCOP). These services may be covered under Specialized Medical and Therapeutic Supplies.

Acceptable documentation is a case note referencing the COVID-19 pandemic and the need for PPE to help access necessary services. The following service documentation outlined in the CLTS Waiver Program Manual, P-02256 (PDF) is not required for PPE:

  • An order or prescription from the child's physician.
  • A written recommendation from a medical or therapy professional. 
  • A case note for a verbal contact between the support and service coordinator and the medical or therapy professional verifying recommendation of the item or supply.

For all other supports authorized under Specialized Medical and Therapeutic Supplies during COVID-19 pandemic, service documentation requirements outlined in the CLTS Waiver Program Manual, P-02256 (PDF) for the Specialized Medical and Therapeutic Supplies service must be followed.

Additional PPE resources:

Can other services be provided remotely to support a participant’s and family’s needs in lieu of respite that was otherwise provided face-to-face? 

Yes, other services may be authorized to address outcomes that may otherwise have been addressed via face-to-face provision of respite. 

Refer to the question “Can any CLTS Waiver Services be provided remotely?” for more information.

Can the basic cost of child care for children under 12 years of age be waived?

Not at this time; outlier applications may be considered when child care is provided on a one-on-one basis due to access or care needs.

Refer also to the April 2020 All in For Kids newsletter for information about connecting essential workforce families to child care and these Wisconsin Department of Children and Families resources: 

What are the Health Insurance Portability and Accountability Act (HIPAA) regulatory requirements for remote communications technologies during the pandemic?

On March 17, 2020, the U.S. Department of  Health and Human Services (HHS) Office of Civil Rights (OCR) issued a notification of enforcement discretion for telehealth remote communications during the COVID-19 pandemic. In the notice, OCR stated that they will exercise enforcement discretion by not imposing penalties for noncompliance with regulatory requirements under HIPAA in connection with the good faith provision of telehealth during the national COVID-19 public health emergency.

During the COVID-19 pandemic participants may be in close proximity to other household members, and participants may have limited options for private telehealth communications in their homes. Providers must continue to implement reasonable safeguards to protect patient information against intentional or unintentional impermissible uses and disclosures.

Are face-to-face group services prohibited?

No, in-person provision of services for groups of participants is not prohibited during the pandemic. Instances of in-person group services may be warranted in some limited circumstances and must take into account:

  • The necessity of the service.
  • The risk to all participants, most notably those who are at high risk and vulnerable.
  • The risk to all caregivers.
  • Social distancing practices.
  • Protective equipment utilization.

The CWA must ensure the family’s decision is authorized in compliance with program requirements, and the provider must ensure they are able to deliver the service safely and appropriately for all in-person group services.

Can camps be authorized through the CLTS Waiver Program during the COVID-19 pandemic?

Yes, camps may be authorized through federal procedure codes T2036 and T2037 (refer to the CLTS Waiver Program Benefit Code Crosswalk, P-02283), and provided remotely or face-to-face. There are no changes to the steps for submitting claims to the third party administrator (TPA) to receive payment for these services. 

Refer to the Wisconsin Department of Children and Families Guidance for Licensed Day Camps for Children for addition information.

Can services provided to groups of participants be delivered remotely?

Yes, services with an existing allowance to be provided remotely or that can be provided remotely due to the COVID-19 pandemic and that otherwise are provided to groups of participants can be provided remotely.

CWAs and service providers must work with families to affirm their acceptance of remote service during this health pandemic. Discussion should include information about available options and any risks to confidentiality associated with each option. The family leads this decision, the CWA assures the family’s decision is authorized in compliance with program requirements, and the provider assures they are able to provide the service in the mode identified by family. 

CWAs must remind providers that additional privacy considerations apply to remote service provision for a group of participants. Remote service provision to groups can potentially allow other household members to see other group members, which violates the privacy of those other members. Video-based formats may also allow participants to record or obtain screenshots, which violates the privacy of other participants. Services delivered remotely via audio-only formats may afford more privacy for group members, as long as group participants avoid using the speaker-phone feature. 

Group leaders (i.e., providers) have an obligation to provide information about issues of privacy and confidentiality to their participants at the beginning of group sessions that are provided remotely. Participants should affirm their understanding of the risks and acceptance of remote provision of group services in writing or verbally, with documentation in the participant’s record. Providers should direct group members to participate in remote group sessions in ways that prevent violating one another’s privacy, without disclosing group members’ faces, names, identifying details, or circumstances. Providers may not compel members to participate in remote group sessions and should make individual services available to the greatest extent possible for participants who elect not to participate in remote group sessions due to privacy concerns.

What services can be provided remotely to groups of participants?

  • Counseling and therapeutic services for which the desired outcome can be accomplished via verbal and visual cueing
  • Community integration services
  • Consumer education and training
  • Daily living skills training
  • Day services
  • Housing counseling
  • Mentoring
  • Supported employment–small group
  • Supportive home care
  • Training for parents and/or guardians and families of children with disabilities 

Some consumer education and training and training for parents and/or guardians and families of children with disabilities is not a real-time or live interaction. Can a CWA authorize those services?

Yes. 

Consumer education and training includes but is not limited to: 

  • Training courses 
  • Conferences and other similar events 
  • Enrollment fees 
  • Books and other educational materials 
  • Transportation 

Training for parents and/or guardians and families of children with disabilities includes but is not limited to: 

  • In-person training 
  • Parent-to-parent mentoring 
  • Conferences 
  • Resource materials 
  • Online training
  • Registration and training fees associated with formal instruction  

Are there DHS resources about personal protective equipment (PPE)?

Yes, in order to support long-term care providers who are caring for COVID-19 positive individuals, the State Emergency Operations Center has developed a process for requesting reserve resources from the strategic national stockpile. Refer to the Personal Protective Equipment (PPE) Reserve Request Process (P-02630) (PDF) for more information.

Can a participant’s sibling provide respite services to the participant during the pandemic?

Yes, siblings can provide respite during the pandemic. This is also possible under typical, ongoing circumstances; there are no changes to policy for providing respite services. Decisions about siblings delivering respite services are driven by the family. Siblings must meet the required respite provider qualifications and be able to deliver the service safely and appropriately, as determined by the family and the CWA. Refer to the CLTS Manual (P-02256), Chapter 4, Provider Requirements and Allowable Services, for policy guidance.

Is there a change in policy regarding service provision from minors?

No, there are no policy changes regarding providing CLTS Waiver Program services to minors during the pandemic. Refer to the CLTS Waiver Manual, Chapter 4 (P-02256).

Are required provider background checks waived during the pandemic?

No, policy regarding provider background checks is unchanged. Refer to the CLTS Waiver Program Manual (P-00256), Chapter 4.

UPDATED Can a participant’s parent provide services during the pandemic?

Yes, effective March 1, 2020, per Wisconsin’s § 1915(c) Appendix K, WI.0414.R03.03 (approved May 20, 2020), parents may be compensated to deliver services that would otherwise be delivered by paid providers authorized through the CLTS Waiver Program that are not available due to circumstances specific to the COVID-19 pandemic. This flexibility applies only to the CLTS Waiver Program (and not to Children’s Community Options Program).

This flexibility applies only to the following services:

  • Assistive technology and communication aids
  • Child care
  • Community integration services
  • Counseling and therapeutic services
  • Daily living skills training
  • Day services
  •  Home modifications
  • Mentoring
  • Respite
  • Supported employment–individual 
  • Supported employment–small group
  • Supportive home care
  • Transportation

Parents may be authorized to deliver a service when all of these criteria are met:

  • The CLTS Waiver Program service that is typically delivered by a paid provider is unavailable to the child for any COVID-19 pandemic-related reason.
  • Parent(s) want to provide the service.
  • Parent(s) meet the provider qualifications as outlined in the CLTS Manual (P-02256) (PDF), Chapter 4, Provider Requirements and Allowable Services.

Parents who are authorized as paid providers may be paid via Financial Management Services (i.e., a fiscal agent), and are not required to register as a provider in the CLTS Waiver Provider Registry.

Parents may be authorized as paid providers through the CLTS Waiver Program during the COVID-19 pandemic for a period of no longer than 60 calendar days. The authorization can be re-evaluated at the end of the 60-day authorization to determine if another authorization is appropriate. If it is determined appropriate for a child and family’s unique needs, another authorization may be implemented for a period of up to 60 calendar days. There is no limit for the number of 60-day authorizations that may be made, so long as authorization is appropriate for a child and family’s needs. This allowance is temporary and will be rescinded when it is no longer necessary in response to the COVID-19 pandemic. 

CWAs and families use Deciding Together (PDF) to discuss and confirm decisions for parents to be compensated for delivering CLTS Waiver Program services, based on the participant’s and their family’s current and evolving needs during the COVID-19 pandemic. As this allowance is temporary, begin to discuss transition planning with the family at the onset of the temporary services. This conversation should be family-led and child specific and focus on what strategies might make the most sense for the child or youth, which supports and services are likely to be effective, and if the family is comfortable with the plan.  

When a parent’s request to be paid as a CLTS Waiver Program provider is denied, the CWA must issue a notification of appeal rights to the participant and their parent(s).

How can the CLTS Waiver Program support a child or youth and their family while learning from home during the COVID-19 pandemic?

CLTS Waiver Program services should be considered and applied broadly and flexibly to support children and youth and their families while learning from home during the COVID-19 pandemic. CWAs and families use Deciding Together to discuss and confirm decisions about CLTS Waiver Program services, based on the participant’s and their family’s current and evolving needs during the COVID-19 pandemic.

There is only one limitation for using CLTS Waiver Program supports and services to address participant’s and their family’s needs associated with learning from home: CLTS Waiver Program services must not supplant school-based and educational services. An example of this are services indicated on a child’s individualized education program (IEP) that are the responsibility of the school.  The CLTS Waiver Program is the payer of last resort and is not a source of funding for any service that would otherwise be the responsibility of the Department of Public Instruction. Contact your CLTS TA Lead to discuss child-specific questions about this limitation.

CLTS Waiver Program services can be used to address a participant’s and their family’s needs for learning at home on any day of the week and at any time of day. The CLTS Waiver Program services can address outcomes that have changed due to changes in how the child attends school during the COVID-19 pandemic. Counties are encouraged to be resourceful and creative in meeting the needs of children during this time. 

Signature Requirements

Is there flexibility for getting signatures on Individual Service Plans (ISPs)?

DHS continues to require new (initial), six‐month review, annual recertification, and updated ISPs to be completed at the frequency outlined in the CLTS Waiver Program Manual, Chapter 7: Individual Service Plan. These may be completed by telephone or an alternate electronic or virtual method. Consent from a child and their parent(s) and/or legal guardian(s) may be obtained verbally or electronically and must be documented in a case note. Signatures required by policy must still be obtained, and can be completed via mail or electronically. When signatures are obtained electronically, CWAs must make a case note to verify the participant and/or their family or legal guardian(s) received the ISP. 

DHS continues to require signatures for ISPs to be obtained according to the timeframes outlined in the CLTS Waiver Program Manual. Signatures for initial ISPs must be obtained within 60 calendar days following the date the family and SSC agree to the services listed on the ISP. Signatures for ISPs for reviews, updates, and recertifications must be obtained within six months.

How are signatures on other forms that are required by DHS policy, such as the CLTS FS, handled?

Due to the current need to adjust operational practices in response to the COVID‐19 emergency, the following practices can be used temporarily as alternatives to obtaining required signatures in person.

Consent from a child and their parent(s) and/or legal guardian(s) may be obtained verbally or electronically and must be documented in a case note. Verbal or electronic consent will allow service provision to move forward.

CWAs must develop procedures for gaining consent via email or electronically. One example is that CWA staff send an email to the person, formally asking for their consent. That email may look something like this:

“You (individual’s name) are consenting to xxxxx for the CLTS Waiver Program. In order to obtain consent from you via email, please acknowledge that you have the authority to provide this consent on behalf of the program participant and that you consent to this action by stating “yes” in an email reply to this message.”

Signatures required by program policy must still be obtained, and can be completed via mail or electronically but should not delay service provision once verbal consent is given. When signatures are obtained electronically, CWAs must make a case note to verify the participant and/or their family or legal guardian(s) received the document. 

Appeals, Grievances, and Notices of Adverse Actions (NOAs)

Some providers are closing temporarily due to the COVID-19 pandemic. Do CWAs need to issue a Notice of Adverse Benefit Determination (NOA) for reduction in a participant’s authorized services under these circumstances?

No. NOA does not need to be issued to a participant when authorized services on an ISP are reduced due to COVID-19-related provider changes. In this case, the service is not available, and has not been changed as a result of a decision made by the program to reduce, deny, or terminate the service. The CWA must maintain documentation via a case note for a provider’s temporary reduced capacity to deliver services as authorized on an ISP. Additionally, the information on an ISP relating to the affected service should remain unchanged. It is expected that service provision will return to the level identified on the ISP when the provider’s capacity increases.

The CWA should work with the family to determine whether an additional service or support is needed and can be secured during the absence of the identified service/provider.

If a family requests a new support or service or increases to a currently authorized service that is unavailable due to the COVID-19 pandemic, can a decision about authorizing the service be delayed? 

Yes. An NOA must be issued in this circumstance, including the participant’s rights, and a full explanation of why the request is denied. This allows the participant to appeal the decision if they wish to do so.

Staff and Participant COVID‐19 Infections

What if a staff person at a CWA tests positive for COVID‐19?

Notify your technical assistance lead of the infection and how it may affect participants. Do not report identifying information about the staff, only that the infection occurred and the CWA’s plan for other staff and participants. If the staff person who has tested positive for COVID‐19 has had contact with a participant, submit an incident report via the Children’s Incident Tracking and Reporting (CITR) system.

What if a participant or person who lives with the participant tests positive for COVID‐19?

Submit a critical incident report via the CITR system for a participant or person who lives with the participant who has tested positive for COVID-19. This will help coordinate supports and services to assist this participant and their family.

Administration and Contract Compliance

How is the parental payment liability affected by the pandemic?

Parental payment liability (PPL) allows a CWA to consider a family's financial hardship when determining the PPL (Wis. Admin. Code 1.065(3m)(c)).

The COVID-19 pandemic may be a financial hardship. CWAs must reassess PPL for all participants if this has not already occurred.

  • If the family is experiencing financial hardship due to the pandemic, the PPL must be waived. Hardship is defined as a change in eligible household income due to the COVID-19 pandemic and/or a confirmed COVID-19 infection of a member of the participant’s household.
  • If a participant’s supports and services have been reduced due to the pandemic, the PPL must be recalculated using the cost of actual incurred supports and services.

Is DHS planning any changes to incident reporting requirements?

DHS expects no changes in incident reporting requirements. These requirements support participant health and safety and should be a priority. 

Submit a critical incident report via the CITR system for a participant who has tested positive for COVID-19. This will help coordinate supports and services to assist this participant and their family.

Is DHS planning any changes to recent directives for verifying provider qualifications?

The expectation is for this process to continue without changes. Refer to Numbered Memo 2019-10, Implementation of the Enhanced Children’s Long-Term Support Waiver (CLTS) Program Provider Registration and Public Directory.

Will DHS extend the review of approved restrictive measures and reporting around the application of restrictive measures deadline beyond 365 days because of the significant staff shortages due to the COVID-19 pandemic and/or the availability of provider agency staff to participate in the review processes beyond 365 days?

Our priority during this time is health and safety. Restrictive measures must continue to be used only in the manner approved. Expectations remain in place for direct support staff to document each use of the approved restrictive measure.

At this time, DHS is not extending the restrictive measure deadlines. This may be re‐evaluated in the future and can be discussed on an individual basis if there is an urgent situation.

Do the provisions in the Family First Coronavirus Response Act (FFCRA) that require certain employers to provide their employees with paid sick leave and expanded family and medical leave for specified reasons related to COVID-19 apply to CLTS Waiver Program participants who use fiscal agents to pay participant-hired workers?

Yes, the Families First Coronavirus Response Act (FFCRA) is a new federal law that includes provisions to help employees during the COVID-19 pandemic. FFCRA requires certain employers to provide their employees with paid sick leave and expanded family and medical leave for specified reasons related to COVID-19. 

CLTS Waiver Program participants who use fiscal agents to pay participant-hired workers are considered to be small business employers under these FFCRA provisions.

The FFCRA provision provides paid sick time and paid expanded Family Medical Leave Act (FMLA) time to those affected by the COVID-19. It starts April 1, 2020, and goes through December 31, 2020. 

Fiscal agents delivering financial management services and paying CLTS participant-hired workers are responsible to carry out these federal FFCRA requirements.

Rates and Billing

Are there changes to rates and billing processes for remote service provision?

No, the rates and billing process for remote service provision are the same as when services are provided in-person. 

Refer to the CLTS Waiver Manual (P-02256), Chapter 4.05, Allowable Services, for information about activities that are included and prohibited for each service.

 

Any exceptions to CLTS Waiver Program policy or standard practice will only be allowed during the COVID‐19 pandemic.

Last Revised: November 18, 2020