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

Section 8: Service Delivery Standards

CLTS Program providers must comply with the Wisconsin Medicaid Provider Agreement and all CLTS Program policies when delivering services. These requirements ensure services are delivered consistently and safely, in a way that supports the participant-driven outcomes.

Coordination of benefits

Coordination of benefits describes the practice of understanding how CLTS funds are utilized only when other available insurance or coverage options have been eliminated.

All participants have Medicaid coverage and may also be covered by other benefits such as private insurance. Participants may also have access to different systems of support like schools, the Department of Vocational Rehabilitation (DVR), and other organizations within their communities. The CLTS Program is the payer of last resort, meaning it can only cover supports and services within the scope of the waiver that cannot be covered by another benefit package or system.

Families work with their SSC to coordinate benefits during service planning, but some providers may encounter the topic of coordination of benefits if they work across different programs, claim specific service codes that request confirmation of coordination of benefits, or have a family reach out directly to inquire about services. CLTS Service Providers should not deliver services funded by CLTS that are the responsibility of another system of support. For questions about coordination of benefits, connect with the participant’s SSC.

Matching participant outcomes to available providers

An important part of service planning (see Section 7: Connecting with Participants and Families) is matching the right provider to the participant’s desired outcome. SSCs and families use the CLTS Provider Directory to determine appropriate providers based on the participant’s location, the type of service they are seeking, or other considerations.

SSCs and families may partner to reach out to providers. The SSC may also reach out directly. This initial contact aims to determine if the provider has the capacity to take on new participants and to arrange for next steps. While each provider has a unique process when starting services with a new participant and family, there must be an opportunity for the provider to discuss outcomes and availability, and ensure the service is the right fit for everyone involved.

The terminology for this beginning process will vary by provider and by the service they deliver. This might be called a referral, an intake meeting, an initial assessment, a meet-and-great, or a walkthrough.

Providers may have their own provider-specific forms and paperwork that families will need to complete before you provide the service. Others, such as home modification providers, may need to meet with the family to complete a bid or quote for work to be done. Getting started with a new provider may occur before a prior authorization is issued.

Prior authorizations (PAs)

Once a participant is matched with a service provider, the CWA will issue a service authorization called prior authorization (PA).

It is the SSC’s responsibility to inform providers that the PA is complete and services may begin. Providers can see their PAs in real time using the ForwardHealth Portal.

The PA will always list the approved start and end date. It will also include other service-specific information (depending on the PA type), such as:

  • Amount of units authorized.
  • Frequency.
  • Duration.
  • Specific service that supports the outcomes identified in the ISP.
  • Service rates.

Delivering services

When delivering services to participants and families, providers must follow CLTS Program policies outlined in the CLTS Program Waiver Manual, P-02256 (PDF) and the Children's Long-Term Support (CLTS) Waiver Program Provider Agreement and Acknowledgement of Terms of Participation, F-03344. This includes:

  • Ensuring that the individuals working with a participant have the training, qualifications, licensure, and background check (if applicable) to provide that service.
  • Providing only the service outlined in the PA.
  • Respecting participant rights.
  • Maintaining confidentiality.
  • Reporting incidents.
  • Being culturally responsive.
  • Maintaining accurate records.

CLTS Program providers are also expected to maintain professionalism. That includes communicating with families in their preferred method, clearly, and consistently. If appointments must be changed, let the participant or family know as soon as possible. Be punctual. Staying consistent while providing support and flexibility where needed can help lessen the pressure of daily obstacles participants and families can face and build understanding. Other guidance to keep in mind when providing services:

  • The participant is at the center of the CLTS Program. Acknowledge and communicate with the participant as opposed to speaking only to others around the participant.
  • Recognize the participant’s unique strengths, abilities, and interests.
  • Approach interactions with empathy and care. Ensure that the participant feels safe and understood.
  • Use inclusive, person-first, respectful language.
  • Practice active listening.
  • Ask questions and follow up to address concerns.
  • Use language that is easy to understand and free of professional jargon.
  • Evaluate the effectiveness of the service and have open dialogue with the participant and family about their outcomes.

Health and safety

CLTS Program providers are responsible for ensuring services are delivered in a way that protects the health and safety of the participant.

  • Ensure that any individual assigned to deliver services is qualified and has met all training requirements for the service.
  • Follow all health, safety, and supervision requirements.
  • Ensure that all licensing and certification is up to date.
  • Take immediate action to address safety concerns.

Work with CWAs to solve issues

CWAs are responsible for ensuring participants and families are receiving the supports and services authorized according to the participant's service plan. They monitor feedback from families about provider conduct, training, and effectiveness.

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 the caregiver assigned knows how to provide the service.
  • Service effectiveness
    • The support I get from this CLTS Program provider is no longer helping me.
    • My child has not progressed toward their goals since getting this service.
    • I think my child should be getting a different service.

If an issue is identified, the SSC will work together with you and the family to resolve concerns. This might include repairing relationships, defining expectations, and reaching solutions.

If your services do not meet the child’s needs, the family might request a new caregiver or agency. The SSC will work with families to resolve any issues with service quality.

Once services have been delivered and documented, you are ready to bill for the service.

Glossary