Children's Long-Term Support: How much are providers paid?

The Children’s Long-Term Support (CLTS) Program pays authorized claims under two approaches:

• The CLTS Statewide Rate Schedule for CLTS services with a direct care provider component
• Market rate

Services included in the CLTS Rate Schedule

The rates in the CLTS Rate Schedule, P-02184 (PDF), are the maximum payment amounts for each service unit without an outlier rate. Payment may be at lower rates when the service provider's usual and customary cost (the amount the provider charges to the public) is lower than the amount in the CLTS Rate Schedule.  

Services paid at market rate

Some services include subcategories that are not included in the rate schedule because they are paid at market rates (for example, respite camps, bus passes, parking). Please refer to the CLTS Service Descriptions, P-02256 (PDF), and the CLTS Benefit Code Crosswalk, P-02283 (PDF), for more information. 

Outlier rates

For the most part, CLTS participants’ needs will fit within the set rate schedule. Some situations may call for an exception to the set rate due to exceptional circumstances. Outlier rate requests are the exceptions to the rate schedule.

The county waiver agency must decide if an outlier rate is appropriate for the situation. We will consider an outlier rate based on a participant’s unique circumstances. Decisions are based on one of the following:

• The complexity or intensity of the individual’s care needs versus the typical CLTS participant’s needs
• When a provider is not available within the participant’s own county to deliver the necessary service