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Children's Long-Term Support (CLTS) Waiver Forms and Publications - Resources for Counties

Below is a list of all Children's Long-Term Support (CLTS) Waiver forms and publications. If the document is available to order in a paper version, there will be a "Yes" with a link to ordering instructions.

When you are searching for a document, enter the number or a portion of the title in the search box below.

Assigned Number Title Release Date File Type Language Available to Order
F-20985RY Participant Rights and Responsibilities Notification, Rohingya 11/2020 PDF Rohingya No
F-20985SO Participant Rights and Responsibilities Notification, Somali 11/2020 PDF Somali No
F-20985SO Participant Rights and Responsibilities Notification, Somali 11/2020 Word Somali No
F-20985S Participant Rights and Responsibilities Notification, Spanish 11/2020 PDF Spanish No
F-20985S Participant Rights and Responsibilities Notification, Spanish 11/2020 Word Spanish No
F-20985V Participant Rights and Responsibilities Notification, Vietnamese 11/2020 PDF Vietnamese No
F-20985V Participant Rights and Responsibilities Notification, Vietnamese 11/2020 Word Vietnamese No
P-03312B Provider Users: View, Update, and Renew a Registration 05/2024 PDF English No
N/A Querying Data with the CLTS Advanced Query Builder (AQB): Claim Data and Prior Authorization Data presentation 07/2024 PDF English No
F-20987S Representative Designation Medicaid Community Waiver Programs, Spanish 03/2017 PDF Spanish No
F-00926A Request for Use of Medical Restraints - CLTSS 02/2017 Word English No
F-00926A Request for Use of Medical Restraints - CLTSS 02/2017 PDF English No
N/A Sam's Story 04/2018 PDF English No
N/A Sam's Story 05/2018 PDF English No
N/A Sample CLTS Disenrollment Confirmation Notice 06/2019 PDF English No
N/A Sample CLTS Enrollment Confirmation Notice 01/2018 PDF English No
N/A Sample Level of Care Termination Letter 09/2016 Word English No
N/A Santi's Story 04/2018 PDF English No
N/A September 9, 2021, Children’s Long-Term Support (CLTS) Functional Screen Teleconference Slides 09/2021 PDF English No
N/A Spencer's Story 04/2018 PDF English No
N/A State-Level Budget and Enrollment Administration Initiative Special Circumstances and Fiscal Responsibilities Training 11/2020 PDF English No
P-02865 State-Level CLTS Budget and Enrollment Administration Operational Aid for County Waiver Agencies: Fiscal Responsibilities 12/2020 PDF English No
P-02049 Support and Service Coordination Requirements Eligibility and Enrollment Diagram 10/2023 PDF English No
F-02435 Support and Service Coordinator Waiver Basics Training Requirement Attestation 12/2018 Word English No
N/A Susannah's Story 04/2018 PDF English No

Glossary

 
Last revised January 25, 2023