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 Sort ascending	File Type	Language	Available to Order
N/A	Sam's Story	04/2018	PDF	English	No
N/A	Lily's Story	04/2018	PDF	English	No
N/A	Brief Overview of Developmental Domains in Early Childhood	04/2018	PDF	English	No
P-02035A	Children’s Long-Term Support (CLTS) Functional Screen Tip: Social Competency	02/2018	PDF	English	No
N/A	Sample CLTS Enrollment Confirmation Notice	01/2018	PDF	English	No
N/A	Children’s Long-Term Support (CLTS) Waiver Program Enrollment and Eligibility Streamlining (EES) Implementation Next Steps	01/2018	PDF	English	No
P-02035	Children’s Long-Term Support (CLTS) Functional Screen Tips: Presenting Diagnoses	11/2017	PDF	English	No
P-02012	Information about Disability Determinations for County Waiver Agencies	10/2017	PDF	English	No
N/A	Eligibility and Enrollment Streamlining Presentation	09/2017	PDF	English	No
N/A	CLTS/WPS General Claim Submission Requirements	06/2017	PDF	English	No
N/A	WPS CLTS County Waiver Agency Authorization File Tips	06/2017	PDF	English	No
F-20987S	Representative Designation Medicaid Community Waiver Programs, Spanish	03/2017	PDF	Spanish	No
F-21059	Variance Request for Institution Respite	03/2017	PDF	English	No
F-20987	Authorized Representative Designation Medicaid Community Waiver Programs	03/2017	PDF	English	No
F-20987S	Authorized Representative Designation Medicaid Community Waiver Programs, Spanish	03/2017	Word	Spanish	No
F-21072	Determination of Exceptional Care Needs for Children in Child Care or Foster Care Setting	03/2017	Word	English	No
F-20987	Authorized Representative Designation Medicaid Community Waiver Programs	03/2017	Word	English	No
F-21059	Variance Request for Institution Respite	03/2017	Word	English	No
F-00926A	Request for Use of Medical Restraints - CLTSS	02/2017	PDF	English	No
F-00926A	Request for Use of Medical Restraints - CLTSS	02/2017	Word	English	No
F-00412	Third Party Administration (TPA) Children's Medicaid Waivers Provider Billing and Service Information	02/2017	Word	English	No
N/A	Sample Level of Care Termination Letter	09/2016	Word	English	No

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