Children’s Long-Term Support (CLTS) Waiver Program Support and Service Coordinator (SSC) Training: CLTS Waiver Basics

To complete the training, click on the series of links in each module. In most cases, you will be sent directly to the intended information; however, in a few instances you will be required to navigate to a specific section within a resource, for example, Ch. 2, section 2.02 a. (1).

The training is composed of resources citing the most up-to-date CLTS Waiver Program information. These resources include links to applicable sections of the CMS waiver application, Division of Medicaid Services (DMS) Information and Numbered Memos, guidance updates, relevant sections of the Medicaid Home and Community-Based Services (HCBS) Waiver Manual for the CLTS Waiver Program, and information on the Wisconsin Department of Health Services website. The training is based on the Waiver Manual and will be updated as revisions to the manual become available.

An Additional Resource list is also included with most modules. This information is not required for the training and exam but can be used as needed.

The SSC training is a two-step process.

Step 1: Complete the Waiver Basics training and pass the exam to be certified to provide support and service coordination.

Step 2: Complete the Typical and Atypical Child Development Modules (four to six hours), Think Possible! Employment Series (two hours), and CMS Case Manager Training (90 minutes) (Chapter 4) trainings within the first six months of employment. These trainings can be found in the Waiver Basics training designated with an asterisk (*).

Note: The CLTS Functional Screen training is listed as an additional resource. This is not required for the Waiver Basics training, but any SSC who wants to be a functional screener must take the training and pass the exam to be certified.

Following completion of the Waiver Basics training modules, SSCs are required to take the Children's Long-Term Support (CLTS) Waiver Basics Exam, F-02008. A score of 80% must be achieved to receive certification.

The final page of the exam includes notification of successful CLTS Waiver Certification if a passing score is achieved. This notification of certification must be maintained by the County Waiver Agency (CWA) and be available on request. The notification verifies that the SSC serving CLTS Waiver Program participants, and for whom the CWA receives reimbursement, is appropriately trained and qualified.

After finishing each training in step two, print a copy of the completion certificate and keep in your file. If a certificate is not provided, complete an attestation stating that you have completed the training and the date this was achieved. The attestation must be signed by the employee and supervisor. The Support and Service Coordinator Waiver Basics Training Requirement Attestation form, F-02435 (Word), or your own form can be used to fulfill this requirement. This documentation should be printed and kept in the employee's file.

CLTS Waiver Program Description

The purpose of Wisconsin's CLTS Waiver Program is to support children who have substantial developmental, emotional, and/or physical disabilities and are living at home or in the community. The program aims to build on the capacity, resiliency, and unique abilities of children and their families to maximize inclusion in all facets of community and family life. (See About the Children’s Long-Term Support (CLTS) Waiver Program section.)

Wisconsin’s History With the Medicaid Home and Community-Based Waiver (HCBW) Program

Wisconsin began Medicaid HCBW programs in 1983. (See Waiver Basics Manual Ch. 1, section 1.01 (PDF) , paragraphs 1-3.)

State Assurances to CMS

CMS requires states to meet certain requirements for receive HCBW (PDF) funding. If these assurances are not met, a waiver will not be granted or may be terminated. (See Modifications to Quality Measures and Reporting in § 1915(c) Home and Community-Based Waivers (PDF).)

These resources are supplemental only. The material will not be included in the exam.

• The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in § 1915(c) of the Social Security Act. The program permits a state to furnish an array of home and community-based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. (See Application for a 1915 (c) HCBS Waiver (PDF), p. 2.)
• The Fee-for-Service Selective Contracting Program operates concurrently with Wisconsin’s CLTS Waiver Program, a 1915(c) HCBS waiver program for children with developmental disabilities, physical disabilities, and severe emotional disturbances. (See the 1915(b)(4) Waiver application (PDF).)
• In accordance with 42 C.F.R. § 441.302 (PDF), the state must provide assurances to CMS.
• In accordance with 42 C.F.R. § 441.301(b)(1-6) (PDF), a person-centered written plan of care is completed for each participant.
• CMS requires all states that operate HCBS waivers comply with a federal settings rule. The purpose of the settings rule is to ensure that people receiving services through home and community-based waiver programs have access to the benefits of community living and are able to receive services in the most integrated settings.

Eligibility Requirements

• In order to participate, all children or young adults must meet the basic CLTS Waiver eligibility requirements.
• The Wisconsin Functional Screen (FS) system is used to determine eligibility. The FS is a web-based application used to collect information about an individual's functional status, health, and intellectual/developmental or physical disabilities. (See Functional Screen Module #1: Overview of the Children's Long-Term Support Functional Screen, sections 1.1 and 1.2 (PDF), pp. 4-7.)
• To enroll a participant, the SSC enters enrollment data into the online Eligibility and Enrollment Streamlining (EES) system. This information can also be found in Chapter 6: Program Enrollment. (See DMS Numbered Memo 2017-05 (PDF).)

When a Participant Moves

When a participant moves from one county to another, both counties have the responsibility to ensure services continue. (See Waiver Manual Ch. 2, section 2.07 (PDF).)

Institutional Levels of Care

The Institutional Levels of Care guide (PDF) describes the intermediate care facility, psychiatric hospital, nursing home, and hospital levels of care.

Eligible Living Arrangements

The living arrangement of the child is reviewed when eligibility is being determined. (See Waiver Manual Ch. 2, section 2.06 (PDF).)

Services Assessment

SSCs assess the need for services to meet the child and family’s priorities and goals.

Typical and Atypical Development Training*

Typical and Atypical Development training modules, created by the University of Wisconsin–Madison, explore the various stages of child development for both typically and atypically developing children. This training takes four to six hours to complete. Please keep a copy of the training completion certificate for your records.

* This training must be completed within the first six months of employment.

These resources are supplemental only. The material will not be included in the exam.

Functional Screen (FS) System

Wisconsin’s FS system is a web-based application used to collect information about an individual’s functional status, health, and need for assistance for various programs that serve the frail elderly and people with intellectual/developmental or physical disabilities. To become a screener, the SSC completes the FS training and passes the exam to achieve certification. A copy of the training completion certificate should be kept for your records.

• Wisconsin Children’s Long-Term Support Functional Screen Clinical Instructions, P-00936 (PDF)
• CLTS Functional Screen Online Training For Certified Screeners

Medicaid Enrollment Requirements

• Enrollment in Wisconsin Medicaid is a prerequisite for participation in the CLTS Waiver Program. (See DMS Information Memo 2018-01 (PDF).)
• CLTS EES Implementation Interim Guidance Update, P-02277 (PDF), outlines the Medicaid continuous enrollment requirements for CLTS participants.

Parental Payment Limitations

• When a child is participating in the CLTS Medicaid Waiver Program, the parents may be liable for a portion of the cost of their child's waiver services. (See Children's Long-Term Support Waiver Programs - What Does it Cost?)
• The CLTS Parental Payment Limit User's Guide for the Automated Worksheet and the Printed Reference Tables, F-01337a (PDF), is a resource to help navigate and enter data into the worksheet.
• SSCs use the Worksheet for Determination of Parental Payment Limits for CLTS, F-01337, to determine if any parental payments are required.

• The CLTS Parental Payment Limit System Frequently Asked Questions, F-01377b (PDF), includes answers to questions SSCs or families may have about parental payment.

These resources are supplemental only. The material will not be included in the exam.

CARES Process

The CLTS Waiver Program CARES process is used to assess whether the participant and family are eligible for BadgerCare Plus and the Group A Waiver or Group B or B Plus Waiver, based on the child’s income. (See Medicaid Eligibility Handbook, section 28.14.2.)

Katie Beckett Program (an alternative Medicaid source)

The Katie Beckett Program is a special eligibility process that allows certain children with long-term disabilities, mental illness, or complex medical needs, living at home with their families, to obtain a Wisconsin ForwardHealth Medicaid card.

Supplemental Security Income (SSI)

• SSI is a monthly cash benefit paid by the federal Social Security Administration and Wisconsin Department of Health Services (DHS) to people in financial need who are 65 or older or Wisconsin residents of any age who are blind or disabled.
• SSI disability benefits are for adults or children who have a disability and meet income, resource, and living arrangement requirements. Once someone qualifies for SSI, they are also eligible for Medicaid.

Support and Service Coordination

This service (PDF) includes coordinating or facilitating access to all services and supports, both formal and informal, that are needed by the child and family to meet their identified outcomes.

Allowable Services

• The CLTS Waiver Program offers a broad range of services to help families meet their identified outcomes.
• The allowable service descriptions were updated to reflect the five-year renewal of the 1915(c) waiver application and concurrent 1915(b)(4) waiver application, approved by CMS. Some services are subject to rate-setting, while others are not.

Service Codes and Provider Qualifications

• A CLTS Code Crosswalk, P-02283 (PDF), was developed to show the equivalent Health Insurance Portability and Accountability Act (HIPAA) codes.
• The Bureau of Children’s Services (BCS) developed and launched a new online CLTS Waiver Provider Registry and Directory system.

Rate-Setting

In 2019, DHS will use a new uniform rate-setting methodology for service providers.

When Children's Community Options Program (CCOP) and CLTS Waiver Funds can be Used

CCOP funds can be used for supports and services that are not allowable under the CLTS Waiver Program. (See CCOP Procedures Guide, P-01780 (PDF), p. 6 under "CCOP and CLTS Waiver.")

CMS Case Manager Training*

CMS Case Manager training provides information on improving the quality of home and community-based waiver services. The training takes approximately 90 minutes.

* This training must be completed within the first six months of employment.

These resources are supplemental only. The material will not be included in the exam.

HCBS Final Rule

• The purpose of the Final Rule (PDF) is to ensure that individuals receiving long-term services and supports through HCBS programs have full access to benefits of community living and the opportunity to receive services in the most integrated setting appropriate.
• The CMS Fact Sheet: Summary of Key Provisions of the Home and Community-Based Services (HCBS) Settings Final Rule (PDF) summarizes the key HCBS Settings Final Rule provisions.
• HCBS Settings Rule Frequently Asked Questions provide guidance on the requirements in the settings rule.
• The Final Rule requires a person-centered service plan for each individual receiving Medicaid HCBS. CMS developed the System-Wide Person Centered Planning Training (PDF) to help clarify how person-centered planning is incorporated as part of the Final Rule. Review of the PowerPoint presentation will take 15–30 minutes.

Allowable Costs

• If a participant uses substitute care, the care and supervision costs are covered by the CLTS Waiver program, while room and board is not. (See Waiver Manual Ch. 5, section 5.02.)
• Children’s foster care (PDF) services include supplementary intensive supports and supervision services beyond the maintenance payment made to foster parents to address a child’s or youth’s exceptional emotional or behavioral needs, or physical or personal care needs, in a family environment.

These resources are supplemental only. The material will not be included in the exam.

Foster Care Rates

DHS and the Department of Children and Families (DCF) collaborate each year to issue updated CLTS Waiver Program allowable treatment foster care administrative rates to be used by CWAs to calculate costs. (See Children’s Long-Term Support (CLTS) Waiver Program Approved 2018 CLTS Treatment Foster Care Administrative Rates, P-00700 (PDF).)

Foster Care Certification Requirements

• DCF defines the five levels of foster care certification requirements
• The DCF Level 5 Exceptional Treatment Foster Home: Guide for Certification and Placement (PDF) provides an overview of Level 5 Exceptional Treatment Foster Homes by outlining considerations and resources for agencies looking to license a Level 5 Foster Home or place a child into an existing home.

Forms and Instructions

• Calculating Expenses for a CLTS Foster Home Using Actual Expenses, F-01715 (Excel), is used to calculate expenses for a CLTS foster home.
• Calculating Expenses for a CLTS Foster Home Using the Uniform Foster Care Brochure, F-01716 (Excel), is used to calculate expenses for a CLTS foster home.
• Instructions for Calculating CLTS Foster Care Room and Board Expenses, F-01721 (PDF), gives instructions for using F-01715 and F-01716.

Program Policy and Online Enrollment

To enroll a participant, the SSC enters enrollment data into the online EES system. This information can also be found in Chapter 2: Functional Eligibility. (See DMS Numbered Memo 2017-05 (PDF).)

Wait List Policy and Procedures

• A CLTS Waiver Wait List is maintained by counties when they have expended all available funds.
• ​Children meeting the definition of a vulnerable child are allowed to bypass the CLTS program wait list and immediately enroll. (See DMS Numbered Memo 2018-01 (PDF).)
• Children's Long-Term Support (CLTS) Waiver Wait List FAQs clarify the CLTS wait list in the Program Participation System (PPS).

Support and Service Coordination Timeline Requirements

• Timeliness and access standards for eligibility and developing the individual’s person-centered service plan have been established to assist support and service coordinators. (See DMS Numbered Memo 2017-CLTS-1. (PDF))
• Desk aids are available for support and service coordination.
  • CLTS Waiver Program Support and Service Coordination Timeline Requirements, P-02049B (PDF)
  • CLTS Waiver Program Support and Service Coordination Eligibility and Enrollment Requirements, P-02049 (PDF)

Deciding Together Process

The Deciding Together Guide, P-02246 (PDF), and instructions, P-02246i (PDF), provide a clear, step-by-step team approach to facilitate dialogue between service coordinators and families using a family-centered, collaborative decision-making framework to develop comprehensive outcome-based support plans. This approach recognizes and maximizes the capacities, resiliency, and unique abilities of a child and their family and promotes self-determination and inclusion in all facets of family and community life.

Individual Service Plan (ISP) Forms and Instructions

A person-centered approach is used when working with applicants, participants, and their families. An Individual Service Plan (ISP), F-02245 (PDF), is completed for each participant.

• An ISP Individual Outcomes form, F-20445A (PDF), must be completed for each participant.
• The ISP Instructions, F-20445i (PDF), are followed to complete the ISP form and Outcomes form.
• DMS Numbered Memo 2018-08 (PDF) includes information on the ISP forms.

These resources are supplemental only. The material will not be included in the exam.

Written Plan of Care

In accordance with 42 C.F.R. § 441.301(b)(1-6) (PDF), a written plan of care must be completed for each participant.

Eligibility and Enrollment Streamlining (EES)

• View an Enrollment Confirmation Notice example, F-02810 (PDF).
• SSCs enter participation enrollment data into the EES system through the ForwardHealth Portal
• Various reports are available to help county waiver agencies manage their caseloads in EES. (See CLTS EES Implementation Next Steps Update - Reports - 1/4/18 (PDF).)
• CLTS EES Implementation Interim Guidance Update (2/13/18) (PDF) communicates the status of continued suspension of some automated disenrollment features, automated disenrollment, and manual disenrollment.
• The CLTS Waiver Program Eligibility and Enrollment User Guide, P-01991 (PDF), gives instructions on how to use the Enrollment Wizard.

EPSDT

The Medicaid program benefit for children and adolescents is known as Early and Periodic Screening, Diagnostic and Treatment services, or EPSDT. In Wisconsin, EPSDT is known as HealthCheck Other Services. (See A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents (PDF).)

Requirements

For each participant, a recertification, ISP review, and update is completed by the SSC. (See Ch. 7 of the Waiver Manual (PDF).)

Think Possible! Employmen Webinar Series*

Think Possible! is a four-part employment training series developed for service coordinators who work with the Birth to 3 Program, the Children’s Long-Term Support (CLTS) Waiver Program, and the Children’s Community Options Program (CCOP). Think Possible! was developed to help service coordinators support the children, youth, and parents they work with every day to develop and achieve the goal of working in the community. Please keep a copy of the completion certification for your records.

*This training must be completed within the first six months of employment.

Transitioning CLTS Participants to Adult Services

• As young people near adulthood, a transition plan is created to help plan for the participant's life as an adult.
• Aging and disability resource centers (ADRCs) use “Living My Dream” materials when reaching out to youth and their families as they plan for transition into the adult system.

These resources are supplemental only. The material will not be included in the exam.

Transitioning Children to Adult Waiver Services

• Prior to a child turning 17 years and 6 months old, the SSC develops a plan for the child's transition to adult waiver services. (See 1915 (c) Waiver Application Appendix B: Participant Access and Eligibility, B-1: Specification of the Waiver Target Group(s) c. Transition of Individuals Affected by Maximum Age Limitation (PDF), pg. 25.)
• DHS has an interactive map to help find ADRCs throughout the state.

Rights and Processes

CLTS Participants have rights and access to an appeal and grievance process.

Forms

• The Participant Rights and Responsibilities Notification form, F-20985, is provided to each participant.
• The CLTS FS is used to determine functional eligibility. The Informed Consent – Children’s Long-Term Support Functional Screen form, F-21076, is required to be signed by the participant (if age 14 or older and able to sign) or other person legally authorized to consent to the CLTS FS.

Health and Safety Assurance

Assuring the participant’s health, safety and welfare is an essential component of the CLTS Waiver Program. (See Waiver Manual Ch. 9 (PDF).)

Incident Reporting Overview, Instructions, and Form

If a reportable incident occurs, the Incident Report, F-22541 is completed.

Restrictive Measures

The restrictive measures policy is outlined in the Guide and Requirement for the Use of Restrictive Measures. (See Instructions and Requirements for the Use of Restrictive Measures in Long-Term Support Programs for Children, P-02616 .(PDF) )

Mandated Reporter Training

According to the CMS approved Application for a § 1915(c) HCBS waiver, DHS designated SSCs as mandated reporters for child abuse and neglect, and as a part of the county human/social/community service infrastructure, are required to issue referrals to county child protection and child welfare services, when warranted. As mandated reporters, SSCs must take relevant training. The Mandated Reporter Online Training was created by the Wisconsin Child Welfare Professional Development System and takes 30–60 minutes to complete. Please keep a copy of the training completion certificate for your records.

These resources are supplemental only. The material will not be included in the exam.

Systems

• The Program Participation System (PPS) is a web-based IT system that was developed to help streamline program functions and tasks.
• BCS uses PPS to maintain the CLTS Wait List. The Program Participation System (PPS) Step-by-Step Training Guide, P-00697 (PDF), outlines the wait list process.
• The Wisconsin Web Access Management System (WAMS) allows authorized individuals to access state internet applications. A WAMS ID is needed access the PPS system.

Forms Library

• The DHS Forms Library houses all DHS forms.
• The CLTS Forms Library houses all forms created for the CLTS program.

Memos Library

• DLTC Information Memos communicate long-term care information that DHS wants or needs to share with its partners and providers.
• DLTC Numbered Memos detail actions that our partners and providers could or should take regarding long-term care programs.

DHS Communication Tools

• CLTS teleconferences are held on the third Thursday of odd-numbered months with the exception of March and September. Register to receive regular notifications about the teleconferences.
• DHS communicates through GovDelivery. Register to receive regular GovDelivery communications.

Waiver Applications

• The 1915 (c) Home and Community-Based Services Waiver application (PDF) is submitted every five years for the CLTS program.
• The 1915(b)(4) Waiver Fee-for-Service Selective Contracting Program application (PDF) is submitted every five years for the CLTS program.

Family Voices of Wisconsin Fact Sheets

• What is HealthCheck Other Services (HCOS) (PDF)
• Children's Long-Term Support Program (PDF)
• Completing the Functional Screen for CLTS Programs (PDF)
• Comparing the Children’s Community Options Program and Children’s Long-Term Support Waivers (PDF)
• Supplemental Security Income and Children with Disabilities (PDF)
• What is the Katie Beckett Program? (PDF)
• Appealing a Medicaid or BadgerCare Plus Denial: What You Need to Know (PDF)

Regional Centers for Children and Youth with Special Health Care Needs (CYSHCN)

Regional Centers for Children and Youth with Special Health Care Needs (CYSHCN) webpage

Community Resources for Families and Children

National and state resources for children with disabilities and their families

Disability Rights Wisconsin

Children with Disabilities

ABC for Health, Inc.

ABC for Health, Inc. website