CLTS FS Instructions Module 10 - Functional Eligibility Results

Contents

10.1 Information Available on the Eligibility Results Page
10.2 Confirming the Functional Eligibility Results
10.3 Sharing Functional Eligibility Results with Others
10.4 Functional Eligibility Results Affecting Eligibility for Other Programs
10.5 Completed CLTS Functional Screen Summary Report

Once a screen has been completed with information outlined in the previous modules, it can be calculated to determine functional eligibility. Screeners are advised not to calculate the screen before all functional information has been entered.

Screeners should not attempt to change their answer choices to get the results they anticipated. If the screener finds that they unintentionally checked something on the screen, they can use the Edit button to make changes to their answer choices and recalculate eligibility. If the Calculate Eligibility button is selected multiple times on a single child, the screener may be temporarily blocked from calculating eligibility again.

10.1 Information Available on the Eligibility Results Page

Once the screener has selected CALCULATE ELIGIBILITY, a new screen will appear with important identifying information at the top of the page:

• Screen Begin Date
• Screener Name
• Screen Entered By
• Eligibility calculated by Agency

The page will then display the following chart:

The results indicate that the child meets (or does not meet) functional eligibility for certain programs. It does not mean that they meet program eligibility. Some programs have additional criteria, including financial eligibility. The CLTS FS only determines functional eligibility.

For Comprehensive Community Service, the following Eligibility Results are possible:

• Functionally determined to need services
• Not functionally determined to need services

For the Children’s Community Options Program, the following Eligibility Results are possible:

• Functionally eligible
• Not functionally eligible
• Not eligible due to living situation
• For an individual of this age, refer to the adult functional screen

For the Children's Long-Term Support (CLTS) Program, the following Eligibility Results are possible:

• Mental Health Target Group (Psych Hospital LOC)
• Physical Disability Target Group (Nursing Home LOC)
• Physical Disability Target Group (Hospital LOC)
• DD Target Group (ICF-IID/DD1 LOC)
• DD Target Group (ICF-IID/DD2 LOC)
• Not eligible due to living situation
• This screen should not be used for an individual of this age
• Not functionally eligible

Note: The CLTS Waiver Functional Eligibility Results will list all the target groups for which the child meets functional eligibility requirements. The decision of which target group to select for a child is the responsibility of the agency or county using the CLTS Waiver.

For Katie Beckett Medicaid, the following Eligibility Results are possible:

• Psychiatric Hospital Level of Care
• Hospital Level of Care
• Nursing Home Level of Care
• ICF-IID/DD1 Level of Care
• ICF-IID/DD2 Level of Care
• Functionally eligible but is in an ineligible living situation
• Not eligible due to age
• Not functionally eligible

For the Mental Health (MH) Wraparound, the following Eligibility Results are possible:

• Functionally eligible
• Not functionally eligible
• Not eligible due to age

Pending Results may include:

• Requires a disability determination
• Living Situation
• N/A
• None

If a CLTS FS indicates there are Pending Results for functional eligibility, only when those issues are resolved can one determine that a child actually meets the functional eligibility requirement for that particular program. 

The CLTS FS Functional Screen Information Access (FSIA) pending timeframe is 31 days. This allows screeners additional time to review a child’s not functionally eligible (NFE) results, consult with their agency’s CLTS FS lead, and email DHS at dhscltsfs@dhs.wisconsin.gov to resolve any issues. Screeners should continue to check the box to send results to iChange immediately when the calculated result remains eligible. If the screen is NFE, the results should not be sent to iChange.

An exception to Pending Results:

If a child has a pending result that reads, “Requires a disability determination,” for Katie Beckett but the child is applying for the CLTS Program, the application can proceed. This pending result will continue to display for state-funded CLTS requirements.

At the bottom of the page is the reminder that “This does not include FINANCIAL eligibility.” This is important because financial eligibility is significant to certain programs.

10.2 Confirming the Functional Eligibility Results

Screeners, as knowledgeable professionals in the field who have met the child and reviewed valuable information about them, are responsible for confirming that the results of the CLTS FS agree with their professional judgment. If the outcome is not what the screener expected, the screener needs to complete a thorough review of the screen. If the results are the same following this initial review, they should conduct an internal review with someone else from the same agency. If the results are still in question, the screener should email the CLTS FS mailbox at DHSCLTSFS@dhs.wisconsin.gov for assistance.

If the child is found not functionally eligible (NFE), the screener should always request an internal review by their agency. Each agency is responsible for quality assurance at a local level. When specific questions arise and eligibility results cannot be verified, consult with state staff by emailing the CLTS FS mailbox at DHSCLTSFS@dhs.wisconsin.gov.

Online enrollment automatically verifies that waiver participants meet functional eligibility requirements. A screener must determine, initially and annually, that each waiver participant is functionally eligible, as calculated by the CLTS FS. When enrolling a child from the Children’s Long-Term Support Wait List, the screen determining functional eligibility must have been calculated by a certified screener within the last 12 months.

Screeners will only transfer CLTS FS results to iChange (check the box on the Functional Screen Information Access (FSIA) system’s eligibility results page) when a child is found functionally eligible. If a child is found NFE, screeners should email the CLTS FS mailbox at DHSCLTSFS@dhs.wisconsin.gov for assistance. The transfer to iChange box should not be checked until the NFE is confirmed by DHS staff. 

With All NFE Results 

CLTS Functional Screen results can pend up to 31 calendar days before affecting enrollment, allowing time to review screens and address any issues.

Additionally:

• The screener will not check the box on the eligibility results page to transfer NFE results to iChange.
• Screens are subject to DHS NFE protocol. Screeners may be contacted with questions or further instructions.
• Screeners must work with DHS and follow the state’s guidance to resolve any functional screen issues or errors.
• After 31 days, an NFE result for an enrolled participant will automatically be transferred to the EES online enrollment system and the CWA must enter an end date into EES.

10.3 Sharing Functional Eligibility Results with Others

If the screener sees from the results that the child has met the functional eligibility for another program, the screener should discuss these programs with the family, answer any questions they may have about the other programs, and make a referral to these programs if the family would like. Remember, the CLTS FS does not determine program eligibility, so being found functionally eligible for a program does not guarantee program eligibility.

10.4 Functional Eligibility Results Affecting Eligibility for Other Programs

The CLTS FS determines functional eligibility for multiple programs. Therefore, it may find children not functionally eligible for multiple programs. When the functional eligibility results indicate that a child is no longer functionally eligible for a program, they are currently receiving services from, it is the screener’s responsibility to inform that program of the results within two business days of a confirmed NFE. If a screener is completing a CLTS FS for CCOP and the results indicate that the child is no longer eligible for Katie Beckett Medicaid, CCOP has a responsibility to inform Katie Beckett Medicaid of this change immediately. Similarly if a screen is being completed for CCS recertification and the screen no longer reflects functional eligibility for a waiver program, the CCS screener must inform the affected program and work collaboratively to confirm accurate results.

It does not matter which program completed the CLTS FS as the functional eligibility results are binding for all programs the child is enrolled in. Therefore, it is important that the CLTS FS is accurate and is completed using only factual information.

The following outlines the procedure to follow when a screen shows a change to Not Functionally Eligible from previously Eligible:

Step 1: If the screen results change the child’s functional eligibility for Katie Beckett Medicaid from Functionally Eligible to Not Functionally Eligible:

1. Email the KBP Central Office at DHSKatieBeckett@dhs.wisconsin.gov.

• In the “Subject” heading state: Change in FS Results. 
• In the “Message” of the email indicate the first and last name of the child, spelled correctly, and describe the change in their functional eligibility results. 
• Be sure your email includes your full name, title, and phone number.

2. Administrative staff at KBP Central Office will forward your email to the assigned Katie Beckett staff. Staff will contact you to discuss the screen results.

Step 2: If the screen results change the child’s eligibility for any other program (not including Katie Beckett) to Not Functionally Eligible, then you must contact all programs for whom your screen changed eligibility results and work with them to either confirm or update the screen.

The screen lead you contact must reply to you with the needed information within 10 business days. If the previous screener does not reply to your original request within 10 business days, continue with your customary process for finalizing and communicating to the family the eligibility results for your program. Continue to reach out to the other programs.

Step 3: If the child is currently active on both Katie Beckett Medicaid and the CLTS Waiver, the screener for the CLTS Waiver takes the lead in the discussion regarding the change in the CLTS FS results. Katie Beckett Medicaid staff are not involved at this point because they have had no recent contact with the child for review of eligibility. Refer to Termination of CLTS Waiver Participation policy for further information as needed.

Step 4: You and the previous certified screener(s) will have a dialogue about the child’s needs and functional eligibility upon the exchange. Remember that there are many reasons why eligibility results may have changed, including a change in the child’s condition, their age, or that different information was obtained from a variety of sources. You will discuss the need for any further information with the other screener(s) and agree on a method to collect this. If appropriate, you will make edits to the screen using the new or expanded information gathered during this process and recalculate eligibility.

Step 5: If you and the previous screener agree that the results of the most current finalized screen are accurate and reflect your experience with the child and family, then each screener will proceed with the actions appropriate to the program with which they work. 

If the result of this process is that you and the previous screener are unable to reach an agreement about the screen results, you must refer this situation to the CLTS FS team for a final decision. Email the CLTS FS team at dhscltsfs@dhs.wisconsin.gov.

10.5 Completed CLTS Functional Screen Summary Report

At the conclusion of the functional eligibility determination the family must be provided with a copy of the functional screen report and notified of all the programs for which the child in their care is eligible.

When the family is interested in pursuing enrollment in other programs for which the child in their care is eligible, the sending entity/program must assure connection to the other program and include the individual in the process. This should include communication involving the family and both providers. Receiving program shall provide verification of family contact to the sending program.

Receiving program must accept the functional screen as fulfilling their program requirements for functional eligibility and will comply with additional program requirements to complete eligibility and enrollment. Please note functional screens are valid for 12 months and do not need recalculation prior to this time unless eligibility for a program has not been determined.