Summary of Revisions to the Medicaid Home and Community-Based Services Waiver Manual for the Children’s Long-Term Support Waiver Program
The updates included in the most recent (May 2024) version of the Medicaid Home and Community-Based Services (HCBS) Waiver Manual for the CLTS Waiver Program, P-02256 (PDF), are summarized below.
Chapter 1–Overview and Administration
Added § 1.5 Program Quality Measures
Chapter 2–Eligibility
- § 2.8.1: Added condition for enrollment termination: Participant requests to end their enrollment; and retitled condition “The participant fails to meet post-eligibility program requirements” to “The participant fails to meet responsibilities outlined in the Participant Rights and Responsibilities Notification (F-20985) section G., …”
- Added § 2.8.2.1 Considerations for Medicaid Continuous Coverage
Chapter 3–Financial Eligibility
No changes
Chapter 4–Provider Requirements and Allowable Services
- § 4.2.1: Clarification that to initially qualify agency providers, the Wisconsin Department of Health Services (DHS) collects certification, license, education, or experience that is required at the agency level
- § 4.2.2: Clarification that to fully qualify agency providers, county waiver agencies (CWAs) verify any certification, license, education, or experience that is required for rendering providers employed by the agency, to fully meet the selected service description
- § 4.5.2: Added referral to Chapter 5 for information about the exceptional expense process for a participant who resides in or is being placed in a level 5 foster home
- §§ 4.5.3.1 and 4.5.3.2: Removed requirement to update high-cost submissions when the project is delayed to another calendar year
- § 4.5.4: Added instructions for accessing the Children's Long-Term Support (CLTS) Rate Setting Outlier Request Processing Application User Guide in the ForwardHealth portal
- § 4.6.2.3: Added assistive technology service limitation about billing for rendered services, for the purchase of service dogs
- § 4.6.4.2: Added children’s foster care service requirement for prior approval from DHS for payment of costs through this service when the cost for a participant in a level 5 foster home exceeds the maximum amount of the highest Residential Care Center (RCC) facility on the Wisconsin Department of Children and Families’ RCC daily rate schedule
- § 4.6.4.4: Added children’s foster care service exclusion prohibiting claims for the cost of basic care and supervision for participants who reside in or are being placed in a level 5 foster home
- § 4.6.18.3: Added home modifications service limitation about billing for rendered services
Chapter 5–Use of Funding in Substitute Care
- § 5.2: Clarifications related to determining allowable costs for children’s foster care services and adult family home services
- § 5.2.1: Clarifications related to allowable costs of care and supervision for participants who reside in or are being placed in a level 5 foster home
Chapter 6–Enrollment and Recertification
No changes
Chapter 7–Individual Service Plan
No changes
Chapter 8–Participant Rights and Appeal and Grievance Processes
§ 8.2.2: Added notice of adverse action (NOA) requirements for failure to meet participant responsibilities
Chapter 9–Health and Safety
- § 9.3: Clarified incident definition of alleged abuse or neglect
- § 9.3.3: Added incident notification requirements for participants 18 years old or older who do not have a legal representative
- §§ 9.4.1-9.4.7: Reordered to group sections about specific topics together
- § 9.4.5: Added examples of protective equipment that must be considered for DHS approval for planned use, and a reference to Instructions and Requirements for the Use of Protective Equipment and Mechanical Restraints in Children’s Long-Term Support Programs, P-02616 (PDF), for more information about definitions of restrictive measures eligible for approval and conditions under which those measures would be considered for approval
Chapter 10–Transition
No changes
Appendix A
Updated