Children's Long-Term Support Program: Provider Medicaid (MA) Agreement and Qualification Process
The purchase of care and services (POS) is defined in Wisconsin Stat. § 46.036, requiring the Department of Health Services (DHS) to establish standards and requirements for the contractual relationship between purchasers and providers related to the purchase of care and services. Wisconsin’s statutory POS contracting and audit regulations detailed in Wis. Stat. § 46.036 are not applicable to the Children’s Long-Term Support (CLTS) Program.
The practice of county waiver agencies (CWAs) entering into a POS contract with CLTS Program providers and including these providers in the single state audit is no longer appropriate.
Effective January 1, 2025, CWAs will no longer enter into POS contracts with providers for CLTS services.
Federal regulations
The Wisconsin Department of Health Services (DHS) must comply with the requirements described in 42 CFR § 431.51, which requires state Medicaid agencies to allow Medicaid members to get services from any willing and qualified provider.
DHS must provide for the continuous, open enrollment of waiver service providers.
Participant freedom of choice
CWAs, participants, and families have access to the statewide CLTS Provider Directory, which displays willing and qualified providers who meet the qualifications set forth in the CLTS Waiver Manual, P-02256.
No local restrictions may be imposed on the CLTS provider that may cause barriers to the participant’s freedom of choice in using a willing and qualified provider.
CLTS Waiver Program Provider Agreement
CLTS providers sign the Wisconsin Medicaid Provider Agreement and Acknowledgement of Terms of Participation for the CLTS Waiver Program.
The agreement requires CLTS providers to comply with:
- Applicable federal and state statutes and regulations.
- The standards for the specific CLTS waiver service the provider will deliver and other requirements as defined in the CLTS Waiver Program Manual.
- Acceptance of the state’s rate as payment in full for rendering a service.
The agreement between DHS and CLTS providers may be terminated by DHS upon grounds set forth in Wis. Admin. Code ch. DHS 106.06.
Questions and answers
DHS began completing the background checks for sole proprietors beginning January 1, 2025. DHS will update the CLTS Waiver Program Manual in February 2025 to reflect this change. We acknowledge the need for interim guidance on background checks.
- Provider agencies will remain responsible for the staff they employ.
- There is no change to individual providers who are hired and paid via financial management service (FMS) agencies.
CWAs should report concerns with providers that may warrant termination from Wisconsin Medicaid to the Bureau of Children's Services (BCS) by emailing the provider relations inbox at dhscltsproviderrelations@dhs.wisconsin.gov.
DHS requires providers to provide evidence of insurance for transportation, foster care staff, and agencies as outlined in the waiver manual.
DHS will not be entering into an indemnification agreement with the CWAs, as they do not need DHS to indemnify them. The CWAs are not liable for the actions of the CLTS Program providers.
CWAs cannot replace POS contracts with MOUs or different agreements/contracts to authorize services. CWAs will need to use other strategies to establish a shared understanding and a process for sharing information with providers.
For the review period beginning January 1, 2025, Section 4: Qualified Providers and Measure 4.1: Documentation of State and waiver training specific to participant needs, prior to service authorization will no longer be included as record review measure conducted by MetaStar.
Instead, Measure 4.1 will be reported as an administrative measure and DHS will be responsible for collecting necessary documentation from CLTS Program providers. The calendar year 2025 record review tool will be published to reflect this information in early 2025.
Per the 2025 Purchase of Service Memo and Guidance on Purchasing Care and Services Under Wis. Statutes 46.036, P-80048 (PDF) issued on November 4, 2024, Medicaid and Medicaid home and community-based service payments are to be excluded when calculating the cumulative total of DHS funds that count towards the $100,000 threshold.
Medicaid fee-for-service providers are exempt from audits per 2 CFR Part 200 Uniform Guidance.
This change is effective for audit periods ending on or after December 31, 2024, and no retroactive adjustments or allowances for prior periods will be made.
2024 CLTS provider audits are not required, and an audit waiver is also not necessary or appropriate. Do not request or require audits of these providers that you contracted with for CY2024.
Beginning January 1, 2025, DHS "approves" providers instead of the CWA until we are able to remove this functionality within the system. CWAs will continue to have access to all information for approved providers in their county.
The statewide rate methodology primarily sets rates for CLTS services with a direct care provider component. Services exempt from the rate methodology will continue to be paid at market rates.
Market rate providers must provide the CWA with their market rate service cost.
Support and service coordinators (SSCs) enter and use the service provider's market rate for the individual service plan (ISP) development and in parental payment limit (PPL) calculation.
There is no impact to subcontracted relationships for support and service coordination.
Individual service plan (ISP) development and provider selection is very important. SSCs work with families to identify providers who are qualified, willing, and able to provide the service(s) to meet the identified outcome(s).
Once the participant chooses the provider, CWAs should work with the family and provider to ensure the outcome(s) is being met effectively. If not, everyone should work together to support service provision to meet the outcome(s). This may mean deciding to change the staff person from a provider agency or switch to a different provider.
When there are provider issues that cannot be resolved through communication with the service provider and that may warrant termination from Wisconsin Medicaid, contact the DHS CLTS Provider Relations Coordinator at DHSCLTSProviderRelations@dhs.wisconsin.gov.
Questions?
Contact the BCS Technical Assistance Center with additional questions:
Voicemail: 608-267-6767
Email: dhsbcstac@dhs.wisconsin.gov
DHS CLTS Provider Relations: DHSCLTSProviderRelations@dhs.wisconsin.gov