children’s long-term support (clts) waiver program … · children’s long-term support (clts)...
TRANSCRIPT
Wisconsin Department of Health Services
Jill Groblewski
BCLTSS Program and Policy Analyst
Children’s Long-Term Support
(CLTS) Waiver Program and
Online Enrollment
• Online enrollment system that verifies ongoing eligibility
• Initial eligibility determination
◦ Conducted by county waiver agencies (CWAs)
◦ Follows criteria in the Waiver Manual
◦ Completed within 45 days of referral
◦ CWAs must send denial letters to ineligible applicants
CLTS Online Enrollment
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Earliest date all three conditions are met:
◦ Child is enrolled in Medicaid
◦ Child meets CLTS functional eligibility
◦ Support and service coordinator (SSC) has initiated development of an Individual Support Plan (ISP)
Enrollment Effective Date
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Supports and services begin on or after the enrollment effective date.
◦ No backdating enrollment
◦ Current practice continues for:
• SSC enrollment activities up to 90 days prior to enrollment
• Supports and services to facilitate a transition from an ineligible setting
Service Start Date
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• Continuous Medicaid enrollment
• Functional eligibility
◦ Initially determined by an SSC
Within 12 months of enrollment
◦ Annual rescreen
Ongoing Eligibility
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Enter any changes affecting enrollment within 10 calendar days.
Changes
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• Bureau reviews all NFE results.
◦ May contact a CWA with questions or further instructions
◦ Will work with the CWA to resolve issues or errors
• Only send results when child is found functionally eligible.
• Functional Screen Information Access (FSIA) sends results after 10 days.
Not Functionally Eligible (NFE)
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• Do not transfer eligibility results.
• May have a second screener review.
• May ask the Department of Health Services (DHS) to review.
◦ “NFE Review” in subject line
• If confirmed NFE, CWA must send denial notice and appeal rights.
NFE – Initial Application
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• Do not transfer eligibility results.
• Must have a second screener review.
• Must notify DHS.
• Delay disenrollment until the second screener and DHS confirm NFE.
System automatically sends denial notice and appeal rights
NFE – Update or Recertification
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• Notify DHS immediately.
◦ “NFE Review: non-CLTS screener” in subject line
• SSC must review the screen.
• If NFE was calculated in error:
◦ Correct the screen.
◦ Case note the reason.
NFE – By Another Program
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• If there are significant changes in the child’s condition:
◦ SSC conducts a rescreen.
◦ Delay disenrollment until second screener and state confirm NFE.
System automatically sends denial notice and appeal rights
NFE – Another Program (cont.)
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Continue to use ISP and Individual Outcomes forms:
◦ F-20445
◦ F-20445A
ISP Procedures
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• Within EES, this is the date that the SSC and family agree to services listed on the ISP.
• Do not delay enrollment or services while obtaining necessary signatures.
ISP Completion Date
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• Entering this date into the system indicates:
◦ All assessed needs have been addressed on the ISP.
◦ Waiver providers on the ISP meet necessary qualifications.
◦ ISP adheres to CLTS Waiver Program requirements.
ISP Completion Date (cont.)
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• SSCs will change an ISP more often than is recorded in online enrollment.
• Only enter ISP Completion Date online at:
◦ Initial enrollment.
◦ Recertification.
◦ End of a suspension.
ISP
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• Enrollment effective date: SSC has initiated development of ISP
• ISP Completion date: SSC and family have agreed to services listed on the ISP
• ISP signatures: SSC has 60 days from date services are agreed upon to obtain necessary signatures
ISPs and Dates
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• Follow current policy and procedure.
• Continue to use:
Worksheet for Determination of Parental Payment Limit for Children's Long-Term Supports
• Enter monthly amount online.
Even when fee is determined to be $0
Parental Payment Fees
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• SSC annually conducts CLTS Functional Screen.
• SSC annually recertifies participant eligibility for the waiver program.
Can conduct a recertification sooner, but not later, than the last day of the month, 12 months from the enrollment effective date or last recertification completion date.
Annual Recertifications
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• Suspension may last up to 90 days.
◦ Start date: first full day in an ineligible setting
◦ End date: last full day in an ineligible setting
• CWAs must send notice of suspended services.
• Program requirements are also suspended.
Suspend Status
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• May continue to bill for services with monthly fees.
◦ Personal emergency response systems (PERS)
◦ Monthly fiscal agent fees
◦ Waiver-allowable foster care expenses
During Suspend Status
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• Current policy applies to transitioning back to an eligible setting.
◦ Supports and services
◦ Transitional support and service coordination
During Suspend Status (cont.)
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• ISP
◦ Review with the participant/family
◦ Update, as needed
◦ Record updated ISP Completion Date
• Automated notice confirming enrollment sent to the family
Ending a Suspension
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• Recertification due date
◦ Remains 12 months from enrollment or last recertification date
◦ Requires online adjustment
Ending a Suspension (cont.)
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• Complete all of the steps for a recertification according to current policy.
• Follow NFE process, if relevant.
• New recertification date is 12 months from the new effective date.
Ending a Suspension When a
Recertification Was Due
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• It is verified that the child no longer meets CLTS Waiver Program eligibility requirements.
• The family communicates that they do not want to receive services through the program.
Disenrollment Reasons
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• Reasons
◦ Loss of Medicaid enrollment
◦ Loss of functional eligibility
◦ Late annual rescreen
◦ Participant ages out
• Resolved within three months: automatic reenrollment with up to a three-month backdate
• Automated notices
Automated Disenrollment
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• Use reports to track program enrollments and disenrollments
• Need to work collaboratively with other systems
◦ Medicaid sources
For example, Department of Children and Families, Income Maintenance
◦ Functional eligibility determinations
For example, Katie Beckett, Comprehensive Community Services
Avoiding Unintended Disenrollments
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• Inform DHS immediately when a family appeals a decision to disenroll.
• New application is required if a child has been disenrolled longer than 90 days.
Disenrollment
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• Follow current policy and procedures.
• Provide seamless transition.
• Sending county must end enrollment before the receiving county can enter a new enrollment online.
County Transfers
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• Enrollment ends due to aging out, confirmed NFE, or other reason.
• Work with the family to discuss and identify:
◦ Health insurance options.
◦ Other programs and resources.
Transition
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Use reports to:
◦ Track and verify enrollment.
◦ Track and verify disenrollment.
◦ Conduct timely recertifications.
Reports
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For enrollment and disenrollment:
◦ System will automatically send to families
◦ CWAs will no longer send to families
◦ CWAs will no longer send copies to DHS
Automated Notices
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CWAs must continue sending notices to families for:
◦ Initial application denials.
◦ Suspension of services.
◦ Reductions or terminations in services.
◦ Denials of choice in type of waiver service or qualified provider.
Required Notices
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• With online enrollment, discontinue using and sending:
◦ Eligibility Verification Step 1
◦ Eligibility Verification Step 2
◦ Recertification Checklist
◦ Change Report
• Discontinue sending ISPs to the Bureau, except as requested.
Obsolete Forms
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• Children’s services specialist assigned to your county
Contact Information
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