7. What Services Might be Covered?

#7 in our series on the Children’s Long-Term Support Waiver

What is the Children’s Long–Term Support (CLTS) Waiver Program?

The CLTS Waiver Program provides funding and support for families who have children with disabilities, who are Medicaid eligible, so they can care for their children at home and participate in their communities. This fact sheet provides a description of covered service categories in the CLTS Program. This is also called the benefits package.

For the CLTS Program to cover a service, it must be included in a child’s Individual Service Plan (ISP). (See Family Voices of Wisconsin CLTS Fact Sheets #5 and #6 for details on the ISP). As a family works with their service coordinator to develop outcomes and craft their child’s ISP, this list can help you think broadly about what might be helpful and beneficial to your child.

If your child’s service coordinator is not familiar with a covered service or item, families can contact their County Waiver Agency or the Children’s Services staff at the Department of Health Services or go to dhs.wisconsin.gov/clts/waiver/family/services.htm.

Need Help Finding a CLTS Provider?

Your service coordinator is responsible for finding providers for your child’s needed services. Sometimes, especially in rural areas, there aren’t enough qualified and certified providers. Feel free to try to find providers yourself and work closely with your service coordinator.

Services That Can be Covered Under the CLTS Program:

• Adaptive Aids • Adult Family Homes • Assistive Technology and Communication Aids • Children’s Foster Care • Child Care • Community Integration Services • Consumer Education and Training • Counseling and Therapeutic Services • Daily Living Skills Training • Day Services • Financial Management Services • Home Modifications • Housing Counseling • Mentoring • Nursing Services • Personal Emergency Response System • Relocation Services • Respite Care • Specialized Medical and Therapeutic • Supplies • Support and Service Coordination • Supported Employment – Individual • Supported Employment – Small Group • Supportive Home Care • Training for Unpaid Caregivers • Transportation

Children’s Long–Term Support Program Description of Covered Services

Adaptive Aids: Items, controls, or appliances that enable the child or youth to increase his or her ability to perform activities of daily living, and successfully access, navigate, and participate in his or her home and community. Examples include: accessible computer keyboards, adaptive bikes or tricycles, adaptive door handles and locks, adaptive security systems, computers and necessary software, hygiene and meal preparation aids, scald-preventing showerhead, service animals, specialized clothing, standing boards or frames, vehicle lifts or transfer units.

Adult Family Homes: Provides individualized treatment, supports, and services above the level of room and board for one to four people living together in a residence that is certified or licensed as an adult family home.

Assistive Technology and Communication Aids: Items, pieces of equipment, product systems, or services that increase, maintain, or improve functional capabilities of children at home, work and in the community.

Child Care: Ensure the child’s or youth’s exceptional physical, emotional, behavioral, or personal care needs are met during times when his or her family members are working, pursuing education and employment goals, or participating in training to strengthen the family’s capacity to care for their child. For a child under age 12, CLTS will pay for the additional cost of child care to meet the child’s exceptional care needs. This includes staffing necessary to meet the child’s care needs above and beyond the cost of basic child care that all families with young children may pay. For a child age 12 or older, the total cost of child care may be included.

Children’s Foster Care: Services are allowable for a child who is placed in a residence operated as a foster home by a licensed person and includes 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.

Community Integration Services: Primarily for families with children who have multiple and complex mental health and/or behavioral concerns, and are involved in multiple services and service systems, this service covers intensive case coordination and individualized community-based services.

Consumer Education and Training: This service includes education, training and events directly related to building the capacity to manage supportive services. Education and training may be provided for the child and/or the child’s parent(s), unpaid caregiver(s), and/or legal representatives. Types of education and training include: training courses, conferences and similar events, enrollment fees, books and other educational materials, and transportation.

Counseling and Therapeutic Services: Covers professional evaluation and consultation services to children and youth with identified needs for physical, personal, social, cognitive, developmental, emotional, or substance abuse services. This service can include therapies that are not available under the Medicaid State Plan. Counseling and therapeutic services must meet a clearly defined outcome and may include the following: music therapy, art therapy, hippotherapy or equine-assisted therapy.

Daily Living Skills Training: Provides education and skill development or training to support the child’s or youth’s ability to independently perform routine daily activities and effectively use community resources. These instructional services, provided by qualified professionals, focus on skill development (and do not provide substitute task performance).

Day Services: Provide youth with regularly scheduled activities for part of the day to target skill development and maintenance. Services are typically provided up to five days per week in a nonresidential setting and may occur in a single physical environment or in multiple environments, including natural settings in the community. Coordination activities may consist of the implementation of components of the youth’s individualized service plan and may involve family, professionals, and others associated with the youth, as directed by his or her plan.

Financial Management Services: Assist a child and his or her family to manage the CLTS Waiver Program services and funding. A financial management services provider (also called the fiscal intermediary or fiscal agent) performs financial transactions on behalf of the child or youth for the delivery of CLTS Waiver Program services. The fiscal intermediary also serves as an agent for handling employment-related tasks associated with the authorized supports and services in the child’s ISP.

Home Modifications: Include services to assess the need for, arrange for, and provide modification and/ or improvements to the home. Home modifications are generally permanent fixtures and/or changes to the physical structure of the home. This service may be used to ensure safe, accessible means of entry and exit to the home, and provide safe access to rooms, facilities or equipment within the home or adjacent buildings that are part of the residence.

Examples of Home Modifications Include: Fences required for safety; fixed ramps and platforms; porch and/or stair lifts; doors, doorways, door handles, and door opening devices; adaptive door bells, locks, and/or security items or devices; plumbing and electrical modifications related to other adaptations; medically necessary heating, cooling, or ventilation systems; shower, sink, tub, and toilet modifications; accessible cabinetry, countertops, or work surfaces; wall protection; necessary repair, maintenance, and reasonable replacement of an approved home modification.

Housing Counseling: This service provides comprehensive guidance about options for a youth to obtain or retain safe, accessible, and affordable housing in the community that meets their needs and preferences. Housing counseling includes planning, guidance, and assistance in accessing resources in the following areas: home ownership; financing: accessibility and related architectural services and consultation; and health and safety evaluations for physical property.

Mentoring: Improves a child’s ability to interact in their community in socially advantageous ways. The mentor provides the child or youth with experiences in peer interaction, social and/or recreational activities, and employability skill-building opportunities during spontaneous and real-life situations, rather than in a segregated or classroom-type environment.

Nursing Services: Assist a child or youth with health and health-related tasks in the child’s home and community. Covers medically necessary, skilled nursing services that may only be provided safely and effectively by a nurse practitioner, a registered nurse, or a licensed practical nurse working under the supervision of a registered nurse. Nursing services may include periodic assessment of the child’s medical condition and may also include regular, ongoing monitoring of a child’s fragile or complex medical condition as well as the monitoring of a child with a history of noncompliance with medication or other medical treatment needs.

Personal Emergency Response System: This service secures an immediate response and access to assistance in the event of a physical, emotional, or environmental emergency. A PERS uses a community-based telephonic, global positioning system, or other electronic communications device to provide a direct electronic communications link between the child or youth and emergency responders.

Relocation Services: This service assists with preparations for the child’s or youth’s relocation to a safe and accessible community living arrangement. This service includes supports and essential items needed for a child or youth to establish a community living arrangement when he or she is relocating from an institution or foster home to a less restrictive setting, or when the youth is moving out of his or her family’s home to a more independent setting.

Respite Care: Maintains and strengthens the child’s or youth’s natural supports by easing the daily stress and care demands for his or her family, or other primary caregivers, on a short-term basis. This service provides a level of care and supervision appropriate to the child’s needs while his or her family or other primary caregivers are temporarily relieved from daily caregiving demands. Respite care may take place in a residential or institutional setting, the family’s home, the home of a caregiver, or in other community settings.

Specialized Medical and Therapeutic Supplies: This service includes items that prevent regression of a child’s or youth’s condition, maximize integration within the community, and promote and enhance peer interaction and social inclusion. Allowable items may include the following (items listed are illustrative examples and not an exhaustive list): Items and aids designed to augment a professional therapy or treatment plan, Items and aids to support environmental regulation assessed as necessary for the child’s or youth’s condition.

Support and Service Coordination: 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.

Supported Employment—Individual: Assists a youth to attain sustained employment paid at or above minimum wage in an integrated setting in the general workforce, in a job that meets the youth’s personal and career goals.

Supported Employment—Small Group: Assists a youth to attain sustained employment and work experiences that foster further career development and individual, integrated community-based employment, in a job that meets the youth’s personal and career goals.

Supportive Home Care: Directly assists the child or youth with daily living activities and personal needs, to promote improved functioning and safety in his or her home and community. SHC may be provided in the child’s home or in a community setting and includes: direct assistance with instrumental activities of daily living, supervision necessary for safety at home and in the community, including observation to assure appropriate self-administration of medications, assisting bill paying and other aspects of money management, assisting with communication, arranging and using transportation, checking out library books; and other household tasks.

Training for Unpaid Caregivers: Training focuses on techniques for supporting children with and without disabilities, keeping family balance and harmony in the home, and communicating effectively, which promote inclusion, support independence, and foster growth for both the child or youth and their family. This service includes, but is not limited to, in-person training, parent-to-parent mentoring, conferences, resource materials, online training, registration and training fees associated with formal instruction.

Transportation: This service funds nonmedical, nonemergency transportation needs related to engaging and participating in a child or youth’s community—with the people, places, and resources that are meaningful for his or her self-determination—and to meet his or her goals and daily needs.

If you have questions, you can contact your service coordinator, your service coordinator’s supervisor, or your Regional Center for Children and Youth with Special Health Care Needs. To find your Center, go to dhs.wisconsin.gov/cyshcn/regionalcenters.htm or call 800.642.7837.