Children's Long Term Support (CLTS) Guidelines & Forms

Guidelines and Forms for Medicaid Waiver Payments

• CLTS Audit Guidelines
• CLTS  Waiver Manual

• Calculating CLTS Foster Care Room and Board Expenses
• F-01715 Actual Expenses
• F01716 Uniform Foster Care Brochure
• Foster Care Expense Letter
• Foster Home Specific Expenses Worksheet

• Contract 21
• CLTS Appendix A
• CLTS Appendix B
• CLTS Appendix C
• CLTS Appendix D
• Form W-9

How to become an approved provider for CLTS services:

The link below will assist you with the process of registering to become a provider.  Registering with the Department of Health Services (DHS) is the first step in becoming an approved provider of CLTS waiver services.

https://www.dhs.wisconsin.gov/clts/provider-home.htm

Third –Party Administration (TPA) Claims Processing for CLTS

The Department of Health Services (DHS) has contracted with a Third Party Administrator (TPA) claims processing vendor for the Children's Long-Term Support (CLTS) Waiver provider services. The DHS TPA vendor is Wisconsin Physicians Service (WPS). WPS processes and issues payments for CLTS services, collects and reports claims data, and recovers overpayments on behalf of DHS according to federal regulations.  The link below will assist you with claims process for CLTS.

https://www.dhs.wisconsin.gov/clts/tpa.htm