STATE OF WISCONSIN
Department of Health and Family Services
Division of Children and Family Services
Division of Disability and Elder Services
               DCFS Memo Series 2005 -09
               DDES Memo Series 2005 -19
               October 19, 2005

         Re:  POLICY GUIDANCE ON 
                 SERVING CHILDREN IN THE
                 CHILDREN'S LONG TERM 
                 SUPPORT WAIVERS
                AND CHILD WELFARE SERVICES

 

To:  County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County Child Welfare Supervisors
County Mental Health Supervisors
County Long Term Care Coordinators
From: Burnie Bridge
Administrator
Division of Children and Family Services
Sinikka Santala
Administrator
Division of Disability and Elder Services

 Document Summary

This memo provides a synopsis of the Children's Long Term Support Waivers (CLTS) and child welfare services, with programmatic and fiscal direction for administering case management services and exceptional placement cost claiming for children enrolled in both programs.

 

The purpose of this memo is to describe the requirements of and provide direction on state and local claiming for administrative and service expenditures associated with the Children's Long-Term Support Medicaid Home and Community-Based Services Waivers (CLTS Waivers) and child welfare services. Attachments A & B provide an overview of the program background and philosophy, service requirements and components, and a fiscal overview for each program respectively.

This memo was developed jointly by the Division of Disability and Elder Services (DDES) and the Division of Children and Family Services (DCFS), in collaboration with county representatives, Human Services Area Coordinators and the Division of Management and Technology (DMT). The memo briefly describes related federal requirements and provides state policy related to program operation and fiscal claiming for case management or service coordination activities and exceptional placement costs when children and their families are being served in both the CLTS Waivers and child welfare programs.

Case Management Claiming for Title IV-E and Support and Service Coordination for CLTS Waivers

The federal Centers for Medicaid and Medicare Services (CMS) has established a policy related to third party liability in cases where services can be claimed to Title IV-E. This requirement states that whenever a service can be claimed to Title IV-E, Title IV-E must be payor of first resort (an exception to this is noted in "Exceptional Placement Cost Claiming " below). As such, Medicaid, whether claimed through the CLTS Waivers or through some other Medicaid program, such as Targeted Case Management (TCM), may be claimed only if the service is not covered by Title IV-E.

The CLTS Waivers generally pay AFTER Medicaid Fee for Service, however TCM is paid first by the CLTS Waiver for Waiver clients and not through Medicaid Fee for Service (exception: Children in Community Support Program (CSP) and CLTS Waiver will bill TCM to CSP, NOT CLTS Waiver).

To ensure that duplicate billing for services does not occur, if a child is temporarily being served in the Child Welfare program AND the child has been determined eligible and received a CLTS Waiver slot for which the county is also providing Support and Service Coordination, the county agency should do one of the following:

  • Have two different staff persons provide Support and Service Coordination (case management) functions where one staff person is responsible for CLTS Waiver functions and the other staff person is responsible for child welfare functions. Ensuring that:
  1. Support and Service Coordination through the CLTS Wavier is related to disability or waiver services and is performed by a staff person who is not also providing child welfare case management to address child welfare concerns.

  2. Child welfare case management is performed by a staff person who is not also providing disability or waiver-related case management for the same client or client family. This staff person is to be included in the agency's staff roster submitted as required for the Department's Social Services Random Moment Time Study (SS RMTS).

OR

  • Have one staff person provide both CLTS Waiver Support and Service Coordination and child welfare case management functions. If child welfare and CLTS Waiver case management is performed by one staff person, the county agency must ensure that claims to the Medicaid program under the CLTS Waiver are consistent with Medicaid third party liability policy. Claiming practices which meet the Department's SS RMTS requirements and ensure consistency with Medicaid third party liability are as follows:
  1. The staff person is to be listed on the agency's staff roster per the Department's direction for SS RMTS requirements and;

  2. Support and Service Coordination activities are claimed as an allowable expense under the CLTS Waiver only when the activity is directly and solely related to one or more of the services covered under the CLTS Waiver program. A list of these services is provided in Attachment A of this memo.

  3. Activities that are related to child welfare case management are claimed as an allowable administrative activity to the Title IV-E program through the Department's Cost Allocation Methodology and may not be claimed by local county agencies to the Medicaid program under the CLTS Wiaver. A list of the general case management activities that are covered by and, therefore, claimed to Title IV-E by the Department is provided in Attachment B of this memo.

Documentation of all contacts on behalf of the child and his/her family is required for both programs. Documentation of contacts should be recorded in eWISACWIS Case Notes window for child welfare services and must be documented in the Support and Service Coordinator's case notes for CLTS Waiver services. This documentation is to include the date and time of contacts, the participants in the contact, the purpose of the contact and the results of the contact. Documentation must be kept in this manner regardless of whether a county has separate program support and service coordination/case management staff for each program, or a single individual performing support and service coordination/case management for both programs. This ensures accountability to the programs' respective federal regulations.

Exceptional Placement Cost Claiming

The CLTS Waivers list "Foster Care" as a possible service. Allowable services under Foster Care for the CLTS Waivers are those supports that are supplemental for supporting a child with a disability in a foster care setting, not basic or routine expenses for general foster care services. Exceptional and supplemental foster care service costs may be claimed to the waiver if the child meets specific needs as identified in the "Determination of Exceptional Care Needs for Children in a Child Care or Foster Care Setting" checklist (Attachment C).

If supplemental and/or exceptional placement costs are determined to be appropriate for the CLTS Waiver, Title IV-E does not need to be claimed first for these costs, as the Center for Medicare and Medicaid Services (CMS) has approved this CLTS Waiver allowable service to be billed under the CLTS Waiver first.

Medicaid reimbursement claimed by the county agency under one of the CLTS Waivers for supplemental and/or exceptional placement costs must be documented in eWiSACWIS in order to offset the DHFS Title IV-E claim for placement costs and prevent double-billing to both Medicaid by the county and Title IV-E by the Department. Examples of when and how to document these claims are provided in the eWiSACWIS Placement Documentation Manual as noted below.

Related Policies

CENTRAL OFFICE CONTACT: Michelle Rawlings
DHFS/DCFS/BPP 1 W. Wilson St. Rm. 550
Madison, WI 53707
608.264.9846
e-mail: rawlimm@dhfs.state.wi.us
Kristina Stuart
DHFS/DDES/BLTS 1 W. Wilson St. Rm. 418
Madison, WI 53707
608.235.6636
e-mail: stuarkc@dhfs.state.wi.us 

Attachments:

Attachment A:  Children's Long-Term Support Medicaid Home and Community-Based Services Waivers (PDF, 26 kb)

Attachment B:  Child Welfare Services  (PDF, 21 kb)

Attachment C:  Children's Long-Term Support Medicaid Home and Community-Based Services Waivers  (PDF, 22 kb)

cc:  Human Service Area Coordinators
Bureau Directors
Program Office Directors/Section Chiefs
Tribal Chairpersons/Human Services Facilitators
Division of Management and Technology, Don Warnke


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