Thank you for your interest in providing assistance to children with long-term support needs and their families. A Medicaid program called the Children’s Long Term Support Waiver (or CLTS for short) pays for these services. The program helps children remain in their home and participate fully in their community. Since a combination of federal, state and local tax dollars fund the program, CLTS providers must complete some mandatory paperwork. The steps to becoming a Dane County CLTS provider are:
1. Familiarize yourself with Children’s Long Term Support (CLTS) services.
2. Notify Dane County, CLTS lead, Angela Radloff or Community Services Manager, Monica Bear of interest in providing CLTS services. Contact:
Angela: Radloff.Angela@countyofdane.com / (608) 242-6225 or
Monica: bear@countyofdane.com / (608) 242-6438
Note: Even if your organization has an agreement or contract with another Wisconsin county, you will need a Dane County agreement or contract to do business in Dane County.
3. Register to do business in Wisconsin. Cost $130. Time: Approximately 30 minutes
4. Register to provide CLTS services in Dane County on the Wisconsin DHS CLTS Provider registry. No cost. Time: Approximately 30 minutes.
5. Obtain the right type of insurance to provide CLTS services. Cost: Varies with insurance provider. Time: Varies depending on insurance provider.
For contracts over $11,000 per year, there may be a small additional fee to list Dane County as an “additional insured”.
If you plan to do more than $11,000 per year worth of CLTS business per year, your insurance agent will need to provide Dane County with a Certificate of Insurance (COI). This certificate must list Dane County as an “additional insured” (for more information: Additional Insured Requirements). Insurance companies typically charge $100 - $200 for this service. Businesses who have employees based in Wisconsin must provide workers’ comp at Wisconsin statutory limits. Contact bear@countyofdane.com if you have questions.
Depending on the type of service your business provides, you must have at least one of the following:
6. Email completed County forms to bear@countyofdane.com
No cost. Time: Approximately 15 minutes.
Forms include:
Note: Completion of these forms starts the Dane County contracting process. A signed rate schedule is not a contract.
7. Sign and return CLTS agreement or contract. As noted earlier, contracts will require a certificate of insurance with Dane County as listed as an “additional insured”.
No cost. Time: Approximately 15 minutes.
After signing, E-mail legible, signed contracts or agreements in their entirety to dcdhscontracts@countyofdane.com. If you cannot e-mail a legible document, you may mail your agreement or contract to Dane County Human Services at 1202 Northport Drive, Madison WI, 53704 Attn: Contract Coordination Assistant. Dane County cannot accept and will return illegible or incomplete documents.
8. Set up account with WPS, Wisconsin’s CLTS Third Party Administrator (TPA).
No cost. Time: Approximately 30 Minutes.
9. After receiving all initial CLTS paperwork and registrations, Dane County will add services provided by your business to our CLTS IT system. Dane County Program Specialist, Eric Linn-Miller Miller.eric@countyofdane.com / (608) 242-6447 will e-mail service authorizations to your business via Excel Spreadsheet. He will also discuss the process for submitting claims to and receiving payment from WPS Insurance.