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DEPARTMENT OF HEALTH SERVICES Division of Long Term Care F-00102 12/2010 STATE OF WISCONSIN Bureau of Long Term Support Children s Services Section CHILDREN S LONG-TERM SUPPORT WAIVERS HSRS SLOT CHANGE REQUEST Completion of this form is voluntary. New Target Group choose one DD SED / MH PD INDIVIDUAL COMPLETING THIS FORM Title Name Type or Print Telephone Number County Waiver Agency Email Address Confirmation will be sent to this email address Su...
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What is clts hsrs form?
CLTS HSRS form refers to the Community Long Term Care (CLTS) Home and Community Based Services (HCBS) Rate Setting (HSRS) form. It is a form used to determine the appropriate funding rates for home and community-based services provided under the CLTS program.
Who is required to file clts hsrs form?
The CLTS HSRS form is required to be filed by providers of home and community-based services under the CLTS program.
How to fill out clts hsrs form?
To fill out the CLTS HSRS form, providers need to provide detailed information about the services they offer, the number of individuals served, and the associated costs. The form typically requires data on staff wages, benefits, overhead expenses, and other relevant financial information.
What is the purpose of clts hsrs form?
The purpose of the CLTS HSRS form is to assess and determine the appropriate funding rates for providers of home and community-based services under the CLTS program.
What information must be reported on clts hsrs form?
The CLTS HSRS form requires providers to report information such as the number of individuals served, staff wages and benefits, overhead expenses, and other relevant financial data.
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