Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 05 - Developmental Disabilities Services
Rule 016.05.19-014 - Autism Waiver and the Autism Waiver Medicaid Provider Manual
Current through Register Vol. 49, No. 9, September, 2024
Section II Autism Waiver
All Autism Waiver providers must meet the Provider Participation and enrollment requirements contained within Section 140.000 of this manual, as well as the following criteria, to be eligible to participate in the Arkansas Medicaid Program:
Autism Waiver providers must be certified by the Division of Developmental Disabilities Services (DDS) or its contracted vendor as having met all Centers for Medicare and Medicaid Services (CMS) approved provider criteria, as specified in the Autism Waiver document, for the service(s) they wish to provide.
NOTE: Certification by the Division of Developmental Disabilities Services (DDS) or its contracted vendor does not guarantee enrollment in the Medicaid Program.
All Autism Waiver providers must submit current certification and/or licensure to the Provider Enrollment Unit along with their application to enroll as a Medicaid provider. View or print the provider enrollment and contract package (Application acket). View or print Provider Enrollment Unit contact information.
Copies of certifications and renewals required by the Division of Developmental Disabilities Services (DDS) or its contracted vendor must be maintained by Autism Waiver Providers to avoid loss of provider certification. View or print the Provider Certification contact information.
An Autism Spectrum Disorder (ASD) Intervention Provider must:
OR
Be certified by the state of Arkansas to provide services under the Developmental Disabilities Services (DDS) Community Employment Supports (CES) Waiver program.
The ASD Intervention provider will serve as the billing provider while employing the consultant, lead and line therapists who serve as the performing provider of waiver services.
A qualified Consultant must:
Hold a minimum of a master's degree in Psychology, Spe OR each-Language Pathology, Occupational Therapy, Special Education, or related field and have a minimum of two (2) years of experience providing intensive intervention or overseeing the intensive intervention program for children with ASD.
A qualified Lead Therapist must:
OR
Have completed an Autism Certificate Program, and
In a hardship situation, the Division of Developmental Disabilities Services (DDS) or its contracted vendor may issue a provisional certification to enable services to be delivered in a timely manner. A hardship situation exists when a child is in need of services and staff is not available who meet all training/experience requirements. Provisional certification of a particular staff person requires that the total number of training hours be completed within the first year of service.
A qualified Line Therapist must:
In a hardship situation, the Division of Developmental Disabilities Services (DDS) or its contracted vendor may issue a provisional certification to enable services to be delivered in a timely manner. A hardship situation exists when a child is in need of services and staff is not available who meet all training/experience requirements. Provisional certification of a particular staff person requires that the total number of training hours be completed within the first year of service.
Autism Waiver Providers must develop and maintain sufficient written documentation to support each service for which billing is made. This documentation, at a minimum, must consist of:
Additional documentation and information may be required dependent upon the service to be provided.
The purpose of the Autism Waiver is to provide one-on-one, intensive early intervention treatment for beneficiaries ages eighteen (18) months through seven (7) years with a diagnosis of Autism Spectrum Disorder (ASD) . The waiver participants must meet the ICF/IID level of care and have a diagnosis of ASD.
When providing services to children under the Autism Waiver, only natural home and community settings that provide inclusive opportunities for the child with ASD will be utilized. The setting will primarily be the child's home, but other community locations, identified by the parent (such as the park, grocery store, church, etc.) may be selected based on the skills and behaviors of the child that need to be targeted.
The community-based services offered through the Autism waiver are as follows:
The waiver program is operated by the Division of Developmental Disabilities Services (DDS) or its contracted vendor under the administrative authority of the Division of Medical Services.
Each beneficiary on this waiver must be diagnosed with Autistic Disorder (View ICD codes.), based on the diagnostic criteria set forth in the most recent edition of the Diagnostic Statistical Manual (DSM). The initial and annual determinations of eligibility will be determined utilizing the same criteria used for a child with Autism Spectrum Disorder (ASD) being admitted to the state's ICF/IID facilities.
Each beneficiary eligible for the Autism Waiver must have an individualized plan of care. The authority to develop an Autism Waiver plan of care is given by the Division of Developmental Disabilities Services (DDS) or its contracted vendor. A copy of the plan of care, prepared by the Division of Developmental Disabilities Services (DDS) or its contracted vendor's Autism Waiver Coordinator and the waiver participant's parent or guardian, is forwarded to the Autism Spectrum Disorder (ASD) service provider(s) chosen by the participant. Each provider is responsible for developing an Individual Treatment Plan in accordance with the participant's service plan. Each Autism Waiver service must be provided within an established timeframe and according to the participant's service plan. The original plan of care will be maintained by the Division of Developmental Disabilities Services (DDS) or its contracted vendor.
The ASD plan of care must include:
The treatment plan must be designed to ensure that services are:
NOTE: Each service included on the Autism Waiver plan of care must be justified by the Division of Developmental Disabilities Services (DDS) or its contracted vendor's Autism Waiver Coordinator. This justification is based on medical necessity, the beneficiary's physical, mental, and functional status, other support services available to the beneficiary, cost effectiveness, and other factors deemed appropriate by the Division of Developmental Disabilities Services (DDS) or its contracted vendor's Autism Waiver Coordinator.
Each Autism Waiver service must be provided according to the beneficiary plan of care. As detailed in the Medicaid Program provider contract, providers may bill only after services are provided.
Revisions to a beneficiary's plan of care may only be made by the Division of Developmental Disabilities Services (DDS) or its contracted vendor's Autism Waiver Coordinator. A revised plan of care will be sent to each appropriate provider.
Regardless of when services are provided, services are considered non-covered and do not qualify for Medicaid reimbursement unless the provider and the service are authorized on an Autism Waiver plan of care. Medicaid expenditures paid for services not authorized on the Autism Waiver plan of care are subject to recoupment.
NOTE: No waiver services will begin until all eligibility criteria have been met and approved.
A Consultant, hired by the ASD Intensive Intervention community provider performs this service, which include the following components:
As additional research on intervention strategies expands the list of accepted practices, additional options may be added to the menu for use by providers. The specific selection of strategies will be individualized for each child based on an evaluation conducted by the Consultant at the onset of service implementation. The individualized program will be documented in the Individual Treatment Plan.
The Consultant will assess the availability of necessary therapeutic aides and behavioral reinforcers in the home. If the Consultant determines that availability is insufficient for implementation of the Individual Treatment Plan, the Consultant will purchase those therapeutic aides necessary for use in improving the child's language, cognition, social, and self-regulatory behavior.
NOTE: If the two (2) year minimum participation is not completed, all aides/materials purchased for implementation of treatment must be returned to the Consultant. These aides/materials are to be left with the participant upon successful completion of the waiver program.
The Lead Therapist is responsible for assurance that the treatment plan is implemented as designed; weekly monitoring of implementation and effectiveness of the treatment plan; reviewing all data collected by the Line Therapist and parent/guardian; providing guidance and support to the Line Therapist(s); receiving parent/guardian feedback and responding to concerns or forwarding to appropriate person and notifying the Consultant when issues arise.
The Line Therapist is responsible for on-site implementation of the interventions as set forth in the treatment plan: recording of data as set forth in the treatment plan and reporting progress/concerns to the Lead Therapist/Consultant as needed.
The Autism Spectrum Disorder (ASD) Clinical Services Specialist will provide Consultative Clinical and Therapeutic Services. These services are therapeutic services to assist unpaid caregivers (parents/guardians) and paid support staff (staff involved in intensive intervention services) in carrying out the Individual Treatment Plan, as necessary to improve the beneficiary's independence and inclusion in their family and community.
These professionals will provide technical assistance to carry out the Individual Treatment Plan and monitor the beneficiary's progress resulting from implementation of the plan. If review of treatment data on a specific beneficiary does not show progress or does not seem to be consistent with the skill level/behaviors of the beneficiary, as observed by the Clinical Services Specialist, the Clinical Services Specialist will either provide additional technical assistance to the parents and staff implementing the intervention or contact the Division of Developmental Disabilities Services (DDS) or its contracted vendor's Autism Waiver Coordinator responsible for the beneficiary to schedule a conference to determine if the Intervention Plan needs to be modified. Since the Clinical Services Specialists are independent of the provider agency hiring the consultant and other staff, this service provides a safeguard for the beneficiary regarding the intervention. This service will be provided in the beneficiary's home or community location, based on the Individual Treatment Plan, or via the use of distance technology, as appropriate.
The maximum benefit limit is 90 hours per plan of care year.
There is a maximum reimbursement of $1,000.00 per participant per lifetime. These aides/materials are left with the participant upon successful completion of the Waiver program.
The maximum benefit limit is 6 hours per week
The maximum benefit limit is 25 hours per week.
The maximum benefit limit is 36 hours per plan of care year.
The Autism Waiver providers use the CMS-1500 claim form to bill the Arkansas Medicaid Program, on paper, for services provided to eligible Medicaid beneficiaries. Each claim should contain charges for only one beneficiary. Procedure codes can be found by following this link:
View or print the procedure codes for therapy services.
Section III of this manual contains information about Provider Electronic Solutions (PES) and other available options for electronic claim submission.
Click here to view the Autism Waiver procedure codes.
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Field Name and Number |
Instructions for Completion |
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1. (type of coverage) |
Not required. |
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1a. INSURED'S I.D. NUMBER (For Program in Item 1) |
Beneficiary's 10-digit Medicaid or ARKids First-A or ARKids First-B identification number. |
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2. PATIENT'S NAME (Last Name, First Name, Middle Initial) |
Beneficiary's last name and first name. |
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3. PATIENT'S BIRTH DATE |
Beneficiary's date of birth as given on the Medicaid or ARKids First-A or ARKids First-B identification card. Format: MM/DD/YY. |
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SEX |
Check M for male or F for female. |
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4. INSURED'S NAME (Last Name, First Name, Middle Initial) |
Required if insurance affects this claim. Insured's last name, first name, and middle initial. |
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5. PATIENT'S ADDRESS (No., Street) |
Optional. Beneficiary's complete mailing address (street address or post office box). |
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CITY |
Name of the city in which the beneficiary resides. |
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STATE |
Two-letter postal code for the state in which the beneficiary resides. |
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ZIP CODE |
Five-digit zip code; nine digits for post office box. |
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TELEPHONE (Include Area Code) |
The beneficiary's telephone number or the number of a reliable message/contact/ emergency telephone. |
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6. PATIENT RELATIONSHIP TO INSURED |
If insurance affects this claim, check the box indicating the patient's relationship to the insured. |
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7. INSURED'S ADDRESS (No., Street) |
Required if insured's address is different from the patient's address. |
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CITY |
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STATE |
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ZIP CODE |
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TELEPHONE (Include Area Code) |
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8. RESERVED |
Reserved for NUCC use. |
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9. OTHER INSURED'S NAME (Last Name, First Name, Middle Initial) |
If patient has other insurance coverage as indicated in Field 11d, the other insured's last name, first name, and middle initial. |
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a. OTHER INSURED'S POLICY OR GROUP NUMBER |
Policy and/or group number of the insured individual. |
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b. RESERVED |
Reserved for NUCC use. |
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SEX |
Not required. |
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c. RESERVED |
Reserved for NUCC use. |
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d. INSURANCE PLAN NAME OR PROGRAM NAME |
Name of the insurance company. |
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10. IS PATIENT'S CONDITION RELATED TO: |
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a. EMPLOYMENT? (Current or Previous) |
Check YES or NO. |
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b. AUTO ACCIDENT? |
Required when an auto accident is related to the services. Check YES or NO. |
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PLACE (State) |
If 10b is YES, the two-letter postal abbreviation for the state in which the automobile accident took place. |
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c. OTHER ACCIDENT? |
Required when an accident other than automobile is related to the services. Check YES or NO. |
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d. CLAIM CODES |
The "Claim Codes" identify additional information about the beneficiary's condition or the claim. When applicable, use the Claim Code to report appropriate claim codes as designated by the NUCC. When required to provide the subset of Condition Codes, enter the condition code in this field. The subset of approved Condition Codes is found at www.nucc.org under Code Sets. |
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11. INSURED'S POLICY GROUP OR FECA NUMBER |
Not required when Medicaid is the only payer. |
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a. INSURED'S DATE OF BIRTH |
Not required. |
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SEX |
Not required. |
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b. OTHER CLAIM ID NUMBER |
Not required. |
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c. INSURANCE PLAN NAME OR PROGRAM NAME |
Not required. |
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d. IS THERE ANOTHER HEALTH BENEFIT PLAN? |
When private or other insurance may or will cover any of the services, check YES and complete items 9, 9a and 9d. Only one box can be marked. |
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12. PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE |
Enter "Signature on File," "SOF" or legal signature. |
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13. INSURED'S OR AUTHORIZED PERSON'S SIGNATURE |
Enter "Signature on File," "SOF" or legal signature. |
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14. DATE OF CURRENT: ILLNESS (First symptom) OR INJURY (Accident) OR PREGNANCY (LMP) |
Required when services furnished are related to an accident, whether the accident is recent or in the past. Date of the accident. |
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Enter the qualifier to the right of the vertical dotted line. Use Qualifier 431 Onset of Current Symptoms or Illness; 484 Last Menstrual Period. |
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15. OTHER DATE |
Enter another date related to the beneficiary's condition or treatment. Enter the qualifier between the left-hand set of vertical, dotted lines. The "Other Date" identifies additional date information about the beneficiary's condition or treatment. Use qualifiers: 454 Initial Treatment 304 Latest Visit or Consultation 453 Acute Manifestation of a Chronic Condition 439 Accident 455 Last X-Ray 471 Prescription 090 Report Start (Assumed Care Date) 091 Report End (Relinquished Care Date) 444 First Visit or Consultation |
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16. DATES PATIENT UNABLE TO WORK IN CURRENT OCCUPATION |
Not required. |
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17. NAME OF REFERRING PROVIDER OR OTHER SOURCE |
Primary Care Physician (PCP) referral is required for Chiropractic services. Enter the referring physician's name and title. |
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17a. (blank) |
Not required. |
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17b. NPI |
Enter NPI of the referring physician. |
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18. HOSPITALIZATION DATES RELATED TO CURRENT SERVICES |
When the serving/billing provider's services charged on this claim are related to a beneficiary's or participant's inpatient hospitalization, enter the individual's admission and discharge dates. Format: MM/DD/YY. |
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19. ADDITIONAL CLAIM INFORMATION |
Identifies additional information about the beneficiary's condition or the claim. Enter the appropriate qualifiers describing the identifier. See www.nucc.org for qualifiers. |
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20. OUTSIDE LAB? |
Not required |
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$ CHARGES |
Not required. |
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21. DIAGNOSIS OR NATURE OF ILLNESS OR INJURY |
Enter the applicable ICD indicator to identify which version of ICD codes is being reported. Use "9" for ICD-9-CM. Use "0" for ICD-10-CM. Enter the indicator between the vertical, dotted lines in the upper right-hand portion of the field. Diagnosis code for the primary medical condition for which services are being billed. Use the appropriate International Classification of Diseases (ICD). List no more than 12 diagnosis codes. Relate lines A-L to the lines of service in 24E by the letter of the line. Use the highest level of specificity. |
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22. RESUBMISSION CODE ORIGINAL REF. NO. |
Reserved for future use. Any data or other information listed in this field does not/will not adjust, void or otherwise modify any previous payment or denial of a claim. Claim payment adjustments, voids and refunds must follow previously established processes in policy. |
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23. PRIOR AUTHORIZATION NUMBER |
The prior authorization or benefit extension control number if applicable. |
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24A. DATE(S) OF SERVICE |
The "from" and "to" dates of service for each billed service. Format: MM/DD/YY. 1. On a single claim detail (one charge on one line), bill only for services provided within a single calendar month. 2. Providers may bill on the same claim detail for two or more sequential dates of service within the same calendar month when the provider furnished equal amounts of the service on each day of the date sequence. |
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B. PLACE OF SERVICE |
Two-digit national standard place of service code. See Section 262.100 for codes. |
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C. EMG |
Enter "Y" for "Yes" or leave blank if "No." EMG identifies if the service was an emergency. |
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D. PROCEDURES, SERVICES, OR SUPPLIES |
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CPT/HCPCS |
One CPT or HCPCS procedure code for each detail. |
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MODIFIER |
Modifier(s) if applicable. For anesthesia, when billed with modifier(s) P1, P2, P3, P4, or P5, hours and minutes must be entered in the shaded portion of that detail in field 24D. |
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E. DIAGNOSIS POINTER |
Enter the diagnosis code reference letter (pointer) as shown in Item Number 21 to relate to the date of service and the procedures performed to the primary diagnosis. When multiple services are performed, the primary reference letter for each service should be listed first; other applicable services should follow. The reference letter(s) should be A-L or multiple letters as applicable. The "Diagnosis Pointer" is the line letter from Item Number 21 that relates to the reason the service(s) was performed. |
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The full charge for the service(s) totaled in the detail. This charge must be the usual charge to any beneficiary of the provider's services. |
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G. DAYS OR UNITS |
The units (in whole numbers) of service(s) provided during the period indicated in Field 24A of the detail. |
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H. EPSDT/Family Plan |
Enter E if the services resulted from a Child Health Services (EPSDT) screening/referral. |
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I. ID QUAL |
Not required. |
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J. RENDERING PROVIDER ID # |
Enter the 9-digit Arkansas Medicaid provider ID number of the individual who furnished the services billed for in the detail or |
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NPI |
Enter NPI of the individual who furnished the services billed for in the detail. |
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25. FEDERAL TAX I.D. NUMBER |
Not required. This information is carried in the provider's Medicaid file. If it changes, please contact Provider Enrollment. |
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26. PATIENT'S ACCOUNT NO. |
Optional entry that may be used for accounting purposes; use up to 16 numeric or alphabetic characters. This number appears on the Remittance Advice as "MRN." |
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27. ACCEPT ASSIGNMENT? |
Not required. Assignment is automatically accepted by the provider when billing Medicaid. |
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28. TOTAL CHARGE |
Total of Column 24F-the sum of all charges on the claim. |
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29. AMOUNT PAID |
Enter the total of payments previously received on this claim. Do not include amounts previously paid by Medicaid. Do not include in this total the automatically deducted Medicaid co-payments. |
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30. RESERVED |
Reserved for NUCC use. |
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31. SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING DEGREES OR CREDENTIALS |
The provider or designated authorized individual must sign and date the claim certifying that the services were personally rendered by the provider or under the provider's direction. "Provider's signature" is defined as the provider's actual signature, a rubber stamp of the provider's signature, an automated signature, a typewritten signature, or the signature of an individual authorized by the provider rendering the service. The name of a clinic or group is not acceptable. |
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32. SERVICE FACILITY LOCATION INFORMATION |
If other than home or office, enter the name and street, city, state, and zip code of the facility where services were performed. |
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a. (blank) |
Not required. |
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b. (blank) |
Not required. |
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33. BILLING PROVIDER INFO & PH # |
Billing provider's name and complete address. Telephone number is requested but not required. |
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a. (blank) |
Enter NPI of the billing provider or |
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b. (bApplication for a §1915(c) Home and Community- Based Services Waiver PURPOSE OF THE HCBS WAIVER PROGRAM The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in §1915(c) of the Social Security Act. The program permits a state to furnish an array of home and community-based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. The State has broad discretion to design its waiver program to address the needs of the waivers target population. Waiver services complement and/or supplement the services that are available to participants through the Medicaid State plan and other federal, state and local public programs as well as the supports that families and communities provide. The Centers for Medicare & Medicaid Services (CMS) recognizes that the design and operational features of a waiver program will vary depending on the specific needs of the target population, the resources available to the state, service delivery system structure, state goals and objectives, and other factors. A State has the latitude to design a waiver program that is cost-effective and employs a variety of service delivery approaches, including participant direction of services. lank) |
Enter the 9-digit Arkansas Medicaid provider ID number of the billing provider. |
Application for 1915(c) HCBS Waiver: AR.0936.R01.01 - Mar 01, 2020
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03/01/20 |
Approved Effective Date of Waiver being Amended: 12/07/17
Purpose(s) of the Amendment. Describe the purpose(s) of the amendment:
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1) To add 30 additional slots to the Waiver 2) To increase the number of unduplicated participants to account for the increase in slots 3) Revise the cost neutrality demonstration to reflect actual Waiver costs are less than originally projected, which allowed the State to add the additional slots. 4) To reflect that DDS took over the administration of the Autism Waiver and is now the operating Agency. |
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Component of the Approved Waiver |
Subsection(s) |
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Waiver Application |
5-B; 6-I; 7-A, B; 8; Attachment 2 |
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Appendix A Waiver |
A-1; A-2b; A-3; A-7; Quality Improvement |
The Autism Waiver provides intensive one-on-one treatment for children ages 18 months through 7 years with a diagnosis of autism spectrum disorder (ASD). The therapy services are habilitative in nature and are not available to children through the AR Medicaid State Plan. These services are designed to maintain Medicaid eligible participants at home in order to preclude or postpone institutionalization. Specifically, these services are offered to children with ASD who meet the institutional level of care criteria, are the appropriate age, and whose parent's agree to actively participate in the treatment plan.
The services offered through the Autism Waiver program are 1)Individual Assessment/Plan Development/Team Training/ Monitoring; 2)Therapeutic Aides and Behavioral Reinforcers; 3)Lead Therapy; 4)Line Therapy; and 5) Consultative Clinical and Therapeutic Services. The first four services are provided by Intensive Intervention providers. Consultative Clinical and Therapeutic Services are provided by Clinical Services Specialists working with a four-year university program.
The goal is to design a system for delivery of intensive one-on-one interventions for young children that
The Autism Waiver program is operated by the Division of Developmental Disabilities Services (DDS) who contracts with a vendor (the "vendor") to oversee many functions of the Waiver. Under this arrangement, the vendor oversees assessments for level of care and eligibility for the Waiver, the development of the Plan of Care (POC), and certifies Autism Waiver providers. The POC outlines the services to be provided, the provider who will provide those services, and the parent(s)/guardian(s)' participation agreement. The Intensive Intervention provider, specifically, the Consultant hired by that provider, then creates an Individual Treatment Plan (ITP) that operationalizes the POC. The Intensive Intervention provider's line therapist provides the day-to-day treatments and therapies with oversight by the lead therapist.
The waiver application consists of the following components. Note: Item 3-E must be completed.
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* Yes. This waiver provides participant direction opportunities. Appendix E is required. * No. This waiver does not provide participant direction opportunities. Appendix E is not required. |
* Not Applicable
* No
* Yes
(select one):
* No
* Yes
If yes, specify the waiver of statewideness that is requested (check each that applies):
[] Geographic Limitation. A waiver of statewideness is requested in order to furnish services under this waiver only to individuals who reside in the following geographic areas or political subdivisions of the state.
Specify the areas to which this waiver applies and, as applicable, the phase-in schedule of the waiver by geographic area:
[] Limited Implementation of Participant-Direction. A waiver of statewideness is requested in order to make participant-direction of services as specified in Appendix E available only to individuals who reside in the following geographic areas or political subdivisions of the state. Participants who reside in these areas may elect to direct their services as provided by the state or receive comparable services through the service delivery methods that are in effect elsewhere in the state.
Specify the areas of the state affected by this waiver and, as applicable, the phase-in schedule of the waiver by geographic area:
In accordance with 42 CFR § 441.302, the state provides the following assurances to CMS:
Note: Item 6-I must be completed.
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In accordance with 42 CFR 441.304(f) we published the following public notice of rule making in the statewide Arkansas Democrat Gazette newspaper,________, and posted a web-based electronic file of the entire Autism Waiver, at ( "NOTICE OF RULE MAKING [will put public comment information here] There are no Federally-recognized Tribal Governments in Arkansas. The autism renewal application was submitted to CMS on_______. |
Note that Appendix C-5 HCB Settings describes settings that do not require transition; the settings listed there meet federal HCB setting requirements as of the date of submission. Do not duplicate that information here.
Update this field and Appendix C-5 when submitting a renewal or amendment to this waiver for other purposes. It is not necessary for the state to amend the waiver solely for the purpose of updating this field and Appendix C-5. At the end of the state's HCB settings transition process for this waiver, when all waiver settings meet federal HCB setting requirements, enter "Completed" in this field, and include in Section C-5 the information on all HCB settings in the waiver.
The State of Arkansas submitted and received final approval, on
a statewide transition plan in accordance with the requirements found at
42 CFR
441.301(c) & 441.710.
This plan can be found at
Arkansas assures that the settings transition plan will be subject to any provisions or requirements included in the State's approved Statewide Transition Plan. Arkansas will implement any required changes upon approval of the Statewide Transition Plan and will make conforming changes to its waiver when it submits the next amendment.
Due to the nature of the Autism Waiver, it has been determined that the Autism Waiver complies with HCBS requirements. The Autism Waiver provides one-on-one, intensive early intervention treatment including individual assessment, treatment development, therapeutic aides, behavioral reinforcement, plan implementation, monitoring of intervention effectiveness, lead therapy, line therapy, and consultative clinical and therapeutic services for beneficiaries 18 months through 7 years of age who have been diagnosed with autism and meet ICF/IID level of care. All of the waiver services provide a team approach to intervention for children with Autism Spectrum Disorders (ASD). The intervention team includes the parents/guardians as active interventionists for their child, with requirements for them to be present and implement the intervention strategies for a minimum of 14 hours per week.
All of the settings for this waiver comply with HCBS requirements because they are all natural community settings that provide inclusive opportunities for the children with autism served by the waiver. These settings include locations such as the child's home, church, places where the family shops, restaurants, ball parks, etc. There are no segregated settings utilized in this program. This waiver does not offer services for children in residences other than their natural home with their parent/guardian. The homes, where the majority of services occur, are where the children live with their families. This waiver utilizes no residential settings operated by the State or private providers that are offered as out-of-home alternatives for living situations. The other natural community settings where services occur are not specialized or segregated settings but rather places where the family frequents and where the child with ASD has difficulty functioning. The community settings are tied to specific treatment goals where children need to learn functional skills or replacement behaviors to be able to be included in natural community locations.
Ongoing Assessment of Settings
The Division of Provider Support and Quality Assurance (DPSQA), Office of Long Term Care (OLTC) Licensure unit is responsible for onsite visits for environmental regulatory requirements. The DPSQA OLTC Licensure unit licenses the facilities to operate as an Assisted Living Facility or an Adult Day Care or Adult Day Health Care facility and approve the number of slots that individuals may utilize in these settings. The DPSQA Provider Certification Unit certifies the providers to provide care under the waiver(s) once they are enrolled to be Medicaid providers. On-going compliance with the assessment of settings will be monitored collectively with DMS, DDS and DPSQA staff.
Licensed and certified settings are subject to periodic compliance site-visits by the DPSQA Provider Certification Unit. HCBS Settings requirements will be enforced during those visits. DPSQA expects every residential and non-residential setting to receive a visit at least once every three years. These visits will include a site survey and beneficiary experience surveys with a select number of Medicaid beneficiaries. The agency's registered nurses, case managers, and provider certification staff has been trained on the HCBS Settings rule. Information on the HCBS Settings rule will be included in annual training opportunities for agency employees. Ongoing training for providers on the HCBS Settings rule will be provided during biannual provider workshops hosted by the DPSQA Provider Certification Unit, as well as through annual meetings of provider membership organizations and via updates to the Arkansas HCBS website.
Settings found to have deficiencies will be required to
implement corrective actions and can lose their license or certification when
noncompliance continues or is egregious. Providers who wish to appeal our
findings can follow the appeal rights process described in Section 160.00
Administrative Reconsideration and Appeals of the Arkansas Medicaid Provider
Manual (
Regularly scheduled on-site visits completed by the DPQSQA Licensure and Certification unit, that oversees HCBS regulatory requirements, will occur to ensure HCBS Settings compliance. DDS and DPSQA expect every residential setting to receive a visit at least once every three years, in addition to the current random home visit procedure (minimum 10% per staff caseload) of DPSQA Licensure and Certification unit. These visits will include a site survey and beneficiary experience surveys with a select number of Medicaid beneficiaries. DDS Community and Employment Supports Waiver staff and DDS Licensure and Certification staff have been trained on the HCBS Settings rule. Information on the HCBS Settings rule will be included in annual training opportunities for DDS and DPSQA staff. Ongoing training for providers on the HCBS Settings rule will be provided through annual meetings of provider membership organizations and via updates to the Arkansas HCBS website.
Settings found to be out of compliance with the new regulations during these routine reviews will be required to submit and have approved a corrective action plan which includes a timeframe for its completion. Failure to complete that plan may jeopardize the agency's certification and participation in the waiver program. Providers who wish to appeal our findings can follow the appeal rights process described in DDS Policy 1076 Appeals.
PUBLIC COMMENT
Website
The Statewide Transition Plan (STP), including the timeline and narrative, was available for public review and comment August 17, 2016 through September 15, 2016. The STP was posted online at http://www.medicaid.state.ar.us/general/comment/comment.aspx. This was the URL throughout the 30-day public comment period. The state assures that the link provided to the public directed individuals to the STP during the public comment period. All components of the STP - narrative, timeline chart, and public comments and responses - were made available to the public through a functional URL. The Medicaid website page with hyperlinks remained consistent throughout and provided the appropriate hyperlinks to the documents at all times.
Public Notice
A notice referencing the STP was published in the statewide newspaper, Arkansas Democrat-Gazette, on August 17, 2016 through August 19, 2016. The entire STP was not published in the newspaper; however, the notice stated: "The Statewide Transition Plan is available for review at the Division of Medical Services (DMS), 2nd floor Donaghey Plaza South, 700 South Main Street, P.O. Box 1437, S-295, Little Rock, Arkansas 72203-1437, by telephoning 501-320-6429 or can be downloaded at "http://www.medicaid.state.ar.us/general/comment/comment.aspx." The state provided instructions via the public notice, during the stakeholder meeting, and on the website with regard to how comments could be submitted. The public notice stated: "Comments may be provided during the 30-day comment period, (August 17, 2016 - September 15, 2016), during the stakeholder meeting, in writing to DMS at the address indicated above or by email to becky.murphy@dhs.arkansas.gov. All comments must be submitted by no later than September 15, 2016."
Public Hearing/Stakeholder Meeting
In addition, the State held a Statewide Transition Plan Large Stakeholder Meeting (open to the public) on August 23, 2016 to receive comments. The public notice published in the statewide newspaper on August 18, 2016 stated: "Comments may be provided during the 30 -day comment period, (August 17, 2016 - September 15, 2016), during the stakeholder meeting, in writing to DMS at the address indicated above or by email to becky.murphy@dhs.arkansas.gov."
Print Format
The STP was made available to the public in printed format to be picked up in person at the state DHS office, in printed format during the stakeholder meeting, mailed, emailed, and posted on the state Medicaid website. It was also distributed and discussed during several follow up meetings and teleconferences. Participants of the various meetings included key stakeholders, family members, and advocacy representatives from around the state.
Communication/Stakeholder Input
After the 30-day public comment period, a summary of the public comments and the state's responses to the public comments were posted for the public to review on the state's Medicaid website. They were also sent to each commenter.
The State reviewed and considered all comments received; summarized all comments, including those which agree or disagree with the state's determination about compliance with the settings requirements; and made changes, as appropriate, to the STP.
Comments/Responses
No comments were received which specifically addressed the Autism Waiver AR. 0936
Additional Needed Information (Optional)
Provide additional needed information for the waiver (optional):
Appendix A: Waiver Administration and Operation
Appendix B: Participant Access and Eligibility
Appendix C: Participant Services
Appendix D: Participant-Centered Planning and Service Delivery D-1: Service Plan Development (1 of 8)
Appendix E: Participant Direction of Services
Appendix F: Participant Rights
Appendix G: Participant Safeguards
Appendix H: Quality Improvement Strategy (1 of 3)
Appendix I: Financial Accountability
Appendix J: Cost Neutrality Demonstration
