Current through Register Vol. 49, No. 9, September, 2024
26400
Autism Waiver
MS Manual 10-1-12
The Autism waiver provides one-on-one, intensive early
intervention treatment for children ages eighteen (18) months through six (6)
years who have a diagnosis of autism. The waiver participant must have a
diagnosis of autism, a disability determination and meet the ICF/MR level of
care.
For the first year of the program, there will only be 100 slots
available. When the 100 slots are filled, the remainder of the applications
will be put on a waiting list maintained by Partners for Inclusive Communities
(Partners).
The waiver program is operated by Partners under the
administrative authority of the Division of Medical Services.
MS 26410 Waiver Services
MS Manual 10-1-12
The services offered through the Autism waiver are as
follows:
* Individual Assessment, Program Development/Training
* Provision of Therapeutic Aides and Behavioral
Reinforcers
* Plan Implementation and Monitoring of Intervention
Effectiveness
* Lead Therapy Intervention
* Line Therapy Intervention
These services are designed to maintain Medicaid eligible
children at home in order to prevent or postpone institutionalization of the
child.
MS 26420 Eligibility Criteria
MS Manual 10-1-12
To qualify for coverage under the Autism Waiver, a child must
meet the following criteria:
1. Age-To
apply for services, the child must be between eighteen (18) months and 5 years
old. A child 5 years and 1 day old is over the age limit for application. If
approved, coverage will be for a minimum of 2 years and a maximum of 3 years.
If coverage has not ended prior to the child's seventh
(7th) birthday, coverage w/ill end the day before
the child's seventh (7th) birthday.
2. Citizenship or Alien Status-The child must
be a US citizen or a qualified alien.
3. Residency-The child must be a resident of
Arkansas.
4. Diagnosis-The child
must have a medical diagnosis of autism by a speech-language pathologist, a
physician, and a psychologist.
5.
Disability-The child must have a disability determination from either the
Social Security Administration (SSA) or the Medical Review/ Team
(MRT).
6. Social Security
Enumeration-The child must meet the Social Security Enumeration requirements as
stated in MS 1390.
7. Income-The
child's income must be at or below three times (300%) the SSI income level.
Parental income will be disregarded.
8. Resources-The child's countable resources
cannot exceed $2,000.00. Parental resources will be disregarded.
9. Child Support-Referral to or cooperation
with child support is voluntary if the custodial parent does not receive
Medicaid.
10. Cost
Effectiveness-The average cost of services provided to the child in the
community must be less than the cost of services for the child If he or she was
in an institution. The Division of Medical Services determines the cost
effectiveness.
11. Medical
Necessity-The child must meet the ICF/MR level of care. The level of care will
be determined by the Office of Long Term Care (OLTC), Utilization Review Team
based on information submitted by Partners.
12. Plan of Care-Each child eligible for the
Autism waiver must have an individualized plan of care. The plan of care will
be developed by Partners and forwarded to the Autism service provider chosen by
the child's parent(s) or guardian.
MS 26430 Application Process
MS Manual 10-1-12
If a parent or guardian inquires at the county office about the
Autism Waiver, county office personnel will:
a. Provide the Autism Waiver
brochure.
b. Inform the inquirer
that he or she must contact Partners at the phone number listed on the brochure
for more information or to start the application process.
c. If the child doesn't have a pending
Medicaid application or an open Medicaid case, explain Medicaid/ARKids
requirements and assist the parent or guardian if he or she wishes to apply for
Medicaid or ARKids.
When the parent or guardian contacts Partners, Partners
will:
a. Explain the program and
program requirements.
b. Screen the
applicant to determine if he or she meets the program criteria.
c. Send the following forms to the parent or
guardian, if the child meets the therapeutic requirements:
1. DCO-9700, TEFRA and Autism Waiver
Application;
2. If a disability
determination is needed, a DCO-108C, Social Report for Children;
3. DCO-106, Disability Worksheet;
and
4. DHS-4000, Authorization to
Disclose Health Information.
d. Advise the parent or guardian to return
completed forms to Partners.
Upon receipt of the application and documentation, Partners
will:
a. Review the application and
documentation to determine if the application should be denied based on
Partners' autism diagnosis assessment.
b. Send the application and documentation to
the Area TEFRA Processing Unit (ATPU).
c. Complete form DHS-703, Evaluation of
Medical Need Criteria if the applicant meets Partners medical criteria and
forward it to the Office of Long Term Care (OLTC). OLTC will document the level
of care determination on the DHS-704 and return the form to Partners. Partners
will forward the completed DHS-704 to the appropriate ATPU.
d. Send notification of ineligibility denial
to ATPU via the DHS-3330 if the applicant does not meet medical criteria.
ATPU will:
a. Register
all applications received from Partners in category 41 {Autism Non-SSI) or
category 45 (Autism SSI).
b. Deny
application and send the applicant's parent or guardian a system generated
notice of denial, if the applicant is determined not to be eligible based on
Partner's medical criteria,
c.
Determine financial eligibility, if the child meets the autism
criteria.
d. Forward medical
records (Forms DCO-106, DCO-108C and DHS-4000) to MRT while determining
financial eligibility, if a disability determination is required.
e. Determine financial eligibility and if
found not eligible:
1. Deny the
application.
2. Send the parent or
guardian a system generated notice of denial and a DHS-3330 to
Partners.
3. Notify MRT to stop the
disability determination if the determination has not been received.
f. Approve the application, if the
applicant is medically and financially eligible:
1. The Medicaid begin date will be the date
the application is approved.
2.
Send the parent or guardian a system generated notice of approval and a
DHS-3330 to Partners.
The application will be processed within 45 days or 90 days, if
a MRT disability decision is required.
MS 26440 Reevaluation Process
MS Manual 10-1-12
Autism Waiver cases will be reevaluated every 12 months by the
ATPU. ATPU will mail the parent or guardian a DCO-7779 to redetermine
eligibility. A MRT disability redetermination may or may not be necessary at
the time of the reevaluation. A need for a disability redetermination by MRT
will be indicated on the DCO-109 received during the initial determination and
case reviews, if applicable. When certification was made based on a previous
SSI determination of disability and there has been no SSI payments or
subsequent redetermination bySSA, a MRT disability redetermination will be made
one year after the initial certification for the Autism Waiver. All eligibility
factors, except the autism diagnosis, will be redetermined at
reevaluation.
If the reevaluation form is not returned, a DCO-700, Notice of
Action, advising that the DCO-9700 must be received within 10 days or the case
will be closed after the notice expires.
To insure that reevaluations are completed by the end of the
twelfth month, the reevaluation process should be started in the
9th month from the date of the last approval or
reevaluation.
MS 26450 Changes
MS 10-1-12
All changes (addresses, income decrease or increase, resources,
etc.) will be processed by the ATPU.
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