Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.56 - Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder
Section 10.09.56.02 - Participant Eligibility
Universal Citation: MD Code Reg 10.09.56.02
Current through Register Vol. 51, No. 19, September 20, 2024
A. Medical Eligibility for the Autism Waiver.
(1) To be
medically eligible for the services covered under the chapter, an applicant
shall be certified by the licensed psychologist or certified school
psychologist, who is a member of the participant's multidisciplinary team and
is employed by the local Infants and Toddlers Program, the local school system,
the Program, or the Program's designee, to need ICF-IID level of care using the
standardized process for determination of eligibility for level of care in an
ICF-IID.
(2) Every 12 months, or
more frequently if determined necessary by the service coordinator or
multidisciplinary team due to a significant change in the participant's
condition or needs, a participant's medical need for ICF-IID level of care
shall be reevaluated by the licensed psychologist or certified school
psychologist on the multidisciplinary team, as part of the multidisciplinary
team process and using the form for determination of eligibility for level of
care in an ICF-IID.
(3) The form
certifying ICF-IID level of care shall be signed by the:
(a) Chairman of the multidisciplinary team,
who is the official representative of the local school system or local lead
agency; and
(b) Team's licensed
psychologist or certified school psychologist.
B. Technical Eligibility for the Autism Waiver. An applicant or participant shall be determined by the multidisciplinary team to meet the waiver's technical eligibility-criteria if the individual:
(1) Is between 1 year old and
the end of the school year in which the individual turns 21 years
old;
(2) Is determined to be
developmentally disabled and is diagnosed with autism spectrum disorder, every
3 years or more often as requested by MSDE, by a qualified diagnostician using
an evaluation methodology considered sufficient by the multidisciplinary
team;
(3) Uses at least one waiver
service monthly, not including family consultation, unless otherwise authorized
by the State Department of Education;
(4) Has an IFSP or IEP;
(5) If the child has an IEP, receives 15
hours or more per week of special education and related services and requires a
more intensive therapeutic program than other students or is currently
participating in an approved Home and Hospital Program pursuant to the
procedures of COMAR 13A.03.05 and 13A.05.01;
(6) Is identified through the public
education or early intervention service system as being potentially qualified
for and needing Autism Waiver services;
(7) Can be safely maintained in the community
with the assistance of Autism Waiver services;
(8) Chooses, or the parent or parents of a
minor child chooses on the child's behalf, to receive Autism Waiver services as
an alternative to services in an (ICF-IID), and documents that choice on the
consent form for Autism Waiver services; and
(9) Is not enrolled in:
(a) Home Care for Disabled Children under a
Model Waiver, in accordance with COMAR 10.09.27;
(b) Community Based Services for
Developmentally Disabled Individuals Pursuant to a 1915(c) Waiver, in
accordance with COMAR 10.09.26; or
(c) Any other Medicaid waiver program under
§ 1915(c) of Title XIX of the Social Security Act.
C. Medical Assistance Eligibility.
(1) Categorically Needy. A
recipient is eligible for Autism Waiver services if the recipient is eligible
for Medicaid in the community according to the categorically needy regulations
in COMAR 10.09.24 or 10.09.11.
(2)
Optionally Categorically Needy.
(a) An
individual is eligible for Autism Waiver services as optionally categorically
needy in accordance with 42
CFR § 435.217 if the individual's
countable income does not exceed 300 percent of the applicable payment rate for
Supplemental Security Income (SSI), and the individual's countable resources do
not exceed the SSI resource standard for one.
(b) For the purpose of determining financial
eligibility for the optionally categorically needy, the individual is treated
as an assistance unit of one.
(c)
For the purpose of determining countable income for the optionally
categorically needy, income is determined based on the income regulations in
COMAR 10.09.24 which are applicable to aged, blind, or disabled individuals who
are institutionalized, with the exceptions specified in §C(4) of this
regulation.
(d) For the purpose of
determining countable resources for the optionally categorically needy,
resources are determined based on the resource regulations set forth in COMAR
10.09.24.08B and
.10 which are applicable to aged, blind, or disabled persons who are
institutionalized, with the exceptions specified in §C(4) of this
regulation.
(3) An
individual is not eligible to receive Autism Waiver services if a disposal of
assets or establishment of a trust results in a penalty under COMAR
10.09.24.08B -1
or .08-2, until the penalty period expires.
(4) All provisions of COMAR 10.09.24 which
are applicable to aged, blind, or disabled institutionalized persons are
applicable to Autism Waiver applicants and participants, with the following
exceptions:
(a) COMAR
10.09.24.04J(1),
(2), and (3);
(b) COMAR
10.09.24.04K;
(c) COMAR
10.09.24.06B(2)(a)(ii);
(d) COMAR
10.09.24.08G(1);
(e) COMAR
10.09.24.08H;
(f) COMAR
10.09.24.09H;
(g) COMAR
10.09.24.10H;
and
(h) COMAR
10.09.24.10H
-1.
(5) Post Eligibility Determination of
Available Income. The participant's or parents' income may not be applied
toward the costs of the participant's:
(a)
Autism Waiver services; or
(b) Room
and board in a residential habilitation facility.
D. Autism Waiver Eligibility.
(1) If an applicant is verified by the
multidisciplinary team and the State Department of Education:
(a) To meet all of the criteria specified in
§§A-C of this regulation, the participant's service coordinator, the
representative of the local school system or local lead agency, the
representative of the State Department of Education, and the Program shall
certify Autism Waiver eligibility and the Program shall establish the effective
date for enrollment; or
(b) Not to
meet all of the criteria specified in §§A-C of this regulation:
(i) The service coordinator, the
representative of the local school system or local lead agency, and the
representative of the State Department of Education shall certify the Autism
Waiver eligibility determination; and
(ii) The applicant, or the parent or parents
of a minor child, shall be informed in writing by the Department for
ineligibility, and the right to appeal and request a fair hearing, in
accordance with COMAR 10.01.04 and
10.09.24.13H, and
42 CFR Part 431, Subpart E.
(2) Every 12 months, or more often if there
is a significant change in the participant's condition or needs:
(a) The multidisciplinary team and the State
Department of Education shall verify whether the participant remains eligible
for the Autism Waiver by meeting all of the criteria specified in
§§A-C of this regulation;
(b) The service coordinator, the
representative of the local school system or local lead agency, and the
representative of the State Department of Education shall certify the
redetermination of Autism Waiver eligibility; and
(c) If the multidisciplinary team and the
State Department of Education verify that the participant no longer meets all
of the eligibility criteria specified in §§A-C of this regulation,
the:
(i) Participant's eligibility shall be
terminated, as of the effective date established by the multidisciplinary team
and the State Department of Education, and
(ii) Participant, or the parent or parents of
a minor child, shall be informed in writing of the determination, the reason or
reasons for ineligibility, and the right to appeal and request a fair hearing,
in accordance with COMAR 10.01.04 and
10.09.24.13H, and
42 CFR Part 431, Subpart E.
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