Articles

Autism Waiver Fact Sheet

By Maryland State Department of Education

Last Updated: November 5, 2009

Purpose

The Autism Waiver, through Medical Assistance, will allow eligible children with Autism Spectrum Disorder to receive specific waiver services to support them in their homes and communities.

Background

House Bill 99 was adopted during the 1998 session of the General Assembly. The bill required the Maryland Department of Health and Mental Hygiene (DHMH) to apply to the Center for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), for a Home and Community-Based Services Waiver that would target services to children with autism. In August 1998, DHMH applied for a Section 1915(c) Home and Community-Based Service Waiver that would allow children with autism certified as needing services from an Intermediate Care Facility for the Mentally Retarded (ICF-MR) to receive the waiver services in their homes and communities.

On September 1, 2000 DHMH received confirmation from CMS that the Home and Community-Based Services Waiver for Children with Autism was approved for 250 children the first year, 300 children the second year, and 350 children the third year.

On February 7, 2002 DHMH received approval from CMS to increase the number of children to be served to a total of 500 the first year. The approved number of children to be served in the waiver will be increased to 750 the second year and to 900 the third year.

CMS approved the waiver for a five-year period, October 1, 2004-September 30, 2009. Changes requested by CMS include the elimination of regular and intensive day habilitation and more specific provider criteria for residential habilitation. Changes requested by DHMH and MSDE included therapeutic integration as an hourly service (minimum 2 hours), a maximum of 30 hours a week of Intensive Individual Support Services (IISS), and a requirement for an Individualized Treatment Plan for each child receiving IISS. Additional changes include improving provider qualifications to expand and enhance the professionals that are qualified to provide Family Training and supervise IISS and Respite technicians providing direct services.

CMS has recently approved the waiver for a five-year period as of July 1, 2009. A change was made to the services already being provided: Supported Employment has been deleted, and Adult Life Planning has been added. Therapeutic Integration has been modified to permit usage on non-school days.

Target Population

  • Children who are diagnosed with Autism Spectrum Disorder, defined in the DSM-IV as 299.00 & 299.80.
  • Children who are ages 1 to 3 years old with an Individualized Family Service Plan (IFSP).
  • Children who are ages 3 through the end of the year that the child turns 21 years old with an Individualized Education Program (IEP) and receive more than 12 hours per week of special education and related services.
  • Children who meet an institutional level of care (Intermediate Care Facility for the Mentally Retarded) and can be served in the community through waiver services. (A diagnosis of mental retardation is not required to be eligible for the waiver.)
  • Children who are currently enrolled in another Medicaid Home and Community-Based Services Waiver and are determined eligible for the Autism Waiver must choose the Waiver program which best meets their needs.
Services to Support the Child in the Community
  • Respite Care
  • Environmental Accessibility Adaptations
  • Family Training
  • Service Coordination
  • Supported Employment
  • Residential Habilitation
  • Intensive Individual Support Services
  • Therapeutic Integration (after school)
Benefits

Waiver participants will be eligible for additional services such as respite care, environmental modifications to their home, and family training.

Once the child is selected and slated to receive services, he or she may receive a maximum of 25 hours of Intensive Individual Support Services per week (no banking of hours) and 168 hours of respite per six months.

The waiver child may use their Medical Assistance card to access additional Medicaid-covered services.

Specialized programs will be able to bill Medicaid for the waiver services that they are approved to provide.

Additional children with autism will become Medicaid eligible.

Administration

Financial eligibility will be based upon the child’s income and resources. The Department of Health and Mental Hygiene determines financial and certain technical eligibility requirements.

The Maryland State Department of Education (MSDE), through the early intervention programs and local school systems, is responsible for administering the waiver.

The waiver is currently full. Parents who are interested should contact the Autism Waiver Registry at 866-417-3480. Children applying to the waiver are referred to MSDE in the chronological order that they are placed on the Registry, when waiver vacancies become available.

The Registry is simply a place keeper. When the child gets to the top of the list, the family must then go through the entire process to determine if the child is eligible for the Waiver. When a child comes to the top of the Registry and there are still spots available, a letter and information packet is sent to the family and the service coordinator is notified. Then all of the eligibility requirements are completed, including financial, technical and medical. If a child meets all requirements the child is offered Waiver services or ICF-MR.

Once a slot is available and your child's number comes to the top of the Registry; you will be contacted 3 times (twice in writing and once by phone). If you do not respond within 21 days your child will be removed from the Registry.

There are no “special circumstances” that permit one family moving ahead of another on the Registry. This is VERY DIFFERENT then how the DDA waiver works.

Keep in mind that once your child is on the Registry, it is your responsibility to notify the Registry of ANY address changes. If you move you can write to the following address if you need to make any changes:

Waiver Services Registry
12051 Indian Creek Ct
Beltsville, MD 20705-1260

Each child on the Waiver is re-determined annually to ensure that the participant still meets all Waiver criteria.

The Autism Waiver was recently renewed by CMS for a five-year period, as of July 1, 2009.

The appeals process for this waiver is through a request for a Fair Hearing under the Maryland State Medical Assistance Program/DHMH.

Waiver Effective Date- July 1, 2001

NOTE: All Waiver Service providers must be approved Medicaid providers.

For more information on the Autism Waiver, please call the Maryland State Department of Education at 410-767-1446 or the Department of Health and Mental Hygiene at 410-767-5220.

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