8217 Waiver for Children with Autism (HCBS/AU) - This waiver serves children under the age of 6 years old who are determined to meet functional eligibility criteria of an Autism Spectrum Disorder (ASD) and would otherwise be at risk of placement in a state mental health hospital. Participation under this waiver shall be limited to a maximum of three years. A one year extension may be approved by the Autism Review team if the child has demonstrated continued improvement.
Individuals seeking coverage under this waiver will file a preliminary functional eligibility application with the waiver program manager. A limited number of children will be served under this waiver. Those children qualifying for an opening will be referred by the program manager for a screening assessment. A wait list will be maintained for those requesting services when no openings exist.
Functional Eligibility Specialists contracted across the state will complete the screening assessments for the waiver. The families of children who meet the clinical autism eligibility criteria will be offered a choice between state mental health hospitalization or HCBS services. If HCBS services are chosen, Autism Specialists will be responsible for developing and maintaining an Individual Behavioral Program (Plan of Care) including the cost of services to meet the child's and family's needs.
A level of care code of AU must be placed on the LOTC screen along with an HC living arrangement code and the appropriate effective dates.
NOTE: Children who are eligible under the waiver and have received SSI benefits in an institutional setting are potentially eligible for a $30/month SSI benefit as though they were institutionalized. The family is to be referred to Social Security if the child meets all waiver criteria and will be Medicaid eligible.
8218 Psychiatric Residential Treatment Facility – Community Based Alternative (PRTF-CBA) Waiver (HCBS/PR) – This waiver serves children and adolescents under the age of 22 as an alternate to placement in a Psychiatric Residential Treatment Facility (PRTF). The child must be determined to be clinically eligible based on having chronic mental health/behavior issues that require treatment in a residential setting, but does not need the level of care provided in a state psychiatric hospital. Generally the children served by this waiver are those who are unable to meet the more restrictive clinical eligibility criteria of the Severe Emotional Disturbance (SED) waiver.
Individuals who are assessed and found to meet clinical eligibility criteria will be offered a choice between placement in a PRTF or receipt of HCBS services. If HCBS is chosen, a plan of care will be developed along with the cost of services.
Designated case managers in each of the Community Mental Health Centers (CMHC’s) will be responsible for developing and maintaining a plan of care to meet the child’s needs as well as provide ongoing case management. EES is responsible for referring the family and child to the appropriate CMHC for assessment (if necessary) and informing the case manager regarding Medicaid eligibility, the amount of any client obligation, and any changes in obligation or eligibility. The case manager is responsible for referring the family for a Medicaid application (if necessary) and providing information to EES concerning the plan of care, the cost of care, and any changes in that care or the child’s living arrangement. The ES-3160/ES-3161 forms shall be used for that purpose.
A level of care code of PR must be placed on the LOTC screen along with an HC living arrangement code and the appropriate effective dates.
NOTE: Children who are eligible under the waiver and have received SSI benefits in an institutional setting are potentially eligible for a $30/month SSI benefit as though they were institutionalized. The family is to be referred to Social Security if the child meets all waiver criteria and will be Medicaid eligible.