Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.12-003 - Medical Services Policy 26400-26450 and Form DCO-9700 - TEFRA and Autism Waiver Application

Current through Register Vol. 49, No. 6, June, 2024
26400
Autism Waiver
MS 26410 Waiver Services
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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