Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 05 - Developmental Disabilities Services › Rule 016.05.19-014 - Autism Waiver and the Autism Waiver Medicaid Provider Manual

Current through Register Vol. 49, No. 6, June, 2024
Section II
Autism Waiver
201.000
Arkansas Medicaid Certification Requirements for Autism Waiver
			 Program
All Autism Waiver providers must meet the Provider
				Participation and enrollment requirements contained within Section 140.000 of
				this manual, as well as the following criteria, to be eligible to participate
				in the Arkansas Medicaid Program:
Autism Waiver providers must be certified by the Division of
				Developmental Disabilities Services (DDS) or its contracted vendor as having
				met all Centers for Medicare and Medicaid Services (CMS) approved provider
				criteria, as specified in the Autism Waiver document, for the service(s) they
				wish to provide.
NOTE: Certification by the Division of Developmental
				Disabilities Services (DDS) or its contracted vendor does not guarantee
				enrollment in the Medicaid Program.
All Autism Waiver providers must submit current certification
				and/or licensure to the Provider Enrollment Unit along with their application
				to enroll as a Medicaid provider.
View or print the provider
				enrollment and contract package (Application acket). View or print Provider
				Enrollment Unit contact information.
Copies of certifications and renewals required by the Division
				of Developmental Disabilities Services (DDS) or its contracted vendor must be
				maintained by Autism Waiver Providers to avoid loss of provider certification.
View or print the Provider Certification contact
				information.
202.000
ENROLLMENT
			 CRITERIA
202.100
ASD
			 Intensive Intervention Providers
An Autism Spectrum Disorder (ASD) Intervention Provider
				must:
A. Be licensed by the state of
			 Arkansas to provide Early Intervention Day Treatment (EIDT) services to
			 children
OR
Be certified by the state of Arkansas to provide services under
				the Developmental Disabilities Services (DDS) Community Employment Supports
				(CES) Waiver program.
B. Be
			 enrolled with Arkansas Medicaid to provide ASD Intervention Provider services.
The ASD Intervention provider will serve as the billing
				provider while employing the consultant, lead and line therapists who serve as
				the performing provider of waiver services.
202.200
Consultants
A qualified Consultant must:
A. Hold a certificate from the Behavior
			 Analyst Certification Board (BCAB) as a Board Certified Behavior Analyst (BCBA)
			 or a Board Certified Assistant Behavior Analyst (BCaBA), and
B. Have a minimum of two (2) years of
			 experience developing/providing intensive intervention or overseeing the
			 intensive intervention program for children with Autism Spectrum Disorder (ASD)
Hold a minimum of a master's degree in Psychology, Spe
OR
each-Language Pathology, Occupational Therapy, Special
				Education, or related field and have a minimum of two (2) years of experience
				providing intensive intervention or overseeing the intensive intervention
				program for children with ASD.
202.300
Lead Therapists
A qualified Lead Therapist must:
A. Hold a minimum of a bachelor's degree in
			 Education/Special Education, Psychology, Speech-Language Pathology,
			 Occupational Therapy, or a related field, and
B. Have completed 120 hours of specified
			 Autism Spectrum Disorder (ASD) training.
1.
			 Introduction to ASD (A maximum of 12 hours on this topic)
2. Communication Strategies, including
			 alternative and augmentative strategies
3. Sensory Processing disorders and
			 over-arousal response
4. Behavior
			 analysis/positive behavioral supports, including data collection, reinforcement
			 schedules, and functional analysis of behavior
5. Evidence-based interventions
6. Techniques for effectively involving and
			 collaborating with parents
OR
Have completed an Autism Certificate Program,
				and
C. Have a
			 minimum of two (2) years of experience in intensive intervention programing for
			 children with ASD.
In a hardship situation, the Division of Developmental
				Disabilities Services (DDS) or its contracted vendor may issue a provisional
				certification to enable services to be delivered in a timely manner. A hardship
				situation exists when a child is in need of services and staff is not available
				who meet all training/experience requirements. Provisional certification of a
				particular staff person requires that the total number of training hours be
				completed within the first year of service.
202.400
Line Therapists
A qualified Line Therapist must:
A. Hold a high school diploma or
			 GED,
B. Have completed 80 hours of
			 specified Autism Spectrum Disorder (ASD) training
1. Introduction to ASD (A maximum of 12 hours
			 on this topic)
2. Communication
			 Strategies, including alternative and augmentative strategies
3. Sensory Processing disorders and
			 over-arousal response
4. Behavior
			 analysis/positive behavioral supports, including data collection, reinforcement
			 schedules, and functional analysis of behavior
5. Evidence-based interventions
6. Techniques for effectively involving and
			 collaborating with parents, and
C. Have a minimum of two (2) years of
			 experience working directly with children.
In a hardship situation, the Division of Developmental
				Disabilities Services (DDS) or its contracted vendor may issue a provisional
				certification to enable services to be delivered in a timely manner. A hardship
				situation exists when a child is in need of services and staff is not available
				who meet all training/experience requirements. Provisional certification of a
				particular staff person requires that the total number of training hours be
				completed within the first year of service.
202.500
Consultative Clinical and
			 Therapeutic Service Providers
A. The
			 Consultative Clinical and Therapeutic Service provider must be an Institution
			 of Higher Education (4 year program) with the capacity to conduct research
			 specific to Autism Spectrum Disorders (ASD). The provider must:
1. Be staffed by professionals who will serve
			 as Clinical Service Specialists and are Board Certified Behavior Analysts or
			 have Master's degree in Psychology, Special Education, Speech-Language
			 Pathology, or a related field and three (3) years of experience in providing
			 interventions to young children with ASD;
2. Have a central/home office located within
			 the state and have the capacity to provide services in all areas of the
			 state;
3. Have a graduate-level
			 curriculum developed and a minimum of three (3) years of experience in
			 providing training toward a graduate certificate in Autism Spectrum Disorders,
			 recognized by the Arkansas Department of Higher Education; and
4. Be enrolled with Arkansas Medicaid to
			 provide Consultative Clinical and Therapeutic Services.
B. This provider must be independent of the
			 intervention service provider (community-based organization) in order to
			 provide checks and balances in situations where progress is not being achieved,
			 where significant maladaptive behavior exists, or where significant risk
			 factors are noted.
203.100
Documentation in Beneficiary's
			 Case Files
Autism Waiver Providers must develop and maintain sufficient
				written documentation to support each service for which billing is made. This
				documentation, at a minimum, must consist of:
A. A copy of the beneficiary's treatment
			 plan
B. The specific services
			 rendered
C. Signed consent by a
			 parent/legal guardian to receive services
D. The date and actual time the services were
			 rendered
E. The name and title of
			 the individual who provided the service
F. The relationship of the service to the
			 treatment regimen of the beneficiary's treatment plan
G. Updates describing the beneficiary's
			 progress or lack thereof. (Updates should be maintained on a daily basis or at
			 each contact with or on behalf of the beneficiary.) Progress notes must be
			 signed and dated by the provider of the service
H. Completed forms as required by the
			 Division of Developmental Disabilities Services (DDS) or its contracted
			 vendor
I. Time sheets of the
			 individual(s) providing the service(s).
Additional documentation and information may be required
				dependent upon the service to be provided.
210.000
PROGRAM
			 COVERAGE
211.000
Scope
The purpose of the Autism Waiver is to provide one-on-one,
				intensive early intervention treatment for beneficiaries ages eighteen (18)
				months through seven (7) years with a diagnosis of Autism Spectrum Disorder
				(ASD) . The waiver participants must meet the ICF/IID level of care and have a
				diagnosis of ASD.
When providing services to children under the Autism Waiver,
				only natural home and community settings that provide inclusive opportunities
				for the child with ASD will be utilized. The setting will primarily be the
				child's home, but other community locations, identified by the parent (such as
				the park, grocery store, church, etc.) may be selected based on the skills and
				behaviors of the child that need to be targeted.
The community-based services offered through the Autism waiver
				are as follows:
A. Individual
			 Assessment/Treatment Development/Monitoring
B. Therapeutic Aides and Behavioral
			 Reinforcers
C. Lead Therapy
			 Intervention
D. Line Therapy
			 Intervention
E. Consultative
			 Clinical and Therapeutic Services
The waiver program is operated by the Division of Developmental
				Disabilities Services (DDS) or its contracted vendor under the administrative
				authority of the Division of Medical Services.
212.200
Level of Care Determination
Each beneficiary on this waiver must be diagnosed with Autistic
				Disorder (
View ICD codes
.), based on the diagnostic criteria set
				forth in the most recent edition of the Diagnostic Statistical Manual (DSM).
				The initial and annual determinations of eligibility will be determined
				utilizing the same criteria used for a child with Autism Spectrum Disorder
				(ASD) being admitted to the state's ICF/IID facilities.
212.300
Plan of Care
Each beneficiary eligible for the Autism Waiver must have an
				individualized plan of care. The authority to develop an Autism Waiver plan of
				care is given by the Division of Developmental Disabilities Services (DDS) or
				its contracted vendor. A copy of the plan of care, prepared by the Division of
				Developmental Disabilities Services (DDS) or its contracted vendor's Autism
				Waiver Coordinator and the waiver participant's parent or guardian, is
				forwarded to the Autism Spectrum Disorder (ASD) service provider(s) chosen by
				the participant. Each provider is responsible for developing an Individual
				Treatment Plan in accordance with the participant's service plan. Each Autism
				Waiver service must be provided within an established timeframe and according
				to the participant's service plan. The original plan of care will be maintained
				by the Division of Developmental Disabilities Services (DDS) or its contracted
				vendor.
The ASD plan of care must include:
A. Beneficiary identification information,
			 including full name, address, date of birth, Medicaid number, and effective
			 date of Autism Waiver eligibility,
B. The medical and other services to be
			 provided, their amount, frequency, scope, and duration,
C. The name of the service provider chosen by
			 the beneficiary to provide each service,
D. The election of community services by the
			 waiver beneficiary, and
E. The name
			 of the Division of Developmental Disabilities Services (DDS) or its contracted
			 vendor's Autism Waiver Coordinator responsible for the development of the
			 beneficiary's plan of care.
The treatment plan must be designed to ensure that services
				are:
A. Individualized to
			 the beneficiary's unique circumstances,
B. Provided in the least restrictive
			 environment possible,
C. Developed
			 within a process ensuring participation of those concerned with the
			 beneficiary's welfare,
D. Monitored
			 and adjusted as needed, based on changes to the waiver plan of care, as
			 reported by the Division of Developmental Disabilities Services (DDS) or its
			 contracted vendor's Autism Waiver Coordinator,
E. Provided within a system that safeguards
			 the beneficiary's rights, and
F.
			 Documented carefully, with assurance that appropriate records will be
			 maintained.
NOTE: Each service included on the Autism Waiver plan of
				care must be justified by the Division of Developmental Disabilities Services
				(DDS) or its contracted vendor's Autism Waiver Coordinator. This justification
				is based on medical necessity, the beneficiary's physical, mental, and
				functional status, other support services available to the beneficiary, cost
				effectiveness, and other factors deemed appropriate by the Division of
				Developmental Disabilities Services (DDS) or its contracted vendor's Autism
				Waiver Coordinator.
Each Autism Waiver service must be provided according to the
				beneficiary plan of care. As detailed in the Medicaid Program provider
				contract, providers may bill only after services are provided.
Revisions to a beneficiary's plan of care may only be made by
				the Division of Developmental Disabilities Services (DDS) or its contracted
				vendor's Autism Waiver Coordinator. A revised plan of care will be sent to each
				appropriate provider.
Regardless of when services are provided, services are
				considered non-covered and do not qualify for Medicaid reimbursement unless the
				provider and the service are authorized on an Autism Waiver plan of care.
				Medicaid expenditures paid for services not authorized on the Autism Waiver
				plan of care are subject to recoupment.
NOTE: No waiver services will begin until all eligibility
				criteria have been met and approved.
220.000
DESCRIPTION OF
			 SERVICES
220.100
Autism Waiver Services
A.
			 Individual Assessment/Treatment Development/Monitoring
A Consultant, hired by the ASD Intensive Intervention community
				provider performs this service, which include the following components:
1. Assess each child to determine a
			 comprehensive clinical profile, documenting skills deficits across multiple
			 domains including language and communication, cognition, socialization,
			 self-care, and behavior. The instruments used will be individualized to help
			 the child's presenting symptoms as determined by the Consultant but must
			 include at a minimum the Verbal Behavior Milestones Assessment and Placement
			 Program (VB-MAP) or the Assessment of Basic Language and Learning
			 Skills-Revised (ABLLS-R at least every four (4) months). Other instruments and
			 clinical judgement of the Consultant may also be utilized so as long as they
			 render a detailed profile of the child's skills and deficits across multiple
			 domains.
2. Use this detailed
			 clinical profile to develop the Individualized Treatment Plan (ITP) that guides
			 the day-to-day delivery of evidence-based interventions and the daily data
			 collection. The Consultant must develop the ITP based on the assessment,
			 utilizing exclusively evidence-based practices, and train Lead and Line
			 Therapists to implement the intervention(s) and collect detailed data regarding
			 the child's progress. The evidence-based practices that will be utilized in
			 this program are those recognized in the National Autism Center's National
			 Standards Project, which included, but are not limited to:
a. Behavioral Interventions
b. Cognitive Behavioral Intervention Package
c. Comprehensive Behavioral
			 Treatment for Young Children
d.
			 Language Training
e. Modeling
f. Naturalistic Teaching
			 Strategies
g. Parent Training
			 Package
h. Peer Training
			 Package
i. Pivotal Response
			 Treatment
j. Schedules
k. Scripting
l. Self-Management
m. Social Skills Package
n. Story-Based Intervention
As additional research on intervention strategies expands the
				list of accepted practices, additional options may be added to the menu for use
				by providers. The specific selection of strategies will be individualized for
				each child based on an evaluation conducted by the Consultant at the onset of
				service implementation. The individualized program will be documented in the
				Individual Treatment Plan.
3. Monitoring services will be performed by
			 the Consultant on at least a monthly basis. Monitoring responsibilities will
			 include the oversight of the implementation of evidence-based intervention
			 strategies by the lead therapist, the line therapist, and the family; educating
			 family members and key staff regarding treatment; on-site reviewing of
			 treatment effectiveness and implementation fidelity; use data collected to
			 determine the clinical progress of the child and the need for adjustments to
			 the ITO, as necessary; and modifying assessment information, as
			 necessary.
B.
			 Therapeutic Aides and Behavioral Reinforcers
The Consultant will assess the availability of necessary
				therapeutic aides and behavioral reinforcers in the home. If the Consultant
				determines that availability is insufficient for implementation of the
				Individual Treatment Plan, the Consultant will purchase those therapeutic aides
				necessary for use in improving the child's language, cognition, social, and
				self-regulatory behavior.
NOTE: If the two (2) year minimum participation is not
				completed, all aides/materials purchased for implementation of treatment must
				be returned to the Consultant. These aides/materials are to be left with the
				participant upon successful completion of the waiver
				program.
C. Lead
			 Therapy Intervention
The Lead Therapist is responsible for assurance that the
				treatment plan is implemented as designed; weekly monitoring of implementation
				and effectiveness of the treatment plan; reviewing all data collected by the
				Line Therapist and parent/guardian; providing guidance and support to the Line
				Therapist(s); receiving parent/guardian feedback and responding to concerns or
				forwarding to appropriate person and notifying the Consultant when issues
				arise.
D. Line Therapy
			 Intervention
The Line Therapist is responsible for on-site implementation of
				the interventions as set forth in the treatment plan: recording of data as set
				forth in the treatment plan and reporting progress/concerns to the Lead
				Therapist/Consultant as needed.
E. Consultative Clinical and Therapeutic
			 Services
The Autism Spectrum Disorder (ASD) Clinical Services Specialist
				will provide Consultative Clinical and Therapeutic Services. These services are
				therapeutic services to assist unpaid caregivers (parents/guardians) and paid
				support staff (staff involved in intensive intervention services) in carrying
				out the Individual Treatment Plan, as necessary to improve the beneficiary's
				independence and inclusion in their family and community.
These professionals will provide technical assistance to carry
				out the Individual Treatment Plan and monitor the beneficiary's progress
				resulting from implementation of the plan. If review of treatment data on a
				specific beneficiary does not show progress or does not seem to be consistent
				with the skill level/behaviors of the beneficiary, as observed by the Clinical
				Services Specialist, the Clinical Services Specialist will either provide
				additional technical assistance to the parents and staff implementing the
				intervention or contact the Division of Developmental Disabilities Services
				(DDS) or its contracted vendor's Autism Waiver Coordinator responsible for the
				beneficiary to schedule a conference to determine if the Intervention Plan
				needs to be modified. Since the Clinical Services Specialists are independent
				of the provider agency hiring the consultant and other staff, this service
				provides a safeguard for the beneficiary regarding the intervention. This
				service will be provided in the beneficiary's home or community location, based
				on the Individual Treatment Plan, or via the use of distance technology, as
				appropriate.
220.200
Benefit Limits
A. Individual Assessment, Program
			 Development/Training Plan Implementation, and Monitoring of Intervention
			 Effectiveness
The maximum benefit limit is 90 hours per plan of care
				year.
B. Therapeutic Aides
			 and Behavioral Reinforcers
There is a maximum reimbursement of $1,000.00 per participant
				per lifetime. These aides/materials are left with the participant upon
				successful completion of the Waiver program.
C. Lead Therapy
The maximum benefit limit is 6 hours per week
D. Line Therapy
The maximum benefit limit is 25 hours per week.
E. Consultative Clinical and
			 Therapeutic Services
The maximum benefit limit is 36 hours per plan of care
				year.
230.000
BILLING INSTRUCTIONS
230.100
Introduction to Billing
The Autism Waiver providers use the CMS-1500 claim form to bill
				the Arkansas Medicaid Program, on paper, for services provided to eligible
				Medicaid beneficiaries. Each claim should contain charges for only one
				beneficiary. Procedure codes can be found by following this link:
View or print the procedure codes for therapy
				services.