8217  Autism Waiver (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 (proposed recipient 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 and HCBS services. If HCBS services are chosen, the family must file an application for medical assistance with eligibility staff.  Once eligibility has been approved by eligibility staff, the Managed Care Organization (MCO) identified on the HCBS choice form will be notified. Autism Specialists will be responsible for developing and maintaining an Individual Behavioral Program/Plan of Care (IBP/POC) including the cost of services to meet the child's and family's needs. HCBS/Autism services may not start until the IBP/POC is authorized by the MCO.

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 Institutional Transitions

The intent of the Institutional Transition program is to transition eligible individuals from Medicaid approved institutional care settings into the community and onto HCBS waiver services (see 8112).  Individuals must be eligible for Medicaid and functionally eligible for one of the following HCBS waivers: Frail and Elderly (FE), Physical Disability (PD), Intellectual and Developmental Disability (I/DD), or Traumatic Brain Injury (TBI).

For HCBS waivers with waiting lists, the individual must be a current resident in an institutional care setting for a minimum of 90 consecutive days before being considered eligible to apply for an institutional transition.  In the event an individual is admitted to a facility for a temporary stay which becomes long term with no disruption of services, the temporary stay days shall count toward the 90 day stay requirement. 

The MCO or State Hospital Discharge Planner is responsible for initiating the referral process and shall send a request for institutional transition to the HCBS Transition Specialist.  The functional assessment will be conducted by the assessing entities that currently serve each of the HCBS waiver populations specified above.  The HCBS Transition Specialist will notify eligibility staff of eligible individuals via the ES-3160.

For individuals eligible for institutional transition, HCBS begins the date the individual transitions from an institutional living arrangement to community living, if approved by the HCBS Transition Specialist.  (See 8200.2). 

Ongoing case management will also be provided by the care coordinator.  Eligibility staff are responsible for informing the care coordinator concerning the Medicaid eligibility decision, the amount of any client obligation, and any changes in obligation or eligibility. The care coordinator is responsible for providing information to eligibility staff concerning the person-centered service plan, the cost of the care, and any changes in that care or in the client’s living arrangement. The ES-3160/ES-3161 shall be used for these purposes.