bureau of autism services, odp...in 2007, bureau of autism services was added to the (then) office...

>www.dpw.state.pa.us >www.dhs.pa.gov

Bureau of Autism Services, ODPPhiladelphia Autism Project Conference

May 12, 2017

Adult Autism Waiver Update

>www.dpw.state.pa.us >www.dhs.pa.gov 2


Medicaid State Plan vs. Waivers

State Plan:• Every state’s Medicaid State Plan lists the services (physical,

mental and behavioral health) that Medicaid recipients may receive. It includes requirements (such as referrals) and limitations (such as number of sessions per year).

• It must be available statewide and everyone who is eligible for Medicaid in the state must be able to access all the services in the State Plan.

• There can be no waiting lists or interest lists

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Waivers:

• There are a number of types of Medicaid waivers (currently 6). When disability communities use the term “waiver” in Pennsylvania, they usually refer to 1915(c) (or just “c”) waivers. This type allows the state to design programs that “waive,” or are not subject to, some of the requirements under the State Plan.

• The state can limit the number of people enrolled in (c) waivers. Waiting lists or interest lists are common.



Pennsylvania currently has nine 1915 (c) Waivers:

Three administered by Office of Developmental Programs:Consolidated, Person/Family Directed Supports, Adult Autism

Five administered by the Office of Long Term Living:CommCare, Independence, Aging, Attendant Care, OBRA

One administered by the Office of Child Development & Early Learning:Infant/Toddler



• (Very) Brief History In 2004, Pennsylvania Autism Task Force recommended

creation of an autism-specific state agency and a waiver for adults with Autism Spectrum Disorder (ASD)

In 2007, Bureau of Autism Services was added to the (then) Office of Mental Retardation to create the Office of Developmental Programs (ODP)

In 2008, the Adult Autism Waiver was approved by the Centers for Medicare & Medicaid Services (CMS) to serve 200 adults with autism

Currently, the AAW is funded to serve 668 adults with autism


• Values and Philosophy Adults with autism can continue to learn and grow throughout their

lives, with appropriate support from properly trained staff Everybody should consider working, and those who wants to work

can find competitive employment in integrated settings. It may take a while to learn the necessary skills and get matched to the right job, but it can be done

If a person with autism is not making progress, the fault is with the goal or the supports, not with the person with ASD

Service delivery should be evaluated regularly—if progress is not made or the participant’s needs/preferences/circumstances change

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• How it Operates

The Adult Autism Waiver is entirely directly administered by the Bureau of Autism Services (BAS)

BAS has 3 regional offices: Philadelphia, Harrisburg, Pittsburgh BAS staff also includes a team of behavioral consultants


• Renewed in 2016 for another 5 years: through June 30, 2021

• Made some changes in the enrollment process• Took some lessons learned and revised some

services• Revised and clarified some provider qualifications


• Changed process for people who come to the top of the interest list when they are between 18 and 21 years old BAS will now wait until they reach age 21 and additional

applications are going out and send them an application at that time. They can “stay at the top of the list” instead of restarting the process. People who are younger than 18 will have to restart the process and get back on the interest list.

• Most unlicensed services may be provided in states that border Pennsylvania (New Jersey, Delaware, Maryland, West Virginia, Ohio and New York)


Specialized Skill Development: one service, three parts1. Behavioral Specialist Service:

Develops a Behavioral Support Plan and Crisis Intervention Plan and makes sure the people in the participant’s life, such as family, friends, employers, and staff of other waiver services, know how to use the plans. The plans help participants reach goals about behavior, such as learning to calm down or ask for help when becoming anxious or afraid.

Includes support directly to the participant and support to the people around the participant, such as family, friends, employers and staff of other waiver services.

Includes making sure the Behavioral Support Plan and Crisis Intervention Plan are working well, and changes them if they are not.


Specialized Skill Development: one service, three parts2. Systematic Skill Building:

Uses teaching methods (based on Applied Behavior Analysis) to help the participant learn skills which help him or her have more independence in the community (for example, learning how to cook or use public transportation).

Develops a Skill Building Plan which reflects the participant’s abilities and learning style. The Skill Building Plan includes targets for measuring progress toward the goals and objectives for this service.

Includes support directly to the participant and support to the people around him or her, such as family, friends, employers and staff of other waiver services.

Monitors the Skill Building Plan to ensure it is working well, and changing it if it is not.


Specialized Skill Development: one service, three parts3. Community Support:

Helps participants with a wide range of skills and activities to help them be more independent with communication, socialization, taking care of themselves, and other skills necessary to live in the community.

Uses the Behavioral Support Plan, Crisis Intervention Plan and Skill Building Plan to support the participant if the participant has any of those plans.

Can be used in small groups or individually, depending on what the participant needs: one staff supporting one participant, one staff supporting two participants, or one staff supporting three participants to attend group activities.


Career Planning: one service, two parts1. Vocational Assessment:

Develops a plan (called a Vocational Profile) to identify a career direction that meets the participant’s goals, needs and abilities and will result in “competitive integrated employment.” That means a job paying minimum wage or more than minimum wage at a job site that includes people without disabilities doing the same or similar work. The plan can also be used to identify a self-employment job instead.

The Vocational Profile also describes what the participant needs to do or learn to follow that career direction and meet his or her employment goals.


Career Planning: one service, two parts2. Job Finding:

Assisting a participant to get a job with an employer that fits with the participant’s goals, likes, needs and abilities and pays minimum wage or higher or to develop a self-employment job. The Job Finding service uses the information from the Vocational Assessment in finding the job. Customized employment can be used. This service includes:• Developing relationships and networking with employers • Working with the participant’s natural supports to help identify potential

contacts or job leads • Job carving (doing part of an existing job) • Helping the participant to do informational interviews • Helping the participant ask for reasonable accommodations


Supported Employment: one service, two partsSupported Employment services are meant to help the participant to be as independent as possible at his or her job. BAS expects that after the participant has learned the job and become familiar with the employer and co-workers, the participant will need less help from Supported Employment staff.

1. Intensive Job Coaching: Provides on-the-job training and support with employment or self-

employment for participants who need support for more than 20% of their work week.

Intensive Job Coaching at the same job site and for the same job duties must be approved again after 6 months and may be approved two more times, for a total of 18 months in a row for the same position.


Supported Employment: one service, two parts2. Extended Employment Supports :

Ongoing support available for as long as needed for 20% or less of the work week.

Both parts of the Supported Employment service may be provided to the participant directly or to the employer, supervisor, co-workers and others who are involved in the participant’s employment. For example, this lets the Supported Employment staff talk, phone, email or text the employer or supervisor, even if the participant is not there at the same time. Includes using the Behavioral Support Plan, Crisis Intervention Plan and Skill Building Plan to support the participant if the participant has any of those plans.


New Federal regulations for states Revisions of Home & Community Based Services (HCBS)

regulations (aka, “HCBS Final Rule”) Issued January 2014; Compliance deadline: March 2022 Designed to promote:

• Integration and inclusion of people receiving waiver services into their communities “to the same extent as people not receiving Medicaid”

• Person-centered planning and delivery of services• Services may not be delivered in ways that isolate waiver participants

from the rest of their community; states may define what that means, within some limitations set by the regulations


New State regulations for providers 55 Pa Code Chapter 51 revision: Chapter 6100 has been

submitted for final approval. Expected to go into effect November/December 2017 Expected to require:

• Training of provider staff• Quality Improvement Strategy• Revisions to incident management• All waiver services must be provided in places that are integrated in the

community and comply with the new Federal regulations


• Email us:[email protected]

• Visit our General Website:www.autisminpa.org

• Visit the ASERT Website: www.PAautism.org• Call us:

Toll-Free in Pennsylvania:

Waivers are living, breathing programs!They change all the time, in ways big and small.

Please stay informed and periodically check for updates!

For more information:


QUESTIONS?

Thank you for your interest.

Pia NewmanAdult Autism Waiver Manager

bureau of autism services, odp...in 2007, bureau of autism services was added to the (then) office...

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