1. Home and Community Based Services for Children with Autism Waiver (HCBS-CWA)

2. Home and Community Based Services for Children with Autism Waiver Advocated for and developed in cooperation with the Autism Society of Colorado, Arcs- Arapahoe/Douglas, Family Voices, Developmental Disabilities Council, Community Centered Boards, other interested parties and families. Advocated for and developed in cooperation with the Autism Society of Colorado, Arcs- Arapahoe/Douglas, Family Voices, Developmental Disabilities Council, Community Centered Boards, other interested parties and families. 02/06/2004 - Introduced in the Colorado Senate as Senate Bill 04-177 by Senators Gordon and Hefley 02/06/2004 - Introduced in the Colorado Senate as Senate Bill 04-177 by Senators Gordon and Hefley 06/01/2004 - Governor Action – Signed into law 06/01/2004 - Governor Action – Signed into law

3. The Colorado Revised Statute of 26-4-691 Authorizes the Department of Health Care Policy and Financing to administer a Medicaid waiver to provide home and community based services for children with autism Authorizes the Department of Health Care Policy and Financing to administer a Medicaid waiver to provide home and community based services for children with autism Established the Colorado Autism Treatment Fund comprised of Tobacco Settlement Moneys to pay for services Established the Colorado Autism Treatment Fund comprised of Tobacco Settlement Moneys to pay for services

4. HCBS Children with Autism Waiver Rules 04/14/2006 - Presented to the Medical Services Board for initial approval 04/14/2006 - Presented to the Medical Services Board for initial approval 05/12/2006 - Presented for final adoption 05/12/2006 - Presented for final adoption 07/01/2006 – Effective date 07/01/2006 – Effective date Implementation – By January, hopefully Implementation – By January, hopefully

5. HCBS-CWA Waiver Limitations 75 clients may be served at any one time 75 clients may be served at any one time Wait list will be maintained for eligible clients Wait list will be maintained for eligible clients Maximum period of 3 years on the program Maximum period of 3 years on the program Maximum of $25,000 in waiver benefits annually per client Maximum of $25,000 in waiver benefits annually per client

6. Initial Selection for the Waivered Services 25 children will be chosen from clients currently on the CES waivers 25 children will be chosen from clients currently on the CES waivers 25 children will be chosen from clients currently on the CHCBS waivers 25 children will be chosen from clients currently on the CHCBS waivers 25 children will be chosen from clients currently receiving SSI benefits 25 children will be chosen from clients currently receiving SSI benefits

7. HCBS-CWA Waiver Eligibility Is under 6 years of age Is under 6 years of age Has a diagnosis of autism as certified by a physician Has a diagnosis of autism as certified by a physician Be at risk of institutionalization in an intermediate care facility as determined by CCB case manager using the ULTC 100.2 Be at risk of institutionalization in an intermediate care facility as determined by CCB case manager using the ULTC 100.2 Can be safely served in the community with Cost Containment Can be safely served in the community with Cost Containment

8. HCBS-CWA Waiver Eligibility Point of entry is the Community Centered Boards Point of entry is the Community Centered Boards Level of Care is determined by the CCB case managers through a functional assessment of the applicant using the ULTC 100.2 Level of Care is determined by the CCB case managers through a functional assessment of the applicant using the ULTC 100.2 Re-evaluations are required for clients every 12 months Re-evaluations are required for clients every 12 months Re-evaluations are also required for client’s if there has been a significant change in the client’s functioning Re-evaluations are also required for client’s if there has been a significant change in the client’s functioning

9. CCB as Case Manager Inform the parent or guardian of the right to choose enrollment in this or other HCBS waivers for which the child is qualified Inform the parent or guardian of the right to choose enrollment in this or other HCBS waivers for which the child is qualified Develop the Care Plan based on the ULTC 100.2 functional needs assessment Develop the Care Plan based on the ULTC 100.2 functional needs assessment Assist the parent or guardian’s selection of qualified providers, if needed Assist the parent or guardian’s selection of qualified providers, if needed

10. Providers for Behavior Therapy 1.Lead Therapist 2.Senior Therapist 3.Line Staff

11. Lead Therapist: Must be a qualified Medicaid provider or be employed by a Medicaid provider agency Must be a qualified Medicaid provider or be employed by a Medicaid provider agency Have experience as a behavior therapist Have experience as a behavior therapist Employs or contracts the services of the senior therapist and line staff Employs or contracts the services of the senior therapist and line staff Prescribes the amount, scope and duration of the therapy and make adjustments when needed Prescribes the amount, scope and duration of the therapy and make adjustments when needed Supervises the Senior Therapist and Line Staff Supervises the Senior Therapist and Line Staff Collects and maintains all documentation Collects and maintains all documentation

12. Senior Therapist’s: Is a licensed psychotherapy provider with a masters degree in a behavior science and completed 400 hours of direct supervised training in behavioral therapies Is a licensed psychotherapy provider with a masters degree in a behavior science and completed 400 hours of direct supervised training in behavioral therapiesor Has a bachelor’s degree in a human services field and have completed at least 2,000 hours of direct supervised training in behavioral therapies Has a bachelor’s degree in a human services field and have completed at least 2,000 hours of direct supervised training in behavioral therapies Provides ongoing supervision and implementation of the treatment plan, including the supervision of line staff. Provides ongoing supervision and implementation of the treatment plan, including the supervision of line staff. Provides training to the families and conduct team meetings with the family, line staff and other providers to review the child’s progress. Provides training to the families and conduct team meetings with the family, line staff and other providers to review the child’s progress.

13. Line Staff: Must be at least 18 years of age and have graduated from high school or have an equivalency degree Must be at least 18 years of age and have graduated from high school or have an equivalency degree Must have 30 hours or more of direct supervised experience under the direction of the a Lead or Senior Therapist in the use of behavioral therapies Must have 30 hours or more of direct supervised experience under the direction of the a Lead or Senior Therapist in the use of behavioral therapies May deliver the behavioral therapies to the client May deliver the behavioral therapies to the client All services shall be under the direction of the senior therapist and shall be documented. All services shall be under the direction of the senior therapist and shall be documented.

14. HCBS-CWA Waiver Services Behavior therapies include: Behavior therapies include: Intensive developmental behavioral therapies Intensive developmental behavioral therapies Treatment goals that are consistent with building elementary verbal skills, teaching imitation, establishing appropriate toy play, interactive play with other children, teaching appropriate expression of emotions and behaviors, and where necessary, reducing self stimulation and aggressive behaviors Treatment goals that are consistent with building elementary verbal skills, teaching imitation, establishing appropriate toy play, interactive play with other children, teaching appropriate expression of emotions and behaviors, and where necessary, reducing self stimulation and aggressive behaviors

15. Recommendations by Autism Waiver Committee “Best Practice Guidelines” document for waiver programs is being written Emphasizes on the important roll of the family in the development and implementation of the child’s program Collaboration between home and school is highly recommended to enhance outcomes /www.chcpf.state.co.us/HCPF/msb/attach_06/MS B%2005-10-11- A%20HCBS%20Autism%20strgrl%20April%20Ini tial.pdf