Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth

	Eligibility Operations Memo 08-01
	January 15, 2008

TO:	MassHealth Eligibility Operations Staff

FROM:	Russ Kulp, Director, MassHealth Operations

RE:	Home- and Community-Based Services Waiver for Young Children with Autism


Introduction
On November 5, 2007, in conjunction with the Department of Mental Retardation 
(DMR), MassHealth implemented the Home- and Community-Based Services Waiver for 
young children with autism.

The purpose of the waiver program is to help children with autism remain in 
their homes. Enrollment will be capped at 80 children.

MassHealth and the Autism Division of DMR will provide interventions and related 
support services to children who are enrolled in the waiver program. Those 
services include the following:
*	homemaker services;
*	habilitation — community integration;
*	habilitation —activities of daily living (ADL)/independent living 
skills;
*	expanded habilitation services — education;
*	respite;
*	adaptive aids/assistive technology;
*	home adaptation/vehicle modification;
*	family training; and
*	individual goods and services.

A clinical reassessment will be done every year to determine ongoing eligibility 
for the program. Waiver eligibility ends when the child reaches his or her ninth 
birthday.

Eligibility Requirements
To be eligible for services provided through the autism waiver, the child
must meet certain requirements. The child must:

*    have a confirmed diagnosis of autism spectrum disorder, which includes 
autistic disorder, pervasive developmental disorder-not otherwise specified 
(PDD-NOS), Rhett’s syndrome, childhood disintegrative disorder, and Asperger’s 
syndrome, subject to verification by DMR;
*	not have reached his or her ninth birthday;
*	be a resident of Massachusetts;
*	meet the level of care required for services from an intermediate-care 
facility for the mentally retarded (ICF/MR), as assessed by DMR; 
*	be able to be safely served in the community; and
*	be eligible for MassHealth Standard.

Enrollment Process
Families will apply for the waiver benefits through DMR.

If the child is not currently on MassHealth, the family will be instructed to 
apply for benefits and will be given a MassHealth Medical Benefit Request (MBR). 
The child must be eligible for MassHealth Standard in order to be enrolled in 
the autism waiver.

If the child has been determined eligible for MassHealth, but not MassHealth 
Standard, DMR will send the applicant a waiver denial notice with appeal rights. 
The notice states that the child is not eligible for services through the autism 
waiver because the child is not eligible for MassHealth Standard. This denial is 
appealable to the MassHealth Board of Hearings. A copy of the notice is attached 
to this memo.

If the child is on MassHealth Standard, DMR will proceed with the clinical 
evaluation.

If the child does not meet the other requirements of the waiver, DMR will send a 
notice of denial. This notice will have appeal rights to DMR. The other reasons 
for denial are that the child
*	is aged nine or older;
*	does not have a verified diagnosis of autism spectrum disorder;
*	does not meet the level of care required for admission to an ICF/MR; and
*	is not able to be safely served in the community.

MA21: Level- of-Care Event
When DMR enrolls a child in the autism waiver, it will forward a written notice 
of clinical approval for the autism waiver to the Revere MassHealth Enrollment 
Center (MEC). Revere MEC staff will put the level-of-care indicator in the event 
screen on MA21. This will allow the correct benefit type to go over to MMIS so claims for waiver services can be processed.

The screen below shows the entry on the event screen.






Questions
If you have any questions about this memo, please have your MEC designee contact 
the Policy Hotline.