Adult Autism Waiver
Approved AAW
The Bureau of Autism Services applied to the Centers for Medicare and Medicaid Services (CMS) and received approval for a five-year renewal of the AAW, effective July 1, 2016. Click on any of the document names below to view or download detailed information and additional resources.
 
 

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General Program Questions

The Adult Autism Waiver is one of two programs in Pennsylvania specifically designed to help adults with autism spectrum disorder participate in their communities in the way that they want to, based on their identified needs. Below are responses to some frequently asked questions about the Adult Autism Waiver. If you can’t find the information you are looking for here, please call 1-866-539-7689 or email us at: RA-odpautismwaiver@pa.gov.

What is the Adult Autism Waiver?

The Adult Autism Waiver (AAW) is a 1915(c) Home and Community Based Services (HCBS) Medicaid waiver designed to provide long-term services and supports for community living, tailored to the specific needs of adults age 21 or older with ASD. The program is designed to help adults with autism spectrum disorder participate in their communities in the way they want to, based upon their identified needs.

What are the goals of the Adult Autism Waiver?

  • Increase the person’s ability to care for themselves
  • Decrease family/caregiver stress
  • Increase quality of life for both the person and the family
  • Provide specialized supports to adults with autism spectrum disorder based on need
  • Help adults with autism spectrum disorder reach their employment goals
  • Support more involvement in community activities
  • Decrease crisis episodes and psychiatric hospitalizations

What are some of the key features of the Adult Autism Waiver?

  • Designed to meet the needs of adults with autism spectrum disorder
  • Administered at the state level directly by the Bureau of Autism Services
  • Does not use IQ as an eligibility factor
  • Providers required to complete autism-specific training and meet standards
  • Clinical and behavioral support, as well as technical assistance, is available to enrolled providers
  • Service planning and measures of success based on individual goals
  • Services based on proven approaches to help participants realize these goals

What are some other important features of the Adult Autism Waiver?

  • Priority given to individuals not receiving ongoing state/federally funded services
  • Physical health services are not included as a waiver service; participants retain existing medical insurance
  • Choice of enrolled provider for each service
  • Residential Habilitation Services (24/7) available if assessment determines need
  • Higher income eligibility threshold than the eligibility threshold usually applied to persons living in the community

Where is the Adult Autism Waiver offered?

Waiver services are available statewide in Pennsylvania.

How many adults can be served under the Adult Autism Waiver?

For Fiscal Year 2014-2015, the Adult Autism Waiver has capacity to serve 518 adults with autism.

If I am already receiving services, can I still apply for the Adult Autism Waiver?

Yes. A person can request an application while receiving services from another waiver program.

Application requests are placed in one of two categories:

Priority 1: Those who are not already receiving state-funded or state and federally-funded home and community-based services.

Priority 2: Those who are already receiving state-funded or state and federally-funded services (e.g., state center, another waiver, state hospital, nursing home, Intermediate Care Facility).

Everyone who is placed into a priority category will receive a status letter to confirm that category.

The Bureau of Autism Services maintains separate lists of people requesting an application based on their Priority status. No applications will be sent out to people on the Priority 2 list until everyone on the Priority 1 list has had their application processed. Since applications are only sent when there is capacity in the program, this means that it may be a while before people who are already on a waiver receive an application for the Adult Autism Waiver. See the section on the AAW Application Process for more information.

How is Waiver capacity distributed?

Within each priority group, BAS allocates waiver capacity on a regional basis to ensure access across the Commonwealth. Four regions are defined as follows:

West: Allegheny, Armstrong, Beaver, Butler, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Venango, Warren, Washington, and Westmoreland Counties

Central: Adams, Bedford, Blair, Cambria, Centre, Clinton, Columbia, Cumberland, Dauphin, Franklin, Fulton, Huntington, Juniata, Lancaster, Lebanon, Lycoming, Mifflin, Montour, Northumberland, Perry, Snyder, Somerset, Union, and York Counties

Southeast: Bucks, Chester, Delaware, Montgomery, and Philadelphia Counties

Northeast: Berks, Bradford, Carbon, Lackawanna, Lehigh, Luzerne, Monroe, Northampton, Pike, Schuylkill, Sullivan, Susquehanna, Tioga, Wayne, and Wyoming Counties

When BAS adds new capacity, it will add capacity to each region so that the total waiver capacity is allocated in proportion to Pennsylvania’s population age 21 or older in each region, according to the most recent version of the U.S. Census Bureau’s Current Population Estimates.

What role does the individual with an autism spectrum disorder play in the Adult Autism Waiver?

The participant is at the center of all service planning and service delivery. During the service planning process waiver participants share their goals, likes and dislikes to help determine what services they will receive. Once enrolled in the Adult Autism Waiver, the participant is actively involved in the services they receive and their ongoing services plan.

What role do families play in the Adult Autism Waiver?

Families have the opportunity to provide information during the service planning process and to provide feedback about the program. Decreased family stress is one goal of the program and is assessed each year.

Eligibility Requirements

Who is eligible for the Adult Autism Waiver?

In order to be eligible for the Adult Autism Waiver, a person must be age 21 or older, a U.S. citizen or qualified alien, a resident of Pennsylvania at the time of enrollment, and meet certain diagnostic, functional and financial eligibility criteria (listed below). Priority is given to people not already receiving state-funded, or state and federally-funded, home and community-based services.

Diagnostic Criteria:

Please note: This information reflects the diagnostic categories prior to changes in the DSM-5. Anyone diagnosed with a pervasive developmental disorder from DSM-IV should still meet the criteria for ASD in DSM-5.

  • Must have a diagnosis of an autism spectrum disorder, ASD, which includes:
    • Autistic Disorder
    • Pervasive Development Disorder, Not Otherwise specified (PDD-NOS)
    • Asperger Syndrome
    • Childhood Disintegrative Disorder
    • Retts Disorder

Functional Eligibility:

Must have substantial functional limitations in three or more of the major life activities listed below:

  • self-care
  • understanding and use of receptive and expressive language
  • learning
  • mobility
  • self-direction
  • capacity for independent living

Financial Eligibility:

  • If the applicant has met all other eligibility criteria, including functional eligibility, the final step in the application process is for the County Assistance Office (CAO) to determine financial eligibility. All waiver programs within the Commonwealth require individuals to meet certain financial eligibility criteria.
  • The individual must meet the income and resource limits for Medical Assistance and Payment of Long Term Care Services. AAW financial eligibility is based on 300% of the Federal Benefit Rate (FBR). More information on the Federal Benefit Rate can be found at www.ssa.gov.

Can someone with a diagnosis of an intellectual disability enroll in the Adult Autism Waiver?

Yes, as long as they meet all the eligibility criteria listed above.

If I only get Base Service Unit funds for people with intellectual disabilities, am I considered in the Priority 2 category?

Base Service Unit funding is not guaranteed from year to year, so it is not considered ongoing funding. A person only receiving Base Service Unit funding would be classified as Priority 1.

If I am found eligible for the Adult Autism Waiver how long can I remain in the program?

There is no time limit or maximum age limit. Participants are assessed each year to ensure they continue to meet all eligibility requirements.

Application Process

View the AAW Application Process Overview document. This document includes a Process Flow Chart and outlines and explains the AAW application process from Intake through Enrollment. Specific timeframes are provided wherever possible.

How do I request an application?

All application requests must be made through the Bureau of Autism Services’ toll free number at 1-866-539-7689. Applications may not be requested via email and are not available on-line.

Call the toll free number and leave a message with the following information:

  • Name of person who wishes to apply
  • Telephone number
  • Address
  • County of residence
  • If you are calling on the behalf of the person who wishes to apply also leave your name and daytime phone number.

What is the AAW application process?

The Bureau of Autism Services maintains an interest list of individuals who has requested applications but have not received them. Requests for applications are processed in the order that they are received.

Application requests are placed in one of two categories:

  • Priority 1: Those who are not already receiving state-funded or state and federally-funded home and community-based services.
  • Priority 2: Those who are already receiving state-funded or state and federally-funded services (e.g., state center, another waiver, state hospital, nursing home, Intermediate Care Facility).

Everyone who is placed into a priority category will receive a status letter to confirm that category.

Applications are not sent until there is capacity in the program. If an individual receives an application, it means there is space within the program, as long as the person meets all of the eligibility requirements. Priority for the Adult Autism Waiver is given to people not already receiving state or federally-funded services.

What is the timeline of the application process?

It is important to note that some steps in the application process will happen in specific timeframes and others depend on external factors. For example, how soon an application is sent out after a request is made depends on program capacity. It is not possible to determine how long it will take from the time an individual is placed on the Interest List to the time that the person will receive an Application Packet.

Specific timeframes have been included in the Application Process Overview wherever possible. If an applicant has specific questions about his/her stage of the application process, please contact the Adult Autism Waiver staff directly by emailing ra-odpautismwaiver@pa.gov or calling 1-866-539-7689.

Please Note: You must contact BAS if your status changes or your contact information changes.

Can I apply for more than one Pennsylvania waiver or the Adult Community Autism Program (ACAP) at the same time, or will applying for one make me ineligible for the other ones?

You may apply for more than one waiver or the Adult Community Autism Program at a time, including the Adult Autism Waiver. However, individuals may not enroll in more than one.

What happens to my waiting list status for the Person/Family Directed Support waiver or the Consolidated waiver if I enroll in the Adult Autism Waiver?

An individual can be on a waiting list for another program while receiving services from the Adult Autism Waiver. However, his or her priority status on that waiting list depends on the individual’s situation and whether unmet needs are anticipated. Applicants should discuss their individual situation with program staff from the Bureau of Autism Services and the Bureau of Supports for People with Intellectual Disabilities, Office of Developmental Programs, which operates the Person/Family Directed Support and Consolidated waivers.

A functional assessment is part of the eligibility process for the Adult Autism Waiver. Who completes the functional assessment and where?

This assessment is completed in-person by trained staff contracting with the Bureau Autism Services. The location is determined jointly with the applicant. Generally, the individual’s home is preferred.

What will the Adult Autism Waiver application packet include? What paperwork will I need to fill out?

The waiver application packet includes a three-page application; if the applicant is not already receiving Medical Assistance, an application for that will also be included. The applicant only needs to complete the application and provide proof of age, such as a copy of a driver’s license, state identification card, or birth certificate. Bureau of Autism Services staff are available to answer questions and help applicants with the form. Specific information about these forms is included in the AAW Application Process Overview.

How do I decide whether to apply for a waiver for people with intellectual disabilities, the Adult Autism Waiver or the Adult Community Autism Program (ACAP)?

For an overview of Pennsylvania programs for adults with developmental disabilities, please reference the Comparison of Medicaid Programs that Serve Adults with Autism Spectrum Disorder.

Comparison of Medicaid Programs that Serve Adults with Autism Spectrum Disorders (ASD)(pdf download)

This chart compares the Adult Autism Waiver and the ACAP program with other Pennsylvania programs where adults with autism spectrum disorder may be eligible.

For a more specific side-by-side look at the Adult Autism Waiver and the ACAP program, please review the Adult Autism Waiver/ACAP Program Comparison Chart.

Adult Autism Waiver - ACAP Comparison(pdf download)

Available Services

What services are offered under the Adult Autism Waiver?

In addition to Supports Coordination, there are 18 services:

  • Assistive Technology
  • Community Inclusion
  • Counseling
  • Environmental Modifications
  • Family Training
  • Job Finding
  • Residential Habilitation
  • Supported Employment
  • Therapies (Occupational, Speech and Language, Counseling)
  • Transitional Work Services
  • Behavioral Specialist Services
  • Community Transition Services
  • Day Habilitation
  • Family Counseling
  • Job Assessment
  • Nutritional Consultation
  • Respite
  • Temporary Crisis Services

For a printable version of these service descriptions, click here: Adult Autism Waiver Service Descriptions

How are individual services determined for participants in the Adult Autism Waiver?

Individual needs and interests are used by the participant and their team to develop the Individual Support Plan (ISP). The ISP Team includes the Supports Coordinator, the individual, and anyone else the individual chooses to have involved. The ISP specifies the services a participant will receive, the reason(s) those services are needed, and the goals and objectives of the services. All plans must be reviewed and approved by the Bureau of Autism Services.

Is there a maximum amount (cap) of waiver- funded services a participant may receive?

No. There is no overall limit (cap) on waiver-funded services. Some services have limits on the number of service hours provided within a specific time frame. In addition, there is a lifetime limit on spending for home modification and assistive technology. Adult Autism Waiver participants receive services based on individual need. More information on service limits can be found at www.autisminpa.org.

Do services change over time? How?

Services in the Individual Support Plan (ISP) will change if the needs of the individual have changed. This is determined at the annual review or at other points during the year if service changes are needed to better support the individual.

Does the Adult Autism Waiver program pay for housing?

While the Residential Habilitation service in the Adult Autism Waiver does include a housing component, it is not designed as a housing alternative for waiver participants who do not need round-the-clock supervision. In order to receive Residential Habilitation services, a waiver participant must show this need during an annual assessment when the service plan is developed. Residential Habilitation is designed for participants who are unable to live at home, either alone, with family or with others, because they require awake support staff 24 hours a day, seven days a week. The intent of this service is to ultimately reduce the participant’s need for this degree of support by improving the participant’s capacity to perform activities of daily living (e.g., bathing, dressing, eating) and instrumental activities of daily living (e.g., communication, shopping, housework). The goal is for the participant to eventually move to a natural setting in the community.

A participant receiving Residential Habilitation services must contribute 72 percent of his or her monthly Supplemental Security Income (SSI) payment to the provider for room and board. Residential Habilitation providers in the Adult Autism Waiver must be licensed by the Department of Human Services’s Office of Developmental Programs as either a Family Living Provider (Title 55 PA Code Chapter 6500) or a Community Home (Title 55 PA Code Chapter 6400).

Do I keep my HealthChoices managed care plan for other medical services after I join the waiver?

Yes. You will continue to receive your physical and behavioral health care through your current health care plan(s). The Adult Autism Waiver does not cover those services.