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Frequently Asked Questions for Providers

Who can provide Autism Waiver Services

Who can be an Autism Service Provider?
The qualifications are outlined in KMAP Provider Manual and the Autism Waiver Policy and Procedure Manual.

How many consumers can each Autism Waiver provider work with?
There is no limit as to how many consumers each Autism Waiver provider can work with.

Can an Autism Specialist decline from accepting a case?

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Getting set up to provide services

How can a professional become an Autism Waiver provider?
Fill out the HCBS Provider packet located here.

Each position has their own requirements which can be found here.

Individuals wishing to be an Autism Service Provider should complete the packet and all related documents located here. As well as obtaining a National Provider Identifier. Once approved as meeting the laid out criteria for each position. Additional paperwork may be required.

Do you have to work for an organization in order to be an Autism Waiver service provider?
An organization can agree to have an employee provide Autism Services or an individual can enroll as an independent provider. In either situation the person providing the service must meet the qualification for that specific service. CSS

How do I apply for a National Provider Identifier (NPI)?
Go to this website and complete the on-line application and have the confirmation e-mailed to you. Then print the e-mail you receive and include in your enrollment packet.

What training is required for providers on the Autism Waiver?
State Requirements for KDADS Autism Providers

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Autism Specialist Responsibilities

How long does the process take?
Once receiving a position on the Autism Waiver the Functional Eligibility Specialist has 5 working days to contact the family and set up the assessment. Once the Vineland II Survey Interview Adaptive Behavior Scales and the child has been determined eligible the family will choose an Autism Specialist and complete the Medicaid Application. The Autism Specialist has 5 working days to make contact with the family upon referral. Assessments and further contacts will start after Medicaid Eligibility has been determined. The Autism Specialist will then complete the Criterion Reference Based Assessment and complete the Individual Behavior Plan/Plan of Care which can take 3 hours to several visits over several days. During this time you can be looking for Intensive Individual Support Workers. The Autism Specialist then has 45 days to enter the Individual Behavior Plan/Plan of Care.

What services are billable for the Autism Specialist?

  • Completion of Criterion Reference Skill Based Assessment
    (initial and annually)

  • Development of IBP/POC (initial and annually)

  • Service Coordination and Implementation as identified per IBP/POC

  • Monitoring of Services

  • Completing the necessary forms required by KDADS

  • Home Visits

  • Contacts may include but not limited to: phone, e-mail, and/or letters providing documentation supports services rendered are coordination and/or implementation of Autism Waiver services

  • Training and technical assistance to parents and paid support staff

  • Assistance with activities of daily living

What is a Criterion Reference Skill Based Assessment (CRSBA)?
It is often, yet not always, used to establish an individual’s competence, (whether he/she can do something). Depending upon which CRSBA is completed a child’s specific skills are identify. One example of a CRSBA is “Assessment of Basic Language and Learning Skills (ABLLS)" or "Assessment, Evaluation, and Programming System (AEPS)".

CRSBA is the foundation from which the evidence-based therapy is developed; it also becomes the frame work for the IBP/POC.

What is an Individual Behavioral Program/Plan of Care?
The IBP/POC incorporates information from the CRSBA and the Vineland II. IBP/POC identifies:

  • functional capabilities,

  • specify goals & actions utilizing an evidenced based therapy,

  • identify current resources available (formal and informal),

  • develop, update or review POC at a minimum annually or as needed,

  • review of domains every 6 months and,

  • evaluate the family’s strengths, goals, and preferences.

Who provides input in the development of the IBP/POC?
The Autism Specialist, family, and individuals the family has chosen to provide feedback.

How can a parent choose their Autism Service Providers?
CSS maintains a list of approved enrolled Medicaid service providers at their website. Since it is necessary for the family and the Autism Specialist to be a good match, families will need to contact an Autism Specialist first to see if the Autism Specialist is available to work with them as well what form of therapy the Autism Specialist ascribes to.

How many domains in the IBP/POC do I need to cover?
Currently you must cover all 12 domains in each child’s IBP/POC.

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Documentation Requirements

What kind of documentation is required

  • Who was involved?

  • What service was provided?
    Type of service provided (Intensive Individual Supports, Autism Specialist, Respite, etc), Description of service type (Observations, feedback to IIS, program planning, time spent working on the Individual Behavior Program/Plan of Care goals, family support, etc.)

  • When was the service delivered?
    Date (month, day, year)
    Start time/end time, am/pm, military time and length of services

  • Where was the service provided?
    Home, community, phone consultation

  • Why was the service delivered?
    Relationship to goals, progress the child has made, facts and evidence

  • How will the services be Implemented, Monitored, Data collection (parent report, facts and evidence), Re-evaluated, Follow up and next steps

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Billing Questions

What are the billing increments and payments?

  • Autism Specialist-50 hours per calendar year or 200 units at $17.50 per unit or $70.00 per hour

  • Intensive Individual Supports-25 hours per week which totals 1,300 hours per calendar year or 100 units per week which totals 5,200 units per calendar year at $6.25 per unit or $25 per hour

  • Respite- 168 hours per calendar year or 672 units at $3.00 per unit or $12 per hour

  • Parent Support & Training-30 hours per calendar year or 120 units at $6.25 per unit or $25.00 per hour , Group rate is $12.00 per hour

  • Family Adjustment Counseling- 12 hours per calendar year or 48 units at $10.00 per unit or $40.00 per hour, Group rate is $20.00 per hour

Note: One unit is equal to 15 minutes.

What services are entered into the Medicaid Management Information System (MMIS) plan of care system?
All waiver services are entered into the MMIS plan of care system except the Autism Specialist. Autism Specialist Services are submitted through the regular claim MMIS system.

Can I bill for services for children who are at school?
Autism Waiver services do not duplicate other Medicaid State Plan services or other services otherwise available to the child at no cost. Public schools access Medicaid dollars and therefore Autism Waiver services cannot be billed for services at a public school. Preschool programs might be billable. Collaboration is recommended between school and home even though it isn’t billable time.

What is a calendar year?
All services run on a calendar year which is January 1st to December 31st. If your child receives services in March of a year you have that allotment of hours through December 31st as well as if your child is offered services in August you have the same allotment of hours through December 31st.

Why do I need an agency code?
Each user ID must be associated with an Agency code which is assigned by EDS. An agency code is needed to bill for the Autism Waiver services.

How do I request additional Autism Specialist hours?
To request additional Autism Specialist hours you need to write a short letter (no longer than a page) and submit it to Kimberly Pierson.

Who do I contact for billing questions?
For billing questions contact the EDS Help Desk at 1-785-274-5961. You should have your Tax ID number and provider number handy.

What if the child’s Medicaid case isn’t coded correctly?

  • Check Eligibility on-line
  • Contact local KDADS representative

If I am an Autism Specialist and an Independent Provider (not working for an agency) am I required to bill for an IIS worker that is also an Independent Provider?
The Autism Specialist as an Independent Provider is not required to bill the hours worked by an IIS worker that is working with one of her consumers on the Autism Waiver. The IIS worker could bill their hours on-line by themselves. However, there would still need to be communication about the number of hours used, etc. to coordinate all services and make sure the Plan of Care is accurate.

Can two IIS workers bill for the same team meeting?
No, you can only bill for one IIS worker at any one time. You could have one IIS worker bill for the team meeting in November and then the other IIS worker bill for a team meeting in December, or they could all split the length of the team meeting

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