As approved by the Centers for Medicare and Medicaid Services (CMS), the Division of Early Intervention and Special Education Services (DEI/SES) is the Operating State Agency (OSA) for a 1915(c) Home and Community Based Services (HCBS) Waiver for Children with Autism Spectrum Disorder (ASD), also known as the Autism Waiver (AW). This waiver is designed to enable children to remain in their home and community and serves as an alternative to an institutional level of care. The AW is jointly administered by the Maryland State Department of Education (MSDE) and the Maryland Department of Health (MDH) and is a national model for interagency collaboration. The CMS requires that states have in place regulations and policies for implementation of the AW, a quality review system for assuring service delivery, and a process for monitoring AW providers. As the OSA, MSDE has primary responsibility for provider compliance with regulations, conducting compliance monitoring, information tracking, and performance measurement and reporting. The MSDE and the local education agencies (LEAs) are responsible for determining and tracking medical and technical eligibility for each AW participant, verifying requirements of age, special education and health related service hours, and ASD diagnosis. The MDH is the single State Medicaid Agency (SMA) responsible for the oversight of the AW, Medicaid reimbursements, and financial eligibility determination of AW participants. Both State agencies work together to sustain the AW and adhere to the approved federal application. In addition, in accordance with the 21st Century Cures Act, passed by Congress on December 13, 2016, states are required to implement an electronic visit verification (EVV) system for all home and community-based personal care services. The MDH is implementing this system for two AW services: Intensive Individual Support Services (IISS) and respite. The MSDE is working collaboratively with MDH and their partners to train and provide guidance to AW stakeholders about policies and practices related to EVV. Both agencies are also working collaboratively on the development of policy and practices in response to “End the Wait” legislation and to screen registrants for technical eligibility. Annually, over 1,600 children receive services through the AW and this number is expected to increase due to “End the Wait”. A prescribed set of federally approved services are delivered by over 60 community-based providers and over 50 Service Coordinators contracted by LEAs.
