PA Adult Autism Services

Co-opprovider.com is a professional entity providing treatment of Adult Autism spectrum disorders Pennsylvania’s new Autism Insurance Law (also known as Act 62) Act 62 requires certain private health insurance plans to cover a broad range of services for children and adolescents under 21 years of age on the autism spectrum.

Adult Autism Waiver (AAW): Service Definitions

The definitions below are summary definitions for services included in the Adult Autism Waiver. For complete descriptions and other information on services included in the Adult Autism Waiver

Adult Autism Waiver Services Provider Information Table (pdf download/printable)

Assistive Technology:

  • This is an item or piece of equipment that is used to help a person be more independent in their daily life activities, including communicating.
  • This service includes help in choosing and learning to use the item or equipment. It also includes yearly service and batteries if that is needed.
  • Equipment that costs $500 or more must be recommended by a professional.
  • There is a limit of $10,000 over the participant’s lifetime, including repair or replacement of the item or piece of equipment.

Some examples are: voice output devices, food preparation aids, modified computer keyboard and vibrating wristwatch.

Behavioral Specialist Services (BSS):

This service provides support to people with behaviors that make it difficult for them to be active in their community and to live at home, including behaviors that may be disruptive or destructive.

  • A Behavioral Specialist provides this service. The Behavior Specialist has training in how to understand why a person may be having difficulty.
  • The Behavioral Specialist creates a plan called the Behavioral Support Plan. The Behavioral Support plan helps everyone who is in regular contact with the waiver participant to support him or her. This service includes training family members and providers in how to support the participant and teach him or her skills to be more independent.
  • The BSS works closely with the Supports Coordinator to make sure that other services are provided according to the Behavioral Support Plan.
  • This service also includes creating a Crisis Intervention Plan. The Crisis Intervention Plan explains how to help the participant if he or she is going into a crisis. Everyone who is in regular contact with the participant who gets this service should know how to use the Crisis Intervention Plan. The BSS agency has someone available 24 hours/day, 7 days/week to help if a participant goes into crisis. An example of Behavioral Specialist service is the development of a plan to teach a participant to ask for a break from an activity when they need one.

Community Inclusion:

This service helps a person to gain the skills needed to live in the community.

  • This service includes things that will help a person improve his or her activities of daily living (ADLs). ADLs are things usually done at home, such as bathing, dressing, and eating, or doing housework, managing money, and cooking.
  • This service also includes teaching and improving skills that will help him or her to be active in their community. These are things like socializing, getting to know the neighborhood where he or she lives, or participating in community activities such as hobbies, shopping or attending an event.
  • The types of community inclusion activities a participant will do depend on his or her Individual Support Plan (ISP). The activities will be ones that are needed to help a participant reach a certain goal written into the ISP.
  • Community Inclusion can take place in a person’s home or in community locations such as libraries or stores.
    • An example of community inclusion is teaching a person with disabilities to use public transportation to get to and from work.

Community Transition Services:

Community Transition Services offer occasional financial assistance with moving from an institution into the community.

  • This service is for one-time only types of expenses such as moving costs, security deposits, or basic household furnishings.
  • It is only for participants who will be directly responsible for their own living expenses.
  • Community Transition Services do not include monthly rent, food, or regular utility charges.
  • A Supports Coordination agency will make the payment directly for the waiver participant.

An example of a Community Transition Service is payment of the security deposit on a new apartment so that a person can move out of a state hospital.

Day Habilitation:

This service is meant to teach skills to give the participant more independence. It is much like the Community Inclusion Service except that it is provided only in adult training facilities. Day Habilitation helps a person acquire the daily living skills needed to live in the community.

  • This service can include personal assistance in completing Activities of Daily Living (ADL’s include bathing, dressing, and eating, or doing housework, managing money, and cooking). However, the goal of Day Habilitation is to improve the participant’s ability to do things on his or her own.
  • This service also helps the participant develop and improve communication, their ability to make decisions and make choices, ask for the help they need and skills needed to successfully live in the community.
  • Day Habilitation service includes transportation to and from the day habilitation facility and day habilitation activities.
  • This service is normally provided for 6 hours or less per day, 5 days a week on a regularly scheduled basis.
  • Community Inclusion, Day Habilitation, Supported Employment, and Transitional Work Services are limited to 50 hours combined per calendar week. An example of day habilitation is learning to prepare a meal while at the adult training facility.

    • Environmental Modification:

    These are physical changes made to a person’s home which are required for a person to remain safe and free from harm and/or live with more independence.

    Changes are limited to these:

    • Alarms and motion detectors on doors, windows, and/or fences, Brackets for appliances,Locks.
    • Changes that need to be made to the home and vehicle that help with a person’s special sensitivity to sound, light, or other environmental conditions
    • Outdoor gates and fences, Plastic windows
    • Electrical switches and sockets placed out of reach
    • Home or vehicle adaptations for participants with physical disabilities, such as ramps, grab bars, widening of doorways, or modification of bathroom facilities.
    • Changes costing over $1,000 must be recommended by an Occupational Therapist; a Speech, Hearing, and Language Therapist; a Behavioral Specialist; or another professional.

    An example of an environmental modification is an alarm installed on the front door that sounds when it is opened.

    Family Counseling:

    This service provides counseling to waiver participants and their families and/or caregivers to build a healthy and stable family relationship.

    • This services aims to either keep the waiver participant in the family home or have the participant return to the family home.
    • The Adult Autism Waiver may not pay for services which another party, such as the family members’ health insurance, is responsible for paying.
    • This service is limited to 20 hours per year. The year begins on the date the Individual Support Plan is authorized.
    An example of need for Family Counseling is when the family is going through a very stressful period, like after the death of a loved one.

    Family Training:

    This service provides training to family members and caregivers to teach them how to help the waiver participant build skills that will improve his or her ability to live independently.

    Training is included in the following areas:

    1. Communication skills
    2. Stress reduction
    3. Self- direction (making decisions and choices)
    4. Daily living skills
    5. Socializing
    • This service does not include training in the use of assistive technology devices, which is included in the Assistive Technology service.
    • This service also does not include the training necessary for family members to carry out the behavioral support plan or crisis intervention plan, which is included in the Behavioral Specialist Service.

    An example of family training is teaching family members to encourage the participant to ask for help instead of guessing what the participant needs.

    Job Assessment and Finding:

    This service helps waiver participants in finding paid or volunteer work in the community.

    Job assessment includes: Review- looking at the participant’s work history, interests, and skills to determine what types of jobs and/or training will be best.

    • The provider then suggests what kinds of jobs in the community match the participant’s skills, abilities, and interests.
    • Situational assessments- this is like a job tryout where the participant performs certain types of job tasks to see if he or she has the ability and/or interest to do that particular type of job.
    Job Finding includes:
    • Finding a specific job that matches the participant’s skills and interests with an employer’s needs.
    • Successful job finding is a permanent job placement where the participant has worked for at least 30 days.
    If the participant also is getting Behavioral Specialist Services, then Job Assessment and Job Finding should be done in a way that includes using the behavioral support plan and the crisis intervention plan

    An example of Job Assessment and Job Finding is being tested for different job skills, sharing areas of interest or experience that might be helpful in a job, and applying for a job with an employer who has already been contacted by the job finding provider.

    Nutritional Consultation:

    This service provides help to waiver participants who have food allergies, food sensitivities, or serious nutritional deficiencies. The nutritional consultation helps participants and their families and caregivers develop a diet and plan meals that will meet the need for healthy eating habits.

    An example of Nutritional Consultation is getting meal planning help and advice for a participant who avoids fruits and vegetables, or whose food choices are limited because of food texture.

    Residential Habilitation:

    This service is provided for participants who need to be in a supervised setting all the time, including overnight. The participant who receives this service lives in a licensed Community Home or Family Living Home owned by the provider. This service is meant to teach skills to give the participant more independence so that the participant will be able to move to a private home setting in the future.
    • Residential Habilitation is provided in two types of facilities: Licensed community homes (group settings) and Licensed family living homes.
    • This service can include personal assistance in completing ADLs ( ADLs are things such as bathing, dressing, and eating, or doing housework, managing money, and cooking) however, the goal of residential habilitation is to reduce the need for personal assistance by improving the participant’s ability to do things on his or her own.
    • This service also helps the participant develop and improve: communication, their ability to make decisions and make choices, ask for the help they need and skills needed to successfully live in the community.
    • Day Habilitation service includes transportation to and from the Day Habilitation facility and day habilitation activities.
    At least once every three months, the Supports Coordinator, with the participant, must review whether goals are being met and check whether goals for this service should be changed in the Individual Support Plan. A participant receiving residential habilitation services can also get other waiver services, except for respite.

    An example of someone using the Residential Habilitation service is living in a Community Home, using Transitional Work Services and Community Inclusion services during part of the day, learning skills to become more independent, and spending holidays with their family at the family home.

    Respite:

    This service gives a participant’s unpaid caregiver a short break hfrom caretaking duties when the caregiver is unable to do so because of unusual circumstances.
    • This service may be provided in or out of the participant’s home.
    • Respite provides assistance in completing Activities of Daily Living (ADLs include bathing, dressing, and eating, or doing housework, managing money, and cooking).
    • The respite service provider must try to follow the participant’s regular schedule of activities.
    • The use of respite can be any combination of in-home or out-of-home respite, as long as the cost is not more than $6,000 during the Individual Support Plan year.
    An example of the use of respite is when a caregiver has jury duty and must be out of the house for a few hours at a time they would usually be home, or needs to be away overnight to attend to a family emergency.

    Supported Employment:

    This service provides ongoing help in keeping a job once the waiver participant has found employment.
    • Supported employment is used to lessen the need for help by supporting the participant to be successful at work without special help.
    • This service is provided for participants who, because of their disability, need ongoing support to function in a work setting.
    • Supported Employment is delivered in a community job setting, either volunteer or paid, which includes co-workers who are not disabled.
    An example of supported employment is having staff accompany the participant to work until they have learned the routine of the work place, providing help to meet co-workers and helping the boss and co-worker to become familiar with the participant. Then the staff can accompany the participant less often, but be available to provide extra support if needed.

    Supports Coordination:

    The supports coordinator makes sure that the participant is receiving the services to which he or she is entitled. Supports Coordination is made up of four major parts:
    1. Assessments: Every year before developing the Individual Support Plan (ISP), the Supports Coordinator will ask the participant and/or family members to complete three tests—the Scales of Independent Behavior-Revised (SIB-R), the Parental Stress Scale (PSS) (if the participant lives with family members) and the Quality of Life Questionnaire (QOL.Q).
    2. Individual Support Plan (ISP): the Supports Coordinator must call a meeting of the Planning Team to create the participant’s Support Plan. The team is made up of the Supports Coordinator, the participant getting services and other people chosen by the participant. A participant may ask current service providers to attend the Planning Team meeting, especially a Behavioral Specialist provider. The services in the ISP should be based on the participant’s goals and needs.
    3. Monitoring: the Supports Coordinator should visit or call the participant or his or her family at least once every month. They have to visit the participant either at home or outside of home while they are getting services, at least once every three months. During those visits or calls, the Supports Coordinator will check to see that the participant is getting the services that are on his or her ISP, and that the providers of those services are doing what they are supposed to be doing. The Supports Coordinator also checks that the participant is doing well.
    4. Coordination of non-waiver services: the Supports Coordinator also helps the participant find and access services that they may need that are not part of the Adult Autism Waiver. Some of those services might be: finding a doctor or dentist, applying for job training and finding services offered by the participant’s community (town or county). An example of the use of Supports Coordination service is to contact the supports coordinator whenever there is an important change in the needs of the participant, or if the participant or family has a concern about the services received through the waiver.

    Temporary Crisis Services:

    This service provides additional staff to help a participant after a crisis. A crisis may exist when the participant’s safety is at risk and services cannot be provided without additional staff.

    This service is used for those unexpected circumstances when a temporary increase in staff is needed to allow the participant to carry out their normal activities.

    Temporary Crisis Services staff will support the family and/or staff in the following areas:

    • Community Inclusion, Residential Habilitation, Day Habilitation, and Family Living Home

    The Bureau of Autism Services (BAS) decides whether someone needs temporary crisis services, based on information from the Supports Coordinator, the Behavioral Specialist (if the participant gets that service) and the rest of the Individual Support Plan (ISP) team. BAS will review the need for this service at least once a week.

    This service is meant to be temporary. If a participant needs this service several times, his or her ISP should be reviewed to understand why the participant is having a crisis so often.

    Only 540 hours of this service may be used in any 12-month period.

    An example of temporary crisis service is an additional staff member is added when the participant goes out to the mall as part of his or her community inclusion service, following the participant’s discharge from a psychiatric hospital stay.

    Therapies:

    These services are provided by healthcare professionals and are intended to enable the waiver participant to maintain his or her ability to perform Activities of Daily Living (ADL).

    Therapies in the Adult Autism Waiver include:

    • Occupational Therapy- provided by a registered occupational therapist. This service can include assistance with a participant’s assistive technology or environmental modification needs.
    • Speech/Language Therapy- this service is provided by a licensed speech therapist or certified audiologist.
    • Counseling- this service is provided by a licensed psychologist or psychiatrist. The psychologist or psychiatrist will deliver the service directly to the waiver participant.

    An example of therapies is a Speech/Language therapist who helps a participant learn to change his or her tone of voice depending on where they are or what they are saying.

    Transitional Work Services:

    This service provides job opportunities in which the participant is working alongside other people with disabilities. This service is meant to transition participants to jobs in the community with mostly non-disabled co-workers.

    Transitional work services options include:

    • Mobile work force- This uses teams of workers who perform their work away from the agency or facility which employs the team. This includes work such as maintenance, lawn care, janitorial services, and other such tasks. The Transitional Work Services Provider contracts with an organization or business to provide the job but participants are paid by the waiver service provider.
    • Work station in industry- This involves individual or group training of individuals at an industry site. Training is run by the waiver provider or by a representative of the industry. Training is phased out as the waiver participant obtains the skills needed to perform the job and meet production standards.
    • Affirmative industry- This refers to an integrated operation where disabled and non-disabled individuals work together on the same job tasks.
    • Enclave- enclave is a business model where disabled individuals are hired by a business/ industry to perform specific tasks while working alongside non-disabled workers.

    An example of transitional work services is participation in a mobile work force team where the participant learns job skills like being on time, taking direction from a supervisor and specific skills like yard maintenance which could be used in getting a job in the future.

    OBRA Waiver

    The OBRA Waiver is a Home and Community Based waiver program that provides services to people with developmental physical disabilities to allow them to live in the community and remain as independent as possible.

    For a printable version of these service definitions, Adult Autism Waiver Service Definitions

    Who is eligible?

    Pennsylvania residents age 18 and older with a severe developmental physical disability requiring an Intermediate Care Facility / Other Related Conditions (ICF/ORC) level of care. The disability must result in substantial functional limitations in three or more of the following major life activities: mobility, communication, self-care, self-direction, capacity for independent living, and learning. Other related conditions (ORCs) include physical, sensory, or neurological disabilities which manifested before age 22, are likely to continue indefinitely, and result in substantial functional limitations in three or more of the following areas of major life activity: capacity for independent living, mobility, self-direction, learning, understanding and use of language, and self-care. A limited number of individuals with an Autism Spectrum Disorder diagnosis can be served under the OBRA Waiver.

    Additional Eligibility Requirements may apply. Services available may include:

    • Adult day services
    • Assistive technology/specialized medical equipment and supplies
    • Community integration services
    • Community transition services
    • Daily living services
    • Education services
    • Environmental adaptations
    • Personal Emergency Response Systems (PERS)
    • Prevocational services
    • Respite services
    • Service coordination
    • Support employment services
    • Therapies (behavior, occupational, physical, speech)
    • Transportation services
    • Visiting nurse

    OBRA Waiver Application

    The OBRA Waiver was initially approved by the Centers for Medicare and Medicaid Services in 1992. View the 2006-2011 OBRA Waiver.

    COMMCARE Waiver

    The COMMCARE Waiver is a Home and Community Based program developed for individuals with a medically determined diagnosis of traumatic brain injury (TBI). COMMCARE prevents the institutionalization of individuals with TBI and helps them to remain as independent as possible. Traumatic brain injury is defined as a sudden insult to the brain or its coverings, not of a degenerative, congenital or post-operative nature, which is expected to last indefinitely.

    Who is Eligible?

    Pennsylvania residents age 21 and older who experience a medically determinable diagnosis of traumatic brain injury and require a Special Rehabilitative Facility (SRF) level of care. The disability must result in substantial functional limitation in three or more of the following major life activities: mobility, behavior, communication, self-care, self-direction, capacity for independent living, and cognitive capacity (judgment, memory and reasoning).

    Additional eligibility requirements may apply.

    Services available may include:

    • Service Coordination
    • Personal Care Services
    • Respite Care
    • Prevocational Services
    • Supported Employment
    • Habilitation and Support
    • Educational Services
    • Environmental Adaptations
    • Non-Medical Transportation
    • Specialized Medical Equipment/Supplies and Assistive Technology
    • Chore Services
    • Personal Emergency Response Systems (PERS)
    • Extended State Plan Services
    • Coaching/Cueing
    • Night Supervision
    • Structured Day Program
    • Behavioral Specialist Consultant
    • Cognitive Therapy
    • Counseling (Consumer and/or Family)
    • Community Integration
    • Community Transition Services
      • View the current COMMCARE Waiver

    Independence Waiver

    The Independence Waiver is a Home and Community Based waiver program that provides services to persons with physical disabilities to allow them to live in the community and remain as independent as possible.

    Who is eligible?

    Pennsylvania residents age 18 and older with a severe physical disability requiring a nursing facility level of care. The disability must result in substantial functional limitations in three or more of the following major life activities: mobility, communication, self-care, self-direction, capacity for independent living and learning.

    Additional eligibility requirements may apply.

    Services Available May Include:

    • Assistive technology/specialized medical equipment and supplies
    • Community integration services
    • Community transition services
    • Daily living services
    • Education services
    • Environmental adaptations
    • Personal Emergency Response Systems (PERS)
    • Respite services
    • Service coordination
    • Therapies (behavior, occupational, physical, speech)
    • Transportation services
    • Visiting nurse

    View the current 2006-2011 Independence Waiver