Presentation Purpose
To provide an overview of the changes to autism
treatment services and behavioral treatment for parents
and guardians.
Reason for changes
Behavioral treatment benefit information
Overall timeline
Scenarios
Note: Presentation information is current as of November 3, 2015;
all dates are tentative and subject to change.
Coverage of Behavioral Treatment by Wisconsins Medicaid Program
Intended Audience
Parents and guardians of children currently receiving
autism treatment services under the Childrens LongTerm Support (CLTS) Waiver Program.
Parents and guardians of children currently on the
state Autism Wait List.
Parents and guardians of children newly diagnosed
with behavioral treatment needs.
Transitioning Services
Right now children are receiving autism treatment
services through the CLTS Waiver Program. Parents
and guardians work with their waiver agency.
In the future, children will receive behavioral
treatment, including autism treatment, as a regular
Medicaid benefit.
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Accessing Behavioral
Treatment Services
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Overall Timeline
November 2015
Providers who wish to provide behavioral treatment under the
ForwardHealth benefit are required to enroll in Wisconsin
Medicaid as a behavioral treatment provider.
January 1, 2016
The behavioral treatment benefit will be available and PA
requests will begin to be processed.
Children on the state Autism Wait List may begin the PA process.
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Scenarios
Coverage of Behavioral Treatment by Wisconsins Medicaid Program
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Scenario #1
A child currently on the state Autism Wait List:
Parent or guardian will confirm that a Medicaid-enrolled
behavioral treatment provider can serve child.
Between November 2015 and January 2016, selected provider
will complete and submit a PA request for the child.
A decision will be made on the PA request and communicated
back to the provider.
On or after January 1, 2016, behavioral treatment may begin for
the child with an approved PA request.
The childs name will be added to the county CLTS Wait List, if
applicable.
Coverage of Behavioral Treatment by Wisconsins Medicaid Program
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Scenario #1 (cont.)
Once the childs name is released from the CLTS Wait List, the
parent or guardian will work with the waiver agency to
determine if additional services are needed.
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Medically
necessary
treatment
authorized
Provider
submits PA
request
Added to
CLTS
Wait List
Assessed for
waiver
services
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Scenario #2
A current CLTS Waiver participant receiving behavioral treatment:
In November 2015, the waiver participant will be assigned a
transition time between May and October 2016.
Between January and June 2016, the Medicaid-enrolled behavioral
treatment provider will complete a PA request on the childs behalf.
After a PA determination is made, the waiver agency will meet with
the parent or guardian to complete a new assessment and determine
if additional waiver services are needed.
The child will continue to receive autism treatment through the
waiver until a PA determination is made and the assessment is
complete.
Coverage of Behavioral Treatment by Wisconsins Medicaid Program
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Waiver
participant
assigned
transition time
Provider
submits PA
request to
ForwardHealth
Medically
necessary
treatment
authorized
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Scenario #3
A Medicaid-eligible child is newly diagnosed with a behavioral
treatment need:
The family identifies a Medicaid-enrolled behavioral treatment provider
who agrees to provide behavioral treatment for the child.
The selected provider completes and submits a PA request for the child.
A PA decision is made and communicated to the provider.
Behavioral treatment starts for the child with an approved PA request.
If the family has additional needs outside of behavioral treatment, the
parent or guardian should contact the waiver agency to determine
eligibility for waiver services.
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Diagnosis
Contact
behavioral
treatment
provider
Provider
submits PA
request
Medically
necessary
treatment
authorized
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Diagnosis
Contact
waiver
agency for
waiver
services
Contact
behavioral
treatment
provider
Provider
submits PA
request
CLTS
Wait List
Start
receiving
waiver
services
Medically
necessary
treatment
authorized
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Additional information
Learn more about the changes and sign up for email updates
at: dhs.wi.gov/clts/waiver/autism/updates.htm
To learn more about the transition of behavioral treatment
services from the CLTS Waivers to ForwardHealth, contact
your waiver agency.
If your behavioral treatment provider has questions about the
ForwardHealth benefit, refer them to the ForwardHealth
Portal at www.forwardhealth.wi.gov
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Questions
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