Autism Treatment Services
Funded by the Children’s Long-Term Support Waiver
The CLTS Waivers provide funding for some specific services that are not covered by the Wisconsin ForwardHealth Medicaid card. For young children diagnosed with an Autism Spectrum Disorder (ASD), early intensive behavioral intervention (EIBI) and consultative behavioral intervention (CBI) are CLTS Waiver services designed to teach new skills and help reduce the challenging behaviors often found in children with an ASD. Eligible children may participate in these programs in any combination for up to three years, after which the child may qualify for ongoing waiver services at a less intensive level that address the more diverse needs of the growing child. The goal of the program is for the child to have fewer needs in the future and to make significant gains towards typical development, including an increase in social, behavioral and communication skills that the child can use at home and in their community.
EIBI and CBI services are typically provided on a one-to-one basis by a team, including a lead therapist, senior staff as well as line staff. The team develops and implements a treatment plan that is individualized to each child’s developmental needs. This treatment approach addresses specific skills for each child that are clearly defined in observable terms and are measured carefully by direct observation throughout each treatment session. Treatment funding provides two service level options for children. Services may be in the child’s home or in the community and be at 10-20 or 30-40 hours per week, depending on the clinical needs of your child. Services must last at least one year at the chosen level of service but no more than three years.
For more information, please go to: Autism Treatment Services.
Eligibility Criteria (for your child’s name to be added to the wait list for funding, your child must meet all of the following criteria):
- Be under eight (8) years of age when approved by DHS for placement on the wait list;
- Be disabled by standards in the Social Security Act;
- Be a United States citizen or have acceptable immigration status;
- Be a Wisconsin resident and a resident for six months if there is a waiting list;
- Live at home with your family;
- Require a level of care typically provided in either a Psychiatric Hospital or an Intermediate Care Facility for the Mentally Retarded (ICF-MR).
- Be provided safe and appropriate care in your family’s home;
- Not have income in their name in excess of the current standards for a child living in an institution;
- Have a diagnostic evaluation that meets these requirements:
- A qualified clinician must complete the evaluation. A qualified clinician is an individual qualified to make a diagnosis and conduct psychological testing per the DSM-5.
- The clinician’s evaluation must state that your child has a diagnosis of Autism Spectrum Disorder.
- The evaluation must have been completed no more than one year prior to application for CLTS Waiver funding for intensive in-home treatment services.
- The evaluation must include supporting documentation that includes a DSM-5 diagnosis and identification of the testing tools used.
- The tests used must be considered validated for the age of your child and the diagnosis given.
- The evaluation must support that your child is a candidate for this treatment methodology.
In addition to the basic eligibility criteria above, you (the parents) will be asked to confirm the following:
- That you agree to participate in at least 12 months of services at the chosen level of service (either EIBI or CBI services);
- That your child must not have already received two or more years of autism treatment services at a level of between 10-40 hours per week;
- That you have located an intensive treatment provider who has agreed to provide treatment for your child. It is your responsibility for getting written confirmation from the provider that they are willing and able to provide services to your child at the time your child becomes eligible for CLTS Waiver funded treatment. You must provide a copy of this information to the Threshold consultant, who will submit it to DHS as part of the application packet.
Parent(s) residing in a Threshold region, should contact the Threshold consultant agency serving families in the county where the family resides. Please see contact information below:
Once the parent has completed all the paperwork and obtained the required documentation, the parent will need to call the Threshold consultant to set up the required home visit. The home visit is used to review the application materials for completeness, verify certain documentation, answer questions and give the consultant an opportunity to meet the family’s child. Once all the application materials are complete, including required documentation, the consultant submits the child’s application to the Bureau of Long-Term Support (BLTS). If the child does not already have a disability determination from the Disability Determination Bureau, the completed application materials are first sent there for this determination to be confirmed or denied. BLTS determines all remaining eligibility including reviewing your child’s diagnosis of Autism Spectrum Disorder against established diagnostic criteria. If the materials submitted are not sufficient to verify the diagnosis, the family will be asked to provide additional information. This may affect the child’s date of eligibility and therefore, their placement on the wait list. A letter will be sent to the family specifying the outcome of the child’s eligibility determination.