Current and Potential Providers FAQs

Q: What are the requirements to receive services from this waiver?

A: In order to be eligible for this waiver a person must meet the following requirements:

Live in Pennsylvania
Be 21 or older
Be a U.S. citizen or qualified alien
Have a diagnosis of Autism Spectrum Disorder, which includes a diagnosis of Autistic Disorder, Pervasive Developmental Disorder (PDD-NOS), Asperger Syndrome, Childhood Disintegrative Disorder or Retts Disorder
Meet Medical Assistance financial and non-financial eligibility
Meet the Intermediate Care Facility level of care

** IQ is not an eligibility criterion for this waiver **

Q: How do I become a provider?

A: To become an Adult Autism Waiver provider please contact the Bureau of Autism Services at 1-866-539-7689, and press 1 for English, press 1 again for the Autism Waiver, and then press 4 for the provider voice mailbox. Leave a message with your name, agency, phone number and email address and you will receive an electronic "Provider Packet" which includes necessary links, information and instructions on how to become an enrolled provider.

Requirements for enrollment as an Adult Autism Waiver provider include:

Be enrolled in PROMISe as a Medical Assistance provider
Complete an Autism Waiver provider application
Complete an Autism Waiver Supplemental Agreement
Submit copies of applicable licenses/credentials to the Bureau of Autism Services
Meet training requirements for the service(s) you intend to provide

Q: What training is required?

A: SPeCTRUM: Supporting Persons Centered Training, Resources, Understanding and Mentorship. This training course is designed to be used by individuals and agencies which provide services to adults with an Autism Spectrum Disorder. The nine class sections will address the multiple needs of adults with ASD. There is also the option of the course being supplied to you via CD-ROM. There will be updated training sessions provided in the future. Some services have additional training requirements.

Prior to becoming a provider for the Adult Autism Waiver, a minimum of one staff person must have completed this training. Additional staff can be trained at any time. All staff working directly with waiver participants must complete training before providing services for this waiver. Some services have additional training requirements.

Additional Training Information

Q: What are the rates for reimbursement and how were they determined?

A: The Bureau of Autism Services engaged Mercer Government Human Services Consulting (Mercer) to develop rates for the Adult Autism Waiver services. The first step in developing the fee schedule was to outline the rate-settling process, which included employee wages, adjustments for employee-related expenses (e.g. employee benefits, insurance), productivity (percentage of an employee’s time that is potentially billable), mileage and transportation expenses (when included in the service), and other expenses (e.g. capital, supplies, administrative overhead). Mercer also reviewed rate-setting components and assumptions utilized in other states. The rates were developed to reflect productivity factors for each service to reflect the amount of time direct care workers would be providing services versus time spent on non-billable activities. Based on discussions between BAS and Mercer, BAS selected a statewide fee schedule for the initial program years. Once sufficient data are available, BAS intends to survey providers to gain better sense of costs associated with providing their services to the enrolled population. Once the survey and utilization data is collected and evaluated, BAS will review the current fee schedule and adjust as necessary. A rate table will be provided in the "Provider Pack."

Q: How will I bill and be reimbursed?

A: All payments will be processed through PROMISe (Provider Reimbursement and Operations Management Information Systems), the HIPAA-compliant claims processing and management information system. Learn more about PROMISe. Though the Bureau of Autism Services will provide technical assistance and support if needed, no reimbursement payments will be made through the Bureau at any time. Providers will be reimbursed on a fee-for-service basis.

Q: How do the services provided with this waiver compare to other similar services?

A: Some of the terms for services are very similar to what is used in other waivers, so please review the document titled: "Autism Waiver Service Descriptions." There you will find descriptions for each service in this waiver. Provider qualifications can be viewed on the document titled: "BAS Adult Autism Waiver Provider Qualification Requirements." This material and the entire "Provider Packet" can be provided to you by request by calling 1-866-539-7689, press 1 for English, press 1 again for the Autism Waiver, and then press 4 for the provider voice mailbox.

For more information on the Autism Waiver please email us at ra-ODPAutismWaiver@pa.gov.