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Adults with Autism · PDF file Highlights Autism Commission ... Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM 3. Provide the Department with an evaluation

Jul 27, 2020




  • Adults with Autism

    Janet George Assistant Commissioner

    Policy, Planning January 9, 2016

  • Introduction and Objectives

     Background of Autism Omnibus Bill-

     Goals:

     Basic Demographics

     Eligibility Process

     Services

     Questions

  • Introduction

     The Autism Omnibus Legislation was signed into law in

    August 2014.

     The legislation required DDS to develop and

    implement revised eligibility processes and criteria for

    an expanded population of people with Autism and

    Prader-Willi without Intellectual Disability and for

    Smith Magenis Syndrome. The review process for

    eligibility began in November 2014.

     Revised regulations were required. They are currently

    in regulatory review process.

  • 2014 Autism Omnibus Bill


     Autism Commission Report 2013 created structure for bill in 2014

     Establishes Autism Commission as permanent body within EOHHS -

     Changes eligibility criteria for DDS ****

     Creates tax-free savings account (ABLE)

     Creates Autism endorsement for special education teachers

     Requires DDS and DMH to develop and implement plan for mental illness and developmental disabilities –including respite, family support, and care coordination ****

     Requires MassHealth to cover medically necessary treatments for children under 21 years of age – including ABA ****

  •  DDS Adult Eligibility only served those with ID

     Massachusetts was one of the few states that

    was an ID state, not a DD state

     Stakeholders and DDS saw that individuals with

    ASD were falling through the cracks

    Why The New Law?

  • Requirements for Eligibility for ASD

     Be domiciled in Massachusetts

     2. Have a primary diagnosis of Autism Spectrum Disorder based on most recent DSM

     3. Provide the Department with an evaluation for ASD completed by a qualified physician or psychologist, that includes standardized instruments.

     4. When not provided a diagnostic assessment by qualified physician or psychologist detailing reasons

  • Adult Eligibility requirements

    Have substantial functional impairments in

    three or more areas of the seven major life

    areas 1. Self-care ( ADLS)

    2. Expressive Communication

    3. Receptive Communication

    4. Learning

    5. Mobility

    6. Capacity for Self-direction

    7. Economic Self- Sufficiency

  • Requirements cont.

     Adaptive Measures required

     Additional information may be needed

     Provide documentation and information that demonstrates ASD manifested prior to age 22

     Provide documentation that demonstrates that the developmental disability is likely to continue indefinitely

     Provide personal, clinical, psychological medical, and educational records that diagnosis was through psychiatric and psychological assessments

     Provide reports of previous adaptive measures

     Although IQ is not determinative factor helps delineate strengths and weaknesses

  • What is a reliable diagnosis of ASD

    for adults?  Full psychological evaluation as a child

    with differential dx and use of ASD scales,

    from a qualified practitioner.

     Evaluation by a hospital based

    developmental clinic

     Well documented history of ASD

    symptoms from multiple reliable sources:

    (pediatrician, school, therapists,

    psychosocial history)

  • Demographics

     Currently there are 454 individuals, aged 18 or older, who have been

    found eligible under the new regulations. 205 are over 22 and 245

    are between 18 and 21 years old.

     Of those 205 individuals, 101 individuals are receiving a total

    of 224 DDS services

     Of the total service enrollments, 18% of the services are being

    provided through Participant Directed or Agency with Choice;

    while the remaining individuals are enrolled in traditional

    Purchase of Service

     There are @104 individuals with Autism age 22+ who DDS

    staff continue to work with and who have service enrollments

    pending at this time

  • Autism Eligible Adults Between

    18-21 Years Old

     245 individuals are between the ages of 18-21.

     While the eligibility for adult services occurs at age 22, there are

    circumstances where individuals aged 18-21 may be receiving

    services, such as employment and/or day services and Family Support


     Individuals no longer in school as well as those determined to need

    the service prior to 22 may be enrolled.

     79 of these individuals are enrolled in a combination of 104 services.

  • Supports Intensity Scale

    Life Activity Subscales: Support is a combination of type, frequency and daily support time. Home Living Activities


    Life Long Learning


    Health and Safety


    Each item is phrased: If the individual were to engage in this activity over the next few months, what type of support would he or she need to be successful?

    Protection and Advocacy

    Exceptional Medical and Exceptional Behavioral

  • How Does the SIS Measure

    Success?  Comparable to the typical adults without


     Individual + Supports = Success

  • Service Array

     DDS provides:

     Service Coordination

     Variety of Employment Supports and Activities During  the Day

     Variety of Family Supports for Individuals Residing in

     the Family Home

     Variety of Individual Types of Supports

     Variety of Goods and Services

     Limited array of housing supports for individuals with

     severe challenges

     Exploring new service options based on needs

  • Infrastructure

     In order to implement the legislative requirements, DDS needed to

    strengthen its infrastructure.

     Additional staff were added to the Regional Intake and Eligibility Teams.

     An Autism Service Coordinator was added to each Area Office.

     Regional Program Coordinator Positions were added.

     Regional Contract Specialist Positions were added.

     A Data Management System was developed that tracks eligible individuals

    on a monthly basis, as well as individuals served and individuals in planning.

     A Fiscal Monitoring System was put in place to monitor the $12.6 million

    appropriation with additional work underway to track expenditures by

    service category.

  • Collaboration with DMH

     Establish joint DDS and DMH training, eligibility determination,

    and service development

     Collaborate with other state agencies, insurance payers,

    stakeholders, & families for needed comprehensive services

     Encourage Autism Centers of Excellence for access to skilled

    care for co-occurring behavioral health needs

     Develop family supports including respite & care coordination

     DDS and DMH have entered into an Interagency Service

    Agreement to collaborate in the development and funding of

    supports and services for individuals who are eligible for service

    in both systems.


    Key highlights:

    Collaboration at all levels

    Commitment to work together

    Better understanding of perspectives

    Dual eligibility

    Decision making process for case management assignment

    Forensic Capacity

    Psychiatric Consultation

    Psychiatric Fellowships

    Co-Central Office Leadership Team

    Engagement of Joint Community Providers

    Demonstrations/Pilots for New Service Models

  • Collaboration with DMH (continued)

     DDS and DMH are learning the similarities and differences between the respective

    agencies through regular local, regional and central office networking

     Agencies commit to joint trainings, service design and implementation and mutual


     Joint Provider Meeting occurred in November 2014

     DDS will purchase and support additional clinical resources from DMH including:

    Two psychiatric fellowships ( Mass General and UMass)

    Short term psychiatric consultation

    Forensic Risk Consultation

    Development of Joint Training Agenda

  • Training Plan

     To expand the knowledge based at DDS, DMH and the provider community, a variety of training opportunities as occurred.

     a series of three trainings for the new autism service coordinators, staff from DMH and providers from ADDP were provided. These trainings were provided by prominent external experts and paid for by the SEIU.

     There ha