Charting the System for Persons with Autism Spectrum Disorder. Page 1

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1 EI Early Intervention Families with eligible children receive an Individualized Family Service Plan (IFSP), which lists the s and supports that are needed for the child to achieve his/her outcomes. Services include, but are not limited to: developmental evaluations and assessments, physical therapy, occupational therapy, speech/language therapy, developmental therapy, coordination, psychological s and social work s. Child and Family Connections (CFC) offices take referrals and coordinate eligibility determination and IFSP development. Services are provided by EI credentialed/enrolled professionals. NA Birth through age 2. Physical or mental condition which typically results in developmental delay* NA 30% or greater level of delay in developmental areas: cognitive; physical, including vision and hearing; language, speech and communication; social-emotional; adaptive self-help skills or being at risk of substantial developmental delays according to informed clinical judgment To make a referral to the Illinois Early Intervention Program, call the local CFC office. For the number in your area, call us/page.aspx?item= Early Intervention An early intervention system which identifies children and adolescents at risk for mental illness or social/emotional challenges accomplished through a multiagency, coordinated and collaborative approach. Community mental health () providers/ professionals N/A Birth - 18 Children and adolescents at risk for mental illness or social/emotional problems N/A N/A Contact the local D regional office in your area us/page.aspx?item= Case Coordination Education, linkage and referral s for persons with including assessment to determine eligibility for programs (ICFs/, Medicaid Waiver, etc.) Contracted Independent None Children and Adults Must have a developmental Service Coordination (ISC) disability Providers Medicaid asset rules screenings and provide s Page 1

2 Respite Services Short-term relief for caregivers of children and adults with (subject to available funding) Contracted Respite Providers None Children and Adults Must have a developmental disability, subject to available funding None Contracted providers determine eligibility ISBE Illinois State Board of Education ISBE provides a continuum of s for students between the ages of 3-21 identified with an autism spectrum disorder. Under ISBE s guidance, Illinois schools focus on the education and support of children with autism spectrum disorders in the least restrictive environment according to the Individual with Disabilities Education Act, as well as for students requiring support Section 504 of the Rehabilitation Act and the Americans with Disabilities Act. Families will receive an Individualized Education Program(IEP) which lists the childs needs sets goals and objectives and details how these will be met within the context of the school Illinois Schools N/A Ages 3-21 Children identified with Autism Spectrum Disorder N/A N/A Contact Local School District. More specifically contact the office of Special Education within the school district. Page 2

3 Mental Health and Schools A delivery system consisting of prevention, early intervention, and treatment in school settings. Community agencies and other child serving systems N/A Ages 6-18 Children and adolescents at risk for mental illness or social/emotional problems N/A N/A Contact school counseling/administrati ve staff Child Group Home Residential settings of up to 10 beds licensed by the Dept. of Children & Family Services providing a continuous program of specialized training and care Licensed Group Home Providers Children age 3 through 21 Diagnosis of developmental Medicaid asset rules disability requiring ICF/ level of care and meet residential priority population criteria, crisis criteria or be selected from PUNS waiting list Individual Care Grant Program Treatment s for children and youth who are severely mentally ill and require therapeutic s in the least restrictive environment Residential Services N/A Ages years of age Children and Youth who are severely mentally ill Contact Value Options for an application. (866) alhealthcollaborative.co m/index.htm Community Services (Out-Patient) Outpatient delivery system that includes an array of clinical and support s Community Providers Children Birth-17, Adults -18 and up All Mental Health diagnosis N/A N/A Self referral to local community health provider. Family referral, medical professional, or third party referral Community In- Patient Services Hospital-based treatment for adults and youth who are seriously mentally ill State Operated Hospitals Medicaid Eligibility rules Ages 12 and up All Mental Health diagnosis N/A N/A Referral from outpatient provider, or other medical professional Page 3

4 Crisis/Emergency Services Screening and Assessment Services System (SASS), Crisis Stabilization Mental Health professionals SASS-Birth to 21 Crisis-age 21 and up Mental Health diagnosis with acute distress Private insurance - not eligible N/A SASS-Call Crisis and Referral Entry Services (CARES) line. Referral from local provider. us/page.aspx?item= Mental Health Juvenile Justice Treatment s for children and youth with serious emotional disturbance (SED) who exit JJ system Mental Health Professionals N/A Ages 6-17 Children N/A N/A Referral from Juvenile Justice Forensic Services In patient or Outpatient s Mental Health for adults and juveniles the court Professionals finds to be unfit to stand trial of not guilty by reason of insanity Court order only No age limit N/A N/A N/A Court Referrals Private Intermediate Care Facility for persons with (ICF/ or SNF/Ped) Residential setting licensed by the Dept. of Public Health providing a continuous program of specialized training and care Private Medicaid Providers Adults, children are served in specialized pediatric facilities Diagnosis of developmental disability requiring ICF/ level of care Medicaid asset rules Page 4

5 DRS Vocational Rehabilitation Job placement and development s including but not limited to job finding, job training, job retention, physical restoration, mental restoration, post secondary training, and support s. Delivery of these s are primarily the responsibility of the local VR Counselor through employment networks, community rehabilitation provider, secondary and post secondary education institutions and medical providers. There is no income test for eligibility. However, there is a financial analysis completed for individuals not recipients of Social Security or customers ing for no cost s. The financial analysis determines any cost share for required s. There is no age minimum or maximum for the provision of VR Services. However, s are usually limited to individuals of appropriate employment age. In order to for VR s a customer must be determined disabled by the Social Security Administration or meet the following three criteria. 1) Have been determined by a qualified person to be physically or mentally disabled; 2) Have been determined by a qualified vocational counselor employed by DHS/DRS to require VR s; and 3) be able to benefit from those VR s. There is no asset test to determine eligibility. However, a financial analysis will determine any cost share for required s. Assets set aside for a customer's vocational benefit will be required to be used for that purpose. In addition to eligibility, Illinois VR uses an order of selection to determine which eligible individuals will receive s. This is a priority for s. Categories are most significant, very significant, significant, and other disabilities. Number of limitations to functional capacities and number of required s determine the category an individual falls in. All others are put in a waiting list, if they choose. Self referral to a local DHS/DRS office, self referral from the DHS web site. Family referral, medical professional, or other concerned party referral may be made to the local DHS/DRS office or web site. v/wrpublic/wr/setreferr al.do Page 5

6 DRS Home Services Program HSP is designed to prevent the unnecessary institutionalization of individuals who may instead be satisfactorily maintained at home at a lesser cost to the State. Services are delivered by private providers, agencies, or entities having rate agreements Personal Assistants, Homemakers, Home Health, Home Delivered Meals, Adult Day Care Facilities, Emergency Home Response Services, and/or Environmental Modifications/Assistive Equipment purchases. No income test for eligibility Must be the age of 60 at the time of application for HSP s, unless the individual is ing for s the HSP AIDS Medicaid Waiver or the HSP Brain Injury Medicaid Waiver, in which case there is no age criteria for application; 1) have a severe disability which is expected to last for at least 12 months or for the duration of life; 2) be an individual with a disability who is in need of long-term care, as determined by the DON score completed as a result of a prescreening (89 Ill. Adm. Code 679) or application for HSP s. In order to be determined to have met this criteria, the individual must receive a DON score of at least 15 points on part A, which includes, if applicable, the 10 points from the Mini-Mental Examination, with a total DON score of at least 29 points; 3) with DHS assistance, obtain certification at least every two years from a physician or from a neuropsychologist for a person with a brain injury (as defined in Section (r)) that indicates the individual is in need of longterm care and this care can safely and adequately be provided in the individual's home according to the physician and the HSP Service Plan. Adult customers, age 18 years or above, may have no more than $17, in non-exempt assets for customers over the age of 18 and up to $35, in total family assets for customers age 18. 1) be a citizen of the United States, or be an individual who is living permanently in the United States after having been legally admitted; 2) have applied for, be a recipient of, or be found eligible for Medicaid benefits through HFS and within 60 days after the date of application for HSP provide verification to the HSP counselor of the aforementioned.3) be a resident of the State of Illinois; 4) not require in-home s that are expected to cost more than the cost the State would pay for institutional care for an individual with a similar DON score. Self-referral to a local All DHS/DRS office or the DHS website. Family referral, medical professional, or other concerned party may refer to the local DHS/DRS office or website. v/wrpublic/wr/setreferr al.do customers with severe disabilities, including ASD, may for the Home Services Program if all criteria of eligibility are met. Page 6

7 Community Integrated Living Arrangement (CILA) Residential settings of up to 8 beds licensed by the Dept. of Human Services providing a continuous program of specialized training and care Licensed CILA Providers Adults age 18 and older Diagnosis of developmental Medicaid asset rules disability requiring ICF/ level of care and meet residential priority population criteria, crisis criteria or be selected from PUNS waiting list Developmental Training (DT) Day programs certified by the Dept. of Human Services providing a continuous program of specialized training and care Certified DT Providers Adults age 18 and older Diagnosis of a developmental disability requiring ICF/ level of care and meet priority population criteria or be selected from PUNS waiting list Medicaid asset rules Supported Employment Job coaching supports for adults to enable them to work in the community Contracted Providers Adults age 18 and older Diagnosis of a developmental disability requiring ICF/ level of care and meet priority population criteria or be selected from PUNS waiting list Medicaid asset rules State-Operated Developmental Center Specialized Intermediate Care Facilities for persons with State-Operated, DHS Division of None Adults age 18 and older Diagnosis of developmental disability requiring ICF/ level of care in State-Operated setting Assets are applied to the cost of care Page 7

8 Adult Day Care Day programs licensed by the Dept. on Aging providing care and support for elders Contracted Providers licensed by the Dept. on Aging Age 60 or due to special needs Subject to prior approval, must be Medicaid asset rules enrolled in Adult Waiver and be retired or unable to attend another day program * including Pervasive Developmental Disorder/Autistic Spectrum Note: Chart provides summary eligibility information. For specific eligibility requirements, see applicable statutes, rules, and policy and procedure manuals. Note: Autism and other disorders within the autism spectrum may be a related condition if all other eligibility criteria are met. Diagnosis must result in substantial functional limitations in three or more of the following areas of major life activity: a. Self-care b. language c. Learning d. Mobility e. Self-direction f. Capacity for independent living Definitions: Pre-admission Screening Services (PAS): An assessment to determine eligibility for Medicaid Waiver and LTC s Pre-admissions Screening Services Agencies: Eighteen independent community agencies selected by DHS to perform assessments, s, and arrangements. Pre-admissions Screening Agent: Agents that screen and assess individuals who are seeking admission into any Medicaid funded setting. Prioritization of Need for Service (PUNS): It is a statewide database that records information about individuals with developmental disabilities who are potentially in need of s now or within the next five-years. The state uses the data for 3 main purposes (1) to select individuals for s as funding becomes available, (2) to develop proposals and materials for the States annual budgeting process, and (3) to plan for future needs. ICF/: Intermediate Care Facility for Persons with Developmental Disabilities SSF/Ped: Skilled Nursing Facilities - Pediatrics, facilities for persons 22 Page 8