Getting Started: Does my Child Need a Diagnosis?
We understand that you may not want to take your child in for an official medical diagnosis, especially when you or someone else suspects they may have autism. There are several reasons to consider investigating obtaining a medical diagnosis of autism. Some of these reasons are listed below.
Keep in mind this list is not exhaustive but meant to provide you with an understanding of why to move forward when you are going through your lists of pros and cons. The biggest list of pros for obtaining a medical diagnosis is access to services. See below for specific details.
The Diagnosis Report
Insurance will not cover applied behavior analysis services without a diagnostic report. This report should provide background information for the child, the assessments used during the evaluation, an overview of the results with descriptive analysis of how the results were determined, and recommendations for moving forward with school, therapy, or both.
If a child has a medical diagnosis of autism and they live in Texas, their parents are encouraged to sign them up for CLASS and HCS waitlists.
What is CLASS?
Community Living Assistance and Support Services (CLASS) provides home- and community-based services to people with related conditions as a cost-effective alternative to placement in an intermediate care facility for individuals with an intellectual disability or related condition (Texas Health and Human Services, n.d.).
What is HCS?
The Home and Community-based Services (HCS) program provides individualized services and supports to persons with intellectual disabilities who are living with their family, in their own home or in other community settings, such as small group homes (Texas Health and Human Services, n.d.).
This waiver is an alternative to receiving services in an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) (Navigate Life Texas, 2019).
See below for more detailed information about CLASS and HCS.
The Benefits of Joining a Waitlist
Even if families do not qualify for services through CLASS or HCS now, it is crucial that their child is on the waitlist for the future. These programs have long waitlists and when your child is an adult, they may qualify for services regardless of family need or income.
Finding a Community of Support
As a parent, you want to learn how to support your child. You want to learn how their brain works so you can effectively meet their needs. A medical diagnosis may allow you to investigate options for your child that you never thought of. It may provide you with insight into their brain and thought processes that allow you to learn with and from your child.
Parent connection and support is necessary for your mental health and well-being. If you have knowledge from a diagnostic report that provides you with detailed information about your child’s unique learning abilities and needs, you may be able to find a support group with other parents. Connecting with others who are in similar positions is beneficial for you, your family, and your child.
Support Through Your Next Steps
We understand that this may be a difficult decision for your family. If you would like to discuss your options with one of our administrative team members, please don’t hesitate to reach out. We are happy to answer questions, offer suggestions for referrals, or provide alternative resources as needed.
More about CLASS
CLASS provides home- and community-based services to people with related conditions as a cost-effective alternative to placement in an intermediate care facility for individuals with an intellectual disability or related condition (Texas Health and Human Services, n.d.).
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Texas resident who is NOT living in an institutional setting
Diagnosed with a related condition prior to the age of 22 years
Diagnoses may be due: cerebral palsy, muscular dystrophy, spina bifida, epilepsy, head injuries, or any of the Approved Diagnostic Codes for Persons with Related Conditions. F84.0 Autistic Disorder is included on this list.The primary diagnosis must be made by a licensed physician or designee (Texas Health and Human Services, 2018).
Individuals must have a qualifying adaptive behavior level.
Moderate to extreme deficits in adaptive behavior based on the administration of a standardized assessment of adaptive behavior (Texas Health and Human Services, 2017). Meet the level-of-care criteria for placement in an ICF/IID. -
Do not exceed specified income and resource limits.
Monthly income of up to 300% of the monthly income limit for Supplemental Security Income (SSI) and no more than $2,000 in assets.
This refers to the child’s income, not the family income (Navigate Life Texas, 2019).
Are not enrolled in any other Medicaid waiver program.
Demonstrate need for one or more services monthly. -
Exhibit substantial functional limitation in three areas of major life activities:
- Learning
- Mobility
- Self-care
- Language
- Self-direction (age 10 and over)
- Independent living (age 10 and over)
- Eligible for or receiving Supplemental Security Income (SSI) or Medicaid. -
Ready to get on the waitlist?
Call 877-438-5658
Ask for the CLASS Waiver Program
Be prepared to provide the following information (Disability Rights, 2018):
● Social Security Number
● Medicaid Number
● Date of Birth
● Type of Disability
● Age of onset of the disability
● Address (of the person needing services)
● Telephone Number (of the person needing services)CLASS services may not be available right away. This phone call may lead to being placed on an interest list and contacted when services are available. It is in the best interest of the person and family you are working with to get on this list even if services are not readily available.
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Individuals have a choice in how their services are delivered, this will be discussed during the service planning process (Texas Health and Human Services, n.d.).
There are two options to choose from during the service planning process:
● Agency Option – The individual chooses to have a CLASS direct service agency deliver
their CLASS program services
● Consumer Directed Services (CDS) Option – The individual serves as the employer of
direct service providers for the CLASS program services chosen to be delivered through CDS. -
● Adaptive aids and medical supplies
● Behavioral support services
● Case management
● Cognitive rehabilitative therapy
● Continued Family Services
● Dental and dental sedation
● Employment assistance
● Habilitation
● Minor home modifications
● Nursing
● Occupational therapy
● Physical therapy
● Pre-vocational habilitation
● Respite care
● Specialized therapies
○ auditory enhancement/auditory integration training, dietary, therapeutic horseback riding, and massage, recreational, music, aquatic and hippo therapies)
● Speech and language pathology
● Supported employment
● Support Family Services
● Transition Assistance Services (Disability Rights, 2018). -
● Habilitation
● Cognitive rehabilitative therapy
● Employment assistance
● Nursing services
● Occupational therapy
● Physical therapy
● Respite care
● Speech and language pathology
● Support consultation
● Supported employment
● Transition Assistance Services
The CDS option requires the use of Financial Management Services (FMS) (Disability Rights, 2018).
More about HCS
The Home and Community-based Services program provides individualized services and supports to persons with intellectual disabilities who are living with their family, in their own home or in other community settings, such as small group homes (Texas Health and Human Services, n.d.).
This waiver is an alternative to receiving services in an Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) (Navigate Life Texas, 2019).
-
Individuals with an IQ of 69 or below or an approved related condition with an IQ of 75 or below.
● Approved Diagnostic Codes for Persons with Related Conditions.F84.0 Autistic Disorder is included on this list.
The primary diagnosis must be made by a licensed physician or designee Texas Health and Human Services, 2018).
● Demonstrates mild to severe deficits in adaptive behavior.
● Meet the level-of-care criteria for placement in an ICF/IID. -
Do not exceed specified income and resource limits.
Monthly income of up to 300% of the monthly income limit for Supplemental Security Income (SSI) and no more than $2,000 in assets.
This refers to the child’s income, not the family income (Navigate Life Texas, 2019).
Eligible for Medicaid benefits.
Is not enrolled in any other Medicaid waiver program, can remain on other waiver interest lists while enrolled in the HCS waiver program (Navigate Life Texas, 2019).
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Contact the individual’s Local Intellectual and Developmental Disability Authority (LIDDA) for the county in which they live.
LIDDAnDirectory
Be prepared to provide the following information (Disability Rights, 2018):
● Social Security Number or Medicaid Number
● Date of Birth
● Type of Disability
● Age of onset of the disability
● Address (of the person needing services)
● Telephone Number (of the person needing services)
HCS services may not be available right away. This phone call may lead to being placed on an interest list and contacted when services are available. It is in the best interest of the person and family you are working with to get on this list even if services are not readily available. -
Individuals have a choice in how their services are delivered, this will be discussed during the service planning process (Texas Health and Human Services, n.d.).
There are two options to choose from during the service planning process:
● Agency Option – The individual chooses to have a HCS direct service agency deliver their HCS program services
● Consumer Directed Services (CDS) Option – The individual serves as the employer of direct service providers for the HCS program services chosen to be delivered through CDS. -
● Adaptive aids
● Audiology
● Behavioral support services
● Cognitive rehabilitative therapy
● Day habilitation
● Dietary
● Dental treatment
● Employment assistance
● Minor home modifications
● Nursing
● Occupational therapy
● Physical therapy
● Residential assistance
● Respite care
● Speech and language pathology
● Supported employment
● Transition Assistance Services (Disability Rights, 2018). -
● Supported Home Living (SHL)
● Employment assistance
● Nursing services
● Supported employment
● Cognitive Rehabilitation Therapy
● Respite
The CDS option requires the use of Financial Management Services (FMS) (Disability Rights, 2018).
References
Disability Rights. (2018). Texas Home and Community-Based Supports and Services. Retrieved from https://www.disabilityrightstx.org/en/handout/texas-home-and-community-based- support s-and -services/
Navigate Life Texas, 2019. Community Living Assistance and Support Services (CLASS). Retrieved from Texas Health and Human Services. (n.d.). Community Living Assistance and Support Services. Retrieved from https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care- providers/community-living-assistance-support-services-class
Texas Health and Human Services, (n.d.). Community Living Assistance and Support Services Provider Manual. Retrieved from https://hhs.texas.gov/laws-regulations/hand books/classpm/section-4000-consume r-directed-services -cds
Texas Health and Human Services. (2018). Approved Diagnostic Codes for Persons with Related Conditions. Retrieved from https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/health/icd10-codes.pdf
Texas Health and Human Services. (2017). Community Living Assistance and Support Services Provider Manual. Retrieved from https://hhs.texas.gov/book/export/html/4261
