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YOUTH EMPOWERMENT SERVICES (YES) WAIVER

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USER GUIDE

December 2017

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CONTENTSGENERAL GUIDELINES.....................................................................................................4

YES WAIVER POLICY MANUAL...........................................................................................4YES WAIVER CONTRACTS.................................................................................................4YES WAIVER QUALITY MANAGEMENT PLAN......................................................................4REGULAR SUBMISSIONS...................................................................................................4FORMS IN THIS SECTION..................................................................................................4

ENROLLMENT...................................................................................................................9INQUIRY LINE....................................................................................................................9INQUIRY LIST....................................................................................................................9PRE-SCREENING...............................................................................................................9ENROLLMENT FORMS.......................................................................................................9DENIALS AND WITHDRAWALS........................................................................................10FORMS IN THIS SECTION................................................................................................10

CLINICAL ELIGIBILITY....................................................................................................12DENIALS.........................................................................................................................17INTAKE...........................................................................................................................17TERMINATIONS...............................................................................................................18ANNUAL RENEWALS.......................................................................................................18FORMS IN THIS SECTION................................................................................................18

INDIVIDUAL PLANS OF CARE.............................................................................................19AUTHORIZATION PROCESS.............................................................................................19FUNDING REQUESTS for Home Modifications and Transitional Needs...........................19TRANSITION FUNDING....................................................................................................20FUNDING REQUESTS for Adaptive Aids and Supports (AA&S)........................................20FORMS IN THIS SECTION................................................................................................22

CMBHS..............................................................................................................................35GENERAL OVERVIEW......................................................................................................35FORMS IN THIS SECTION................................................................................................35

WRAPAROUND...............................................................................................................59OVERVIEW......................................................................................................................59FORMS IN THIS SECTION................................................................................................59

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NON-MEDICAID PARTICIPANTS....................................................................................70OVERVIEW......................................................................................................................70PROCESS OF PARTICIPATION..........................................................................................70HOW TO APPLY FOR MEDICAID......................................................................................71FREQUENTLY ASKED QUESTIONS...................................................................................71TRAININGS......................................................................................................................72CRISIS AND SAFETY PLANNING......................................................................................72CRITICAL INCIDENTS......................................................................................................72TRANSITION AGE YOUTH................................................................................................73YOUTH IN CONSERVATORSHIP.......................................................................................73FORMS IN THIS SECTION................................................................................................73

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GENERAL GUIDELINESYES WAIVER POLICY MANUALThe current YES Waiver Policy Manual can be found on the YES Waiver website. It is recommended that each person who works with YES Waiver participants read the manual and uses it as a reference.YES WAIVER CONTRACTSYes Waiver contracts are formal agreements between LMHA/LBHAs and/or Private Providers and HHSC which outline the contractor’s obligations related to the provisions of YES Waiver services. The contracts include:

1. YESPROV2. Performance Contract Notebook (PCN)3. YES Pre-Engagement (PE)

YES Waiver contracts provide specific detail related to the scope and quality of service provided to participants through the YES Waiver. Examples of topics detailed in contracts include but aren’t limited to: Providing YES Waiver services, enrolling and serving participants, service targets, inquiry list management, transition plan development and coordination, implementation and maintenance of quality management plans, Wraparound facilitation provision, and utilization of Targeted Case Management/Intensive Case Management (TCM/ICM) to coordinate plans of care. YES WAIVER QUALITY MANAGEMENT PLANEach LMHA/LBHA must create a Quality Management Plan which describes how the center will measure, assess, and work to improve program performance on various aspects of care. This is due annually by March 31st to the YES Waiver Inbox.REGULAR SUBMISSIONS

A copy of the center’s current Inquiry List is due monthly. Please submit the list by the fifth day of each month to the Yes Waiver Inbox.

The Quarterly YES Expenditure Report is due quarterly to the Contract Manager. Please submit to the center’s assigned Contract Manager.

The YES Waiver Approved Providers Quarterly Report is due on the fifteenth of the month after the quarter ends. Please submit this report to the YES Waiver Inbox.

FORMS IN THIS SECTION Important YES Waiver Timelines YES Waiver First 30 Days

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mailto:[email protected]

http://www.dshs.texas.gov/mhsa/yes/

Important YES Waiver Timelines

Policy Timeline Policy Number

Add individual to Inquiry List Immediately upon receiving first call

2200.1

Return call to individual and legally authorized representative (LAR) from Inquiry Line

Within 24 hours or 1 business day of receiving call

2200.1

If individual/LAR expresses they are not interested in services or they do not respond to return phone call:

Send Letter of Withdrawal

Within 7 business days 2200.1

Determine demographic eligibility During first telephone contact with LAR/Waiver Participant

2200.1

If demographic eligibility not met:

Send Denial of Eligibility letter, Fair Hearing Request form, and referrals to other services

Within 7 business days of determining demographic ineligibility

2000.1

Submit the up-to-date Inquiry List to HHSC 5th business day of each month 2200.1

Conduct face to face clinical eligibility assessment with individual and LAR

Within 7 business days of initial demographic eligibility determination contact

2000.1

If not clinically eligible:

Send Denial of Eligibility Letter, Fair Hearing Request form, and referrals to other services

Within 7 business days 2000.2

Enter Clinical Eligibility (CE) document in to CMBHS so HHSC can determine eligibility

Within 5 business days of conducting Clinical Eligibility Assessment

2000.1

Conduct annual re-evaluationPrior to expiration date (it is suggested to do approximately 30 days prior to end date to be able to aptly prepare for termination if the Participant is no longer eligible)

2200.4

Provide the Authorization of Services letter to the Waiver participant and LAR

Within 10 business days of DSHS authorization of Clinical Eligibility

2100.1

Initial Child and Family Team (CFT) meeting between Case Manager, participant, and LAR

Within 7 business days of LMHA completing CE Determination

2200.3

Complete Initial Service Authorization (IPC—Initial) with participant and LAR

Within 10 business days of HHSC approving the CE

2100.1

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document

Submit IPC—Initial into CMBHS for approval Within 5 business days of completing IPC with the Child and Family Team

2200.4

Submit IPC—Annual into CMBHS for approval Within 10 business days of the annual CED authorization by HHSC

2200.4

Provide copy of service authorization from LMHA to CWP

Within 3 business days of HHSC authorization

2200.4

Appeal denial of a service authorization Within 14 business days of denial in CMBHS

2200.4

Develop initial Safety and Crisis Plan At first meeting with the family

Inpatient Psychiatric Setting Discharge meeting between Case Manager, participant, and LAR

Within 7 days of discharge 2200.6

Complete and submit Critical Incident Report to Wraparound facilitator

Within 24 hours of being notified of incident

2200.6

Submit Critical Incident Report to HHSC Within 72 hours of receiving report

2200.6

Submit updated Critical Incident Report to HHSC

Within 72 hours of update/follow-up

2200.6

CFT meet to review the services authorization Within 30 days of inpatient discharge

2200.6

Report incident to appropriate authorities Within state required time frames

2200.7

Transitioning to less-intensive services: Submit copy of transition plan to HHSC

At least 30 days prior to the date of participant’s termination from the waiver

2200.8

Aging Out: Begin development of transition plan

At least six months prior to participant’s 19th birthday

2200.9

Aging Out: Submit copy of transition plan to DSHS

At least 30 days prior to participant’s termination date

2200.9

Terminations

Submit Termination authorization request (IPC) Within 10 business days of participant’s termination

2200.8

Provider Services At least 1x per month 2200.3

Child and Family Team Meeting Monthly 2200.3

Safety and Crisis Plan Review Monthly at CFT meeting 2200.3 of 74

Review of IPC Every 90 days, at a minimum, at CFT meetings

2200.3

Enrollment Forms Completed which include:

Freedom of Choice Provisional Enrollment Form Provider Selection Form Notice of Participant Rights Form

At first meeting between Case Manager, participant, and LAR and annually thereafter

2100.3

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ENROLLMENT

INQUIRY LINEEach LMHA/LBHA must maintain an Inquiry Line for potential YES Waiver participants to call. The number must be toll free and manned by a live person. Any voicemail message must be recorded in English and Spanish. Each call must be returned within one business day or 24 hours.

INQUIRY LISTThe Inquiry List must log information on each call that comes into the YES Inquiry Line. The list must include:

Name of potential participant (client name) Name of LAR Date called/added to the list Date of contact/attempt Demographic eligibility met (yes/no) Insurance Date of clinical eligibility assessment Clinical eligibility met (yes/no) Date Denial or Authorization of Services letter sent Date Withdrawal Letter sent

For a sample Inquiry List, visit http://www.dshs.texas.gov/mhsa/yes/Samples.aspx. Inquiry Lists are due the fifth day of each month to [email protected]

PRE-SCREENINGWhen a potential participant calls the Inquiry Line, the LMHA/LBHA can use the Pre-Screening Tool to determine demographic eligibility and gather additional information regarding DFPS conservatorship, if applicable. Clinical eligibility cannot be determined over the phone.

ENROLLMENT FORMSAfter a clinical eligibility assessment has been completed in-person and eligibility has been approved by YES Waiver staff in CMBHS, the following forms are required, as applicable:

Pending Authorization of Services Letter —This letter informs the non-Medicaid participant that they have been deemed clinically eligible to participate in YES Waiver and will be enrolled upon obtainment of Medicaid.

Authorization of Services Letter —This letter informs a Medicaid-enrolled participant that they have been deemed clinically eligible to participate in YES Waiver services and are officially enrolled.

Participant Agreement Form —This form outlines the responsibilities that the participant and his or her LAR agree to while receiving YES Waiver Services.

Freedom of Choice Form —By signing this form, the participant and LAR acknowledge that they are choosing to participate in waiver services rather than institutional services.

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http://www.dshs.texas.gov/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=8589997732



http://dshs.texas.gov/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=12884902130

mailto:mail%20to%[email protected]

http://www.dshs.texas.gov/mhsa/yes/Samples.aspx

Waiver Provider Selection Form —The participant and his/her LAR select the Comprehensive Waiver Provider using this form.

Notice of Participant Rights —This form outlines participant rights and information on complaints.

Wraparound Provider Organization/Comprehensive Service Provider Form —This participant and his or her LAR select the Comprehensive Service Provider

All enrollment forms should be signed by the LAR and the participant if he or she is able. They should be signed at intake and annually thereafter.

DENIALS AND WITHDRAWALSIf a potential participant does not meet demographic or clinical eligibility, he/she must be formally denied services. A Denial Letter, which includes information regarding how to request a Fair Hearing, must be sent within seven business days of the denial.

A Letter of Withdrawal Form is sent when the participant is withdrawn from the program. Reasons for withdrawal include unsuccessfully reaching the participant/LAR to determine demographic eligibility, unsuccessfully reaching the participant after eligibility has been determined, and lack of participation in the program for sixty days. If there is a different reason for withdrawal, this can be noted under “other reason” on the form.

FORMS IN THIS SECTION YES Screening Tool

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http://www.dshs.state.tx.us/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=12884906718



https://www.dshs.texas.gov/mhsa/yes/YES-Forms.aspx

http://www.dshs.texas.gov/mhsa/yes/2016updates/NoticeofParticipantRightsForm.doc


CLINICAL ELIGIBILITYOnce demographic eligibility is confirmed, the LMHA/LBHA must complete the clinical eligibility assessment. Clinical eligibility assessments must be completed by a qualified practitioner per YES waiver policy guidelines.

Completing the clinical eligibility assessment requires a 2-part assessment process using the YES Assessment and clinical eligibility (CE) document in CMBHS.

The YES Assessment includes the CANS assessment and a community data questionnaire. The LMHA/LBHA must submit the YES Assessment into CMHBS manually or electronically via a batch data transfer process from the LMHA/LBHA’s system of origin, if available.

An auto-populate feature is available that allows the majority of the YES assessment to be populated with the CANS data entered into an MH Uniform Assessment (UA) that has been completed in the past 90 days. However, in order for this feature to function properly, the UA must already be available in CMBHS. This means that LMHAs/LBHAs using an electronic batch process to transfer data to CMBHS will only be able to auto-populate the YES assessment once the Uniform Assessment batch transfer is complete. This may mean that some LMHAs/LBHAs may have to capture the YES assessment data manually and enter it into CMBHS when the Uniform Assessment data becomes available. The YES Assessment Data Capture Worksheet is available through the YES Waiver website to assist in manually collecting the data necessary to complete the YES Assessment.

To complete the YES Assessment, the LMHA/LBHA must complete the following steps:1) Open the YES Assessment in CMBHS using the navigation tree (Special Services

Documentation - YES Waiver Services - YES assessment (CANS)2) Notice 2-tabs resembling the Uniform Assessment will be visible: CANS and

Community Data.3) The CANS tab will open automatically. Click on the button that says “Populate

CANS Scores” 4) Notice that the bubbles have been filled in with the information submitted in the

Uniform Assessment. Only a current CANS entered within the previous 90 days may be used to auto-populate a YES CANS.

5) A clinical recommendation will be shown at the bottom of the screen. Enter any comments relevant to the participant’s clinical assessment, functioning, and needs. Deviating to LOC-YES is not required.

6) Click “Save and Continue” or “Next” button. 7) A warning will show on the screen alerting the user that the form cannot be

edited once saved in Closed Complete status. Click OK to confirm that the data is complete and accurate.

8) Click on the “Next” button or on the “Save and Continue” button at the bottom of the screen to open the Community Data tab.

9) Click “Populate Community Data”10) If a YES Assessment has been previously entered, you will notice that the

community data entered in the previous YES Assessment has been populate.

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11) Update all information as needed and answer any remaining questions. Place document in “Closed Complete” status.

12) Click “Save”.

The CE must also be completed and submitted to HHSC in CMBHS for HHSC to perform an eligibility determination. Clinical eligibility is determined in accordance with YES Waiver policy based upon the CANS scores and reasonable expectation that without Waiver services, the individual would qualify for inpatient care under the Texas Medicaid Inpatient Psychiatric Admission Guidelines. The CE pulls in information from the YES Assessment and requires additional fields to be completed.

The CANS Criteria are as follows:

A. The client must score at the identified levels on the following CANS domain:Select one response from the following domains:

Life Domain Functioning

Developmental

Score of 0 or 1 OR

Developmental Score of 2 or 3 AND

Developmental Needs Module: Cognitive

Score of 0, 1 or 2 AND

Developmental Needs Module: Developmental

Score of 0 or 1

B. The client must score at the identified levels on one or more of the following

CANS domains:Select at least one response from one or more of the following

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domains:

Child Risk Behaviors (either of these risk behaviors)Score of 3 for Suicide Risk OR Self-Mutilation OR Other Self HarmScore of 2 or 3 for Danger to Others OR Sexual Aggression OR Fire Setting OR Delinquency

Caregiver Strengths and NeedsScore of 2 or 3 for Involvement with Care OR Family Stress OR Safety

Life Domain FunctioningScore of 2 or 3 for School AND

Score of 2 or 3 on School Module: School Behavior OR Score of 2 or 3 on School Module: Attendance

Psychiatric HospitalizationScore of 1 for Psychiatric Hospitalization AND

Score of 1, 2 or 3 on Psychiatric Hospitalization Module: Time Since Most Recent Discharge

The assessed clinical criteria are documented on the “Clinical Eligibility” document in CMBHS. The document is found in CMBHS through the navigation tree on the left-hand side under Special Services Documentation >> YES Waiver Services >> YES Waiver Clinical Eligibility. The LMHA/LBHA should complete a “Clinical Eligibility” document for all individuals who are assessed. The HHSC YES Waiver office reserves the right to confirm and deny clinical eligibility.

CLINICAL ELIGIBILITY DOCUMENT

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DENIALSIf a potential participant does not meet eligibility criteria, the Clinical Eligibility will be denied by a member of the HHSC YES Waiver staff. Upon denial, the authorized Level of Care will automatically lower to LOC-4. If a different Texas Resilience and Recovery (TRR) package is indicated, enter a new CANS with a new Level of Care. Send a Denial Letter within seven business days.

For more information, see the CMBHS section of this User’s Guide.

INTAKEOf the five clinical eligibility criteria, Criteria A and B are based on the scores of the CANS. If a potential participant does not meet Criterion A, supporting documentation can be provided to YES Waiver staff to be considered during the determination.

Criterion C requires a yes/no answer to whether a potential participant has tried and failed outpatient therapy or partial hospitalization. If a psychiatrist has documented why an inpatient level of care is required, then this criterion is met.

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Criterion D assesses whether a potential participant meets--or will soon meet--inpatient hospitalization guidelines without YES Waiver services. If the potential participant does not meet this criteria, a physician’s signature must be obtained to verify that the criterion is not met.

Criterion E identifies whether the potential participant has a mental health primary diagnosis.

CANS scores and diagnosis must be in CMBHS before the CE document can be submitted in CMBHS (CMBHS pulls CANS and diagnosis data as a part of the CE).

All individuals must be assessed using the 6-18 CANS (rather than the ANSA or CANS-YC). The CANS must be entered into CMBHS manually under the YES LPHA location.

TERMINATIONSWhen a participant decides to end YES Waiver services, termination documentation must be submitted. This documentation includes a Clinical Eligibility termination, Individual Plan of Care termination, and a transition plan. Transition plans are required when a client moves to a lower level of care or ages out of YES waiver to transition to adult services. Please refer to the YES Waiver Policy Manual regarding appropriate and sufficient reasons for a participant to terminate from services. Send a Letter of Withdrawal Form within seven business days if appropriate.

ANNUAL RENEWALSWhen a participant approaches 365 days of receiving YES Waiver services, an Annual Renewal must be completed. Annual renewals of clinical eligibility follow the same process as the Initial assessment in regards to assessing clinical criteria, completing a Uniform Assessment, a YES Assessment, and renewing the diagnosis. A Qualified Mental Health Professional (QMHP) can conduct the renewal assessments and give a recommendation to renew for another year. A Licensed Practitioner of the Healing Arts (LPHA) clinician then must approve the renewal recommendation.

It is best to conduct the annual renewal assessment thirty days before the end date of the current service year. If an Annual Renewal is not completed before the end date, services should not be provided until a new Initial Clinical Eligibility is approved.

Enrollment forms are due annually and must be completed and signed again at the annual assessment.

FORMS IN THIS SECTION CANS Criteria Guide Blank Clinical Eligibility form

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INDIVIDUAL PLANS OF CAREAUTHORIZATION PROCESSYES Waiver services must be authorized by Texas Medicaid and Healthcare Partnership (TMHP) in CMBHS before they are delivered. For more information, see the Texas Medicaid Provider’s Procedure Manual.

To begin the authorization process, the LMHA/LBHA completes a Medicaid Eligibility Verification (MEV) in CMBHS. The purpose of this step is to ensure that the participant’s medical coverage information transmits between TMHP and CMBHS which will allow for billing of YES Waiver services. It is the responsibility of the LMHA/LBHA to review the MEV results to ensure that the information has been successfully transmitted.

The next step is to complete an Individual Plan of Care (IPC) in CMBHS. The services selected on the IPC are based on the recommendations of the Child and Family Team (CFT) and decided on by the family. The wraparound process determines which YES Waiver services will be utilized. The IPC does not determine the strategies of the wraparound plan.

Once the IPC is approved and “Closed Complete” by HHSC, a TMHP authorization number will be assigned and visible on the IPC. Authorizations may not be visible in the system immediately. Services shall not be provided if there is not a TMHP authorization number for the requested service and units.

The IPC must be reviewed by the Child and Family Team a minimum of every 90 days. Changes should then be updated in CMBHS using a “Revision” IPC to receive an updated authorization number. If there are no updates, a “Revision” IPC should be entered into CMBHS and in the notes section, the reviewer should indicate that no changes have been made.

FUNDING REQUESTS for Home Modifications and Transitional NeedsFunds home modifications, and transitional needs are all requested within the Individual Plan of Care. Requests should

Include a statement that background and Health and Safety checks will be completed

Demonstrate a clear link between the use of the requested item, the participant’s need, and the SED

Be approved at CFT meetings as a resource/strategy that links to the identified need, and therefore must be included in the wraparound plan

Verify that other resources were investigated but that Medicaid is being used as the payer of last resort

Be monitored through the Wraparound process to monitor effectiveness

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http://www.tmhp.com/Pages/Medicaid/Medicaid_Publications_Provider_manual.aspx

http://www.tmhp.com/Pages/Medicaid/Medicaid_Publications_Provider_manual.aspx

Include documentation that at least three bids or prices were solicited if the request is over $500

Include an itemized list of goods or services with estimated prices, for exampleo Request is for art supplies which include: two canvases ($20), set of acrylic

paint ($25), and set of 10 brushes ($10) o Request is for karate classes which includes a one-time registration fee

($50), and two months of classes at $70 per month.

TRANSITION FUNDINGA youth who is transitioning to living independently may qualify for one-time transition services funding. A maximum of $2500 may be requested, and a transition plan must be attached in CMBHS to be reviewed by HHSC YES Waiver staff. A list of permitted items to be purchased can be found in the policy manual.

FUNDING REQUESTS for Adaptive Aids and Supports (AA&S)

Requests for AA&S must adhere to all YES Waiver policies and meet criteria outlined in the YES Waiver Policy Manual. The process for securing AA&S is as follows:

1) Review YES Waiver AA&S policy and assure the request meets criteria2) Complete the Adaptive Aids & Supports (AA&S) Request Form (see guidance

below) available through the YES Waiver website3) If good(s) or service(s) requested are included on the Heightened Scrutiny List,

submit an Adaptive Aids and Supports Medical Necessity Attestation form with the AAS Request form.

4) Provide any additional information requested by HHSC, as needed5) Review response from HHSC:

a. If request form is approved by HHSC, submit the request on the IPC in CMBHS. Include the AA&S description in the IPC AA&S justification box and attach the approved AA&S request form to the IPC. NOTE: AA&S are not officially authorized until approved in CMBHS by HHSC.

b. If request form is denied by HHSC, the Wraparound facilitator must send a denial of eligibility letter to the participant that includes the reason for the denial in accordance with YES Waiver policy.

Required to Complete the Adaptive Aids & Supports (AA&S) Form

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To request AA&S, the Wraparound facilitator must complete the Adaptive Aids & Supports (AA&S) Form and include:

1. Date of request, participant CMBHS ID number, WPO, Wraparound facilitator, Wraparound supervisor, CWP, participant name, and reason for participant referral to the YES Waiver;

2. A description and estimated maximum dollar cost for the purchase of the AA&S. If multiple items make up a single request, an itemized list with all names/brands and prices of items being requested must be included;

3. The start and end date of the activity, if applicable, not to exceed 90 days (services must be requested in 90 day increments unless total service duration is less than 90 days);

4. A justification that clearly articulates the link between the requested AA&S and the participant’s reason for referral, their SED, and the needs identified in the CFT. The justification must explain how the AA&S is medically necessary to prevent institutionalization or out-of-home placement. If the request is over $500 or on the Heightened Scrutiny List, HHSC may request additional information and supporting documentation by the program supervisor;

5. A description and summary of the CFT’s brainstorming activities including consideration for no cost options as well as alternative strategies, funding sources, discounts, etc., that were explored and exhausted;

6. Description of three bids or prices that were solicited if request is over $500, and attestation the AA&S requested is the lowest cost based on availability unless explained by specific written justification for using a higher bid;

7. Confirmation that the AA&S request is in compliance with YES Waiver policy and has not been determined unallowable per the AA&S Non-Billable List;

8. Confirmation that the AA&S request is reflective of the Wraparound Plan and will address the participant’s reason for referral, SED, and underlying needs and is medically necessary to prevent institutionalization and/or out-of-home placement;

9. Confirmation that the requested AA&S is being purchased through Medicaid as a last resort, after a CFT brainstorming process in which all other strategies, payments, discounts, family and community resources have been explored and exhausted within the Wraparound process;

10. Confirmation that the request is specified in the Crisis and Safety Plan and is absolutely necessary prior to the first CFT meeting;

11. Signature confirming that YES Waiver program manager reviewed and approved AA&S request;

12. Signature confirming that the CWP reviewed and approved AA&S request;13. An assurance that the health and safety and background checks will be completed

prior to the provision of service.

FORMS IN THIS SECTION Yes Waiver Service Authorization Process Blank Individual Plan of Care

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Signature Page Building Safety and Environmental Health Checklist Unit calculation tip sheet

YES Waiver Service Authorization Process

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Enroll in YES WaiverComplete Clinical Eligiblity AssessmentReceive approval from HHSC

Complete Individual Plan of CareDetermine types and frequency of services through wraparound planning processSubmit IPC to HHSCReceive approved IPC by HHSCObtain TMHP authorization number (generated by CMBHS after IPC has been approved and saved in Closed Complete)

Ensure Service are Provided as AuthorizedMonitor units and end dates of authorized servicesCollaborate with CWP on on-going basisReview progress and efficacy of services on monthly basis through Child Family Team meeting and wraparound planning process

Unit Calculation Tips

# of hours desired per week

X Number of weeks remaining in year

X Unit rate per hour

= Total units to request on IPC

1.5 hours of Art Therapy per week

X 52 weeks (1 year) X 4 (there are 4 units in one hour)

= 312 units

# of hours desired per month

X Number of months remaining in year



10 hours of CLS per month

X 6 months left X 4 (there are 4 units in one hour)

= 240

# of hours desired per week

X Number of weeks in a month

X Number of months remaining in year



5 hours of Respite Camp per week

X 4 X 12 (1 year) X 1 (one hour)

= 240

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CMBHSGENERAL OVERVIEWClinical Management for Behavioral Health Services (CMBHS) is a web-based clinical record keeping system for state contracted community mental health and substance use programs. All YES Waiver documentation is completed in CMBHS. Documents created in CMBHS include:

Medicaid Eligibility Verification—The mechanism of checking for Medicaid coverage and successful communication between TMHP and CMBHS to pay for YES Waiver services

Clinical Eligibility—The document which is submitted to HHSC so that an individual’s clinical eligibility to participate in the YES Waiver program can be determined

Individual Plan of Care—The authorization form which allows for payment of selected YES Waiver Services

Service Notes—Individual entry of delivered YES Waiver servicesAfter the Clinical Eligibility and/or Individual Plan of Care has been completed face to face with the participant, LAR, and Child Family Team members (if applicable), the LMHA/LBHA or Wraparound Provider Organization (WPO) must enter the documents in to CMBHS within five business days. HHSC must then “close complete” the document within five days of being placed in “ready for review”.

FORMS IN THIS SECTION Overview of CMBHS Documents Finding/Adding a Client in CMBHS How to Add an LAR to the Client Profile How to Enter Clinical Eligibility How to Enter Individual Plans of Care IPC Tip Sheet LMHA Transfer Process Flow Chart Transferring from LMHA to Chosen TCM Provider

Overview of CMBHS Documents of 74

Document Types

Clinical Eligibility=CEIndividual Plan of Care=IPC

Medicaid Eligibility Verification=MEV

CE—Pending: Created when a client does not have active Medicaid but is being assessed for future enrollment (once the client has Medicaid)CE—Initial: Created when a client has active Medicaid and is being assessed for enrollmentCE—Annual: Created when a client is a current YES Waiver recipient and is being assessed for an additional yearCE—Termination: Created when a client terminates from YES WaiverIPC—Initial: Created after the CE—Initial as the first IPC requestIPC—Revision: Created when the IPC is updated by the Child Family Team Meeting (required a minimum of every 90 days)IPC—Annual: Created after the CE—Annual as the first IPC request of the renewal yearIPC—Outgoing Estimate: Created to end services with first CWPIPC—Incoming Estimate: Created to start services with new CWP IPC—LMHA Transfer Out: Created when a current YES Waiver recipient moves from one county to another or TCM provider to anotherIPC—LMHA Transfer In: Created by the LMHA who receives a current YES waiver participant from another county or by the new TCM providerCE—LMHA Transfer Out: Created to close out services from the LMHA where the client will no longer live or will no longer be receiving TCM ServicesCE—LMHA Transfer In: Created to open a current YES Waiver client who moved from another county or transferred from a different TCM provider

Document Status

Draft Only the LMHA can see the document Saved but is not being reviewed for approval Put back in “draft” when a correction or clarification is needed by HHSC Can be edited

Ready for Review Shows up on HHSC queue to approve Both the LMHA and HHSC can see the document Can still be edited by LMHA in this status

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HHSC has 5 business days to approve once saved in “Ready for Review”Closed Complete

Cannot be edited Only HHSC can save to “Closed Complete” Document is final after “Closed Complete”

HHSC Review and Approval

Approved: Document has been approved If the “Clinical Eligibility” is marked “approved” it means that the client has been

approved to receive YES Waiver services If the “Individual Plan of Care” is marked “approved” it means that the CWP has

the permission to proceed with providing services as documented. However, it does not guarantee payment of services, if:

o No TMHP number generateso The client does not have active Medicaid

Approved Based on Appeal: Only selected in the instance that an LMHA or LAR has appealed a denial and then was approved to receive YES Waiver servicesDenied: Document was denied

If the “Clinical Eligibility” is marked “denied,” then the client cannot receive YES Waiver services

If the “Individual Plan of Care” is marked “denied,” it means that the changes proposed on the IPC cannot be provided as requested. This occurs when:

o The adaptive aid, minor home modification, or transition service does not meet YES Waiver policy requirements

o A YES Waiver service was not included on the IPCo Only non-medical transportation was requested without the accompaniment

of a YES Waiver serviceDate: Date that the HHSC representative approves or denies the request. This date will never be back-dated. HHSC Authorized Reviewer: HHSC representative who approved/denied the request. If you have questions about the particular document, then you can contact this HHSC representative for further clarification. Document Status Date: Date that the document was “Closed Complete”Reviewer Notes: Notes that are entered by the HHSC representative who approves/denies the request for the purpose of communicating something to the

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requestor or including important documentation that is not otherwise stated elsewhere in the document.

On the “Clinical Eligibility” this will only have notes documented when in “closed complete” status. Notes may include items such as the client’s status of Medicaid or the reason for denial.

On the “Individual Plan of Care,” review notes can been saved in any document status. If a document was placed in “Ready for Review” by the requestor and then saved in “Draft” by HHSC, then review the notes regarding the next steps. Notes are most commonly noted when clarification or change is needed in regards to an adaptive aid, home modification, or transitional service. IMPORTANT: If HHSC is requesting further information but the requestor does not provide the information or answer the question when saved again in “Ready for Review,” HHSC may deny the request.

Created By: Name of the person who opened and created the documentCreated Date: Date when the document was createdLast Saved By: Name of the person who last edited the document will be listed hereLast Saved Date: Date when the last edit was made to the document

FINDING/ADDING A CLIENT IN CMBHS

WEBSITE ADDRESS

Upon logging on to CMBHS, select “Find/Add client” on the left hand side of the screen.

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Enter search criteria then select “Search” at the bottom of the screen.

If the client already exists in CMBHS, the client name will appear at the bottom of the screen. Click on the client’s name and then click on “client profile” to view client information and add/edit client profile or “client workspace” to see CMBHS documents.

If the client is not listed in CMBHS, “no records found” will be stated in the bottom left hand corner of the screen. Below that will be “add new client” which can be selected to enter new client information.

Proceed to enter the required information on each tab.

On the address tab, after inputting data into the field, click “add” to add the record, then click “save.” After “save” is selected, it will show on a list below the tabs.

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HOW TO ADD AN LAR TO THE CLIENT PROFILE

You will see “None Selected” with no drop down option under Legally Authorized Representative (LAR)

Save the document you are currently in to “draft”, then go to top of client information and click on the client name in blue.

Click “Edit” on the window that pops open.

Select “Contacts” tab.

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Highlight the parent name so that the line shows up in a darker blue and then click “Edit.” NOTICE that under the column “LAR”, it says “No.”

Choose relationship type under drop-down menu.

Select “Add” once the drop-down menu has been changed.

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Select “Save”.

Return the document and “select” edit. You should now be able to select the parent name.

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HOW TO ENTER CLINICAL ELIGIBILITY

WEBSITE ADDRESS

From the client workspace, select the following from the left-hand column: Special Services Documentation YES Waiver Services YES Waiver Clinical Eligibility

(Note: If you do not have a valid diagnosis or YES Assessment, an alert box will pop up and not allow you to proceed)

Eligibility Type: Select Pending or Initial

Pending = If client does not have valid Medicaid

Initial = If client has Medicaid

Annual = If a client has already participated in the YES Waiver for almost a year

Termination = If a client is discharging from the program

LMHA Transfer Out/In = If a client is changing from one LMHA to another or one

TCM provider to another

Performed On: It will default to the date that the assessment was created and opened. Select date from calendar or enter date of the day that the Clinical Eligibility Assessment took place. (Note: If it is the annual assessment, it will default to the day after the current year ends and will end 365 days after that date.)

Notes on Eligibility Type: Enter any pertinent notes such as when it was completed or if this was actually an annual renewal but that the previous year ended before the renewal was completed.

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Start Date: This date will default to the date that the document was created. The date cannot be changed.

End Date: This date calculates 364 days out and marks the end of when they will be eligible to participate in YES services (therefore, if renewing, the annual renewal MUST be completed at least 30 days prior to the end date to prevent a lapse in services because once the end date passes, everything EXPIRES). The date cannot be changed on a CE—Initial but can be changed on a CE--Termination.

Has Individual lived in a facility during the last 12 months (i.e. RTC, State School, Group Home)?: Mark YES or NO

If yes, please provide Facility details: Describe where, length of stay, etc.

Axis I Diagnosis, Axis II Diagnosis: Both will auto-populate from the most recent diagnosis available in CMBHS

Assessment Criteria/Assessment Date: The CANS data may be auto-populated from the most recent YES Assessment available in CMBHS. MUST: Ensure that the date is from the most recent YES Assessment

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Criteria A and Criteria B: The information will auto-populate from the most recent CANS assessment

Criteria C—Outpatient therapy or partial hospitalization has been attempted and failed OR a psychiatrist has documented reasons why an inpatient level of care is required.: Mark YES or NO

Criteria D—Check the Medicaid psychiatric inpatient hospitalization criteria below that the client meets.: Mark any that apply.

Criteria E—The Medicaid eligible youth must have a valid Axis I diagnosis as the principle admitting diagnosis.: Mark YES or NO.

Notes on Clinical Eligibility: Enter any pertinent information that should be considered when determining eligibility.

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System Clinical Eligibility Determination: Once all information has been auto-populated and entered, this area will show which criteria has been met/not met.

Signatures: Enter names or select from drop down boxes

Licensed Practitioner of the Healing Arts (LPHA)

Required on all Initial assessments

Qualified Mental Health Professional—Community Services (QMHP)

Entered when a QMHP participated in the assessment

Required if the QMHP conducted the assessment (annuals only)

Physician Required if Criteria D is not met

Client Always required

Legally Authorized Representative (LAR)

Always required

Comprehensive YES Waiver Provider Representative

Required on CE—Termination and CE—LMHA Transfer Out

Dates: Select or enter the date of when the signatures were obtained which should generally match the “performed on” date.

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Save Document: Select “Ready for Review” to send document to HHSC for approval

Unique Circumstances:

If the client does not meet Criteria D, due to CMBHS functionality, something still must be marked in order to proceed with saving the document. Therefore, please indicate in the “Notes on Clinical Eligibility” that the client does not meet Criteria D. At some point in the future, there will be a box labeled “none” that can be marked if the client does not meet Criteria D.

If HHSC has a question about the CE, currently the document cannot include “Reviewer Notes” at the bottom, therefore you will see comments written in the top “Notes” section. You can respond in this section as well and then place the document back in “Ready for Review”

If the “Performed On” date is before the CANS date, then the record will not save, because the “Performed On” date should match the date that the CANS assessment was conducted.

If an LAR has not been entered in to the Client Profile, then only “None Selected” will be an option. You will then need to save the document in “draft” and then enter the LAR information (refer to instructions titled HOW TO ADD AN LAR TO THE

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CLIENT PROFILE). Once the LAR information has been saved, return to the CE and select the LAR name in the drop down box. You will not be able to save the document in to “ready for review” if an LAR name is not selected.

If a client moves to a different LMHA region and a CE—Initial is already in place, CE—LMHA Transfer Out/In types will be used

o LMHA Transfer Out The “Performed On” date will be the last service date at the original

LMHA The remaining information will auto-fill The document will be auto-approved once saved in Ready for Review

o LMHA Transfer In This will be an option once the Diagnosis and CANS assessments from

the receiving LMHA are available in CMBHS The “Performed On” date is the date of the first face to face meeting

between the receiving LMHA, the client, and LAR

*If something seems incorrect (such as a previous adaptive aid is missing) or you get a warning box that you have not previously seen and do not know how to resolve, then call the CMBHS Help Line at (866) 806-7806*

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HOW TO ENTER AN INDIVIDUAL PLAN OF CARE

WEBSITE ADDRESS

From the client workspace, select the following from the left-hand column: Special Services Documentation YES Waiver Services YES Waiver IPC Authorization

(Note: You can enter an IPC Initial even if the CE—Initial has not yet been approved)

IPC Type: Select type

Performed On: It will default to the date that the IPC was created and opened. Select date from calendar or enter date of the day that the IPC was completed

Notes on IPC Type: Enter any pertinent notes such as when it was completed, changes compared to the previous IPC, etc.

Annual IPC Begin Date: Date auto-populates from the Clinical Eligibility Start Date. This date cannot be changed.

Annual IPC End Date: Date auto-populates from the Clinical Eligibility End Date. This date cannot be changed.

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Annual Total Summary for All Waiver Services: Provides breakdown of various costs for the year. Nothing is entered in these boxes. Amount will start over on annual renewals.

YES Waiver Services: General

Each YES Waiver service option is listed For each service selected, Requested Units will need to be entered. The total units

requested can be up to what is expected to be used during the entire year (Note: It is not recommended to only request one month’s worth of units.)

For each service selected, the Provider Name will need to be selected. (Tip: If the Provider Name is selected in the shaded blue area above all services, it will populate the Provider Name in to all services.)

If a service is no longer desired, therefore being removed, and has never been provided, enter the number zero (O) for Requested Units or “x” out of the box and then tab through the field.

CMBHS auto-populates all Requisition Fee line items (LMHA/CWP will never enter information in the Requisition Fee lines)

Type of Service or Type of Requisition Fee

Number of units requested (up to duration of one year)

Unit Time—auto- populates in to IPC once Requested Units are entered

Cost Per Unit—auto populates in to IPC once Requested Units are entered

Total cost of all units requested—will calculate after Requested Units has been entered

Number of units that have been entered in service notes—calculated by CMBHS

Number of units that TMHP has paid—calculated by CMBHS

Name of Provider—Selected in drop down box

Person listed as the contact for the selected provider—auto-populates after Provider Name is selected

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YES Waiver Services: Adaptive Aids and Supports/Minor Home Modification and Transitional Service:

Requested Units is always “1” (one) Unit Rate equals the total price of the request The Justification Box must always be complete to demonstrate how the request

meets YES Waiver policy and benefits the clients for Minor Home Modifications and Transitional Services. The Justification Box must be completed with a description of the AAS and the approved Request Form must be attached.

Non-Waiver Services: Other Medicaid State Plan Services: Enter the number of total hours per year that the client is likely to receive each type of listed service. (Note: At a minimum, every client should have hours listed for Intensive Case Management.)

Non-Waiver Services: Services Provided by Other Funding Sources: List any services that are provided to the youth (or LAR for the benefit of the youth) that are paid by sources other than Medicaid

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Treatment Team Signatures:

Case Manager (QMHP-CS/Wrap Facilitator)

Required on all IPCs

Licensed Practitioner of the Healing Arts (LPHA)

Required on all IPCs

Physician Always optional (provided when the Physician participated in the team meeting)

Participant Always required

Legally Authorized Representative (LAR)

Always required

Comprehensive Waiver Provider (CWP)

Always required—drop down box

Provider Representative (Name of team member/ provider who participated in team meeting)

Required on all except IPC—Initial and IPC—Annual

Dates: Select or enter the date of when the signatures were obtained which should generally match the “performed on” date.

Miscellaneous IPC Tips of 74

Annual renewals IPCs are completed the same as “Initial” IPCs, starting over with all units to be added.

Within 24 hours after the IPC has been approved and saved in “closed complete” by HHSC, the TMHP number will be listed with the date that the TMHP authorization number generated. (Note: It is the responsibility of the LMHA/LBHA to ensure that a TMHP number generates. If a number does not generate, refer to the MEV for more information.)

The annual IPC amount cannot exceed $35,804 so it is important to pay attention to the Total Estimated Cost and Remaining Amount to adjust units if necessary. An IPC cannot be “closed complete” if the estimated cost exceeds the annual limit.

YES Waiver Tip Sheet: Individual Plan of care Initial

Developed at the first face-to-face meeting with the Wraparound Facilitator, youth, and LAR

Because the wraparound process is just beginning at this meeting and the team ha

s not been formed yet, this IPC includes services that may be appropriate strategies for the family.

Revision Completed a minimum of every 90 days Must be revised at Child Family Team meetings Can be completed whenever the team has decided to update a service

based on the proposed wraparound strategies The notes section should indicate if there are no changes or which changes

were made. Examples: “Completed 90 day review. No changes made.” or “Increased art therapy units, removed respite, and requesting AAS#0.”

Outgoing Estimate Completed when the LMHA/family will be ending services with one

Comprehensive Waiver Provider (CWP) and staring with a different CWP All units should be reduced to only what was provided CWP signature is required

Incoming Estimate Created at the first meeting between the Wraparound Facilitator, client, LAR,

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CWP signature is required Request total units desired for services that will be provided by new CWP

LMHA Transfer Out Completed when the youth/family relocates to another area served by a

different LMHA Notes should describe details regarding the transfer. For example, “Family

has moved to Williamson County. They have an appointment scheduled for next Tuesday to begin services at Bluebonnet Trails.”

All units should be reduced to only what was provided LMHA Transfer In

Completed by the receiving LMHA Wraparound Facilitator, youth, and LAR at their first meeting

Request total units desired for services that will be provided by new LMHA Annual

Completed only after the annual CE has been completed to start unit requests over for new year

Policy Requirements: 2100.1 and 2200.4

Transfers and Changes in CWP Providers

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The LMHA/LBHA and wraparound facilitator are responsible for processing changes in service for YES waiver participants per YES waiver policy (See YES Waiver Policy Manual). Participants who relocate to a new service area within the state will need to complete a transfer process. Participants who request a change in CWP will complete a change process requiring service estimates.

The steps required to complete a participant transfer to a new WPO or LMHA as well as changes in CWP are the similar but require the use of different forms in CMBHS. The processes that must be completed in CMBHS are outlined in the table on the following page.

Referring Agency Checklist:

1. Facilitate a child and family team meeting2. Identify where the participant will be moving/has moved and communicate critical

information with the receiving agencya. Family contact informationb. Continuity of care issuesc. Health and Safety pland. Last date of services

3. Contact the client’s direct service providersa. Confirm the last date of servicesb. Confirm whether services have been delivered that still require service notes

to be input into CMBHS. Confirm which services need to remain on IPC. This is important to ensure that the service provider can receive payment for those services.

4. Work with the CWP to determine service usage and remaining dollar or unit balances

5. Submit and process outgoing documents (transfers or estimates) in CMBHS according to the Guide on the following page.

Receiving Agency Checklist:

1. Review information provided by the original agency. of 74

a. Confirm with original CWP which services have already been provided. This guarantees that providers can be paid for services that have been rendered.

b. Discuss with incoming CWP which services need to be continued or identify any changes to services.

c. Confirm that units requested and dates match. Reminder: Original CWP cannot be paid for services provided after end date. Incoming CWP cannot be reimbursed for services that start before the original CWP end date.

2. Contact the participant, LAR, and DFPS Caseworker-if the participant is in substitute care, to schedule a face-to-face meeting within seven business days. At the initial meeting, the wraparound facilitator must work with the family to: a. Identify the child and family team members.b. Review and revise the participant’s IPC, as needed.c. Review and revise the participant’s crisis and safety plan, as needed.

3. Submit and process incoming documents in CMBHS according to the table on the following page

Processing Transfers and CWP Changes in CMBHS

TRANSFER TO A NEW SERVICE AREA or NEW WPO CHANGE CWP PROVIDER

Referring Agency (Out)

1. Create CE- LMHA Transfer Out: a. Information from the most recent CE should auto-fill b. “Performed on” date refers to the last date of service at

1. Create an IPC Outgoing Estimate

a. Reduce all pre-approved YES Service Units to include only

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the original agencyc. Enter transfer the name of the receiving LMHA,

Wraparound facilitator (if known) and case manager (if known) in notes

2. Create IPC Transfer Out:a. When transfer is opened, you will see service units at have

been approved for clients. b. Reduce all pre-approved YES Service Units to include only

those services that client will receive before the last date of service. Include any services that have been provided but have not yet been billed through a service note. *Reminder: Do not include extra units that the client has not and will not use prior to their transfer.

c. “Revoke” any home modifications and/or adaptive aids that have been approved but not purchased. This is located on the hand side of form.

d. Place IPC Transfer Out into ready for review. Only do this after you have completed all previous steps.

3. Create a Discharge CANS after IPC Transfer Out has been approved and placed in “Closed Complete” by HHSC.

those services that client will receive before the last date of service. Include any services that have been provided but have not yet been billed through a service note. *Reminder: Do not include extra units that the client has not and will not use prior to their transfer.

b. “Revoke” any home modifications and/or adaptive aids that have been approved but not purchased.

c. Place IPC Outgoing Estimate in “Ready for Review.”

Receiving Agency (In)

1. Enter Diagnosis and CANS with LOC-A, Complete YES Assessment

2. Create a CE-LMHA Transfer In:a. “Performed on” refers to the last date of service from

previous LMHA. Information, including end-dates, should auto-fill. *Reminder: Make sure that there are no breaks in service.

3. Create IPC Transfer In:a. This should be completed by the receiving LMHA

Wraparound Facilitator, youth, and LAR at their first meeting.

b. Request total units desired for services that will be provided.

1. Create IPC Incoming Estimate

a. Completed by Wraparound facilitator and CFT at the first meeting

b. Request total units desired for services that will be provided by the new CWP*Reminder: An outgoing and incoming estimate cannot be completed on the same day. Prior to doing an incoming estimate, the outgoing estimate must be approved by TMHP which processes overnight.

WRAPAROUND

OVERVIEWWraparound is an ecologically based process designed to build on the collective strengths and actions of a team. Wraparound is not a service or program, but a process designed for families whose children have complex needs, are involved in multiple systems and for whom traditional services and approaches have not worked.

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The National Wraparound Implementation Center (NWIC) Wraparound Practice and Implementation Model was chosen by the Texas Health and Human Services Commission (HHSC) to be the care coordination model for the YES Waiver. Wraparound Facilitators/Care Coordinators are required to follow the NWIC Wraparound planning process to coordinate all care, and is billed as Intensive Case Management.

The Texas Center, in partnership with HHSC and NWIC, supports quality Wraparound practice through the provision of implementation support, training, coaching and fidelity reviews.

All YES Waiver Wraparound Facilitators/Care Coordinators are required to attend a 3-part Wraparound training series available through the Texas Center. Monthly coaching support is also available to all Wraparound Supervisors of the YES Waiver. It is highly recommended to utilize this support.

For more information about Wraparound training, the varied coaching support available and implementation support, please refer to the website at:

http://www.nwic.org/

FORMS IN THIS SECTION Sample Wraparound Plan

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http://www.nwic.org/

YOUTH EMPOWERMENT SERVICES (YES) WAIVER

WRAPAROUND PLAN

CHILD/ADOLESCENT MENTAL HEALTH

Date: Participant Name:

Medicaid Number: Program/Unit:

Case Manager: Case Manager ID:

Case Number:

Initial Plan Monthly Review Transition Plan

Wraparound Team Members

Name Relation to Participant Phone

Participant

LAR

Case Manager

7.

8.

9.

10.

11.

12.

13.

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14.

15.

Participant Name: Case Number:

Family Vision Statement:

Team Mission Statement:

Strengths and Roles

Youth and Family Strengths Informal Support Strengths Formal Support Strengths/Roles

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Medical Providers

Current Psychiatric Provider Current Primary Care Physician

Name: Name:

Address: Address:

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Phone: Phone:

Child’s current medications:

Purpose of medication/Diagnosis:

Child’s/Family’s Therapist, Address, Phone:

School Providers

School: _______ Elementary (NISD) Principal: Ms. _______

Teacher(s): Ms. _______ Vice Principal: Mr. ________

Counselor: Grade Level: 4th

Time Class Grades Comments

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Crisis/Safety Plan

Warning Signs: (a crisis may occur)

Anticipated Concerns:

(areas of risk in home, school, community, etc.)

Prevention:

(strength-based approaches that are currently useful to the family)

Plan/Procedure:

(recommended

At Home:

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interventions) In Community:

At School:

Important Phone Numbers:

(who to contact)


Needs Statement #1

Start date:

End date/Duration:

Outcome Statement

Tracking Toward Need Met:

Strategies Task/Team Member Deadline/

Frequency

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Needs Statement #2

Start date:

End date/Duration:

Outcome Statement

Tracking Toward Need Met:

Strategies Task/Team Member Deadline/

Frequency

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Date: Participant Name:

Case Manager: Case Number:

STATEMENT OF PARTICIPATION: My signature acknowledges that I have been an active participant in this staffing and in the development of this Wraparound Plan. I have been given choices regarding my provider and the location where I will receive services.

Wraparound Plan Participants

Relationship to Consumer Printed name Signature Date

Participant

Parent / LAR

Case Manager

YES Waiver Family Support

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As a Licensed Professional of the Healing Arts (LPHA), I verify that the services authorized in the Authorization Level of Care (LOCA) section are medically necessary and I concur with the plan of care.

_____________________________________________ ______________________________

LPHA Signature /Credentials Date

Date of Next Wraparound Plan Meeting:

_____________________________________

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NON-MEDICAID PARTICIPANTSOVERVIEWYES Waiver Eligible participants have the opportunity to obtain Medicaid insurance based on their mental health disability and by using only the income of the participant. The LMHA/LBHA will assist the participant to obtain the insurance. During the time that the participant awaits approval of Medicaid and has an LOC Authorization of YES Waiver, he/she can receive all TRR services. Once Medicaid is approved, the participant can then begin to receive YES Waiver services.

PROCESS OF PARTICIPATION1. Perform the Clinical Eligibility assessments

a. Request deviation to LOC-YES on the Uniform Assessmentb. Complete YES Assessment and place in “Closed Complete” statusc. Submit CE—Pending to CMBHSd. Complete all standard TRR assessment paperwork (i.e. Diagnosis, Narrative

Assessment)e. Once CE—Pending is approved and “Closed Complete” provide Pending

Authorization of Services letter to family2. Provide Intensive Case Management per Texas Administrative Code regulations

a. Assist the participant with the Medicaid applicationb. Begin Wraparound Process

i. Follow process in orderii. When creating the Wraparound Plan, identify strategies other than YES

Waiver Services3. Enroll Participant in YES Waiver (once Medicaid becomes active)

a. Establish enrollment in to YES Waiveri. Complete CE initial formii. Submit CE—Initial to CMBHS

b. Complete YES Waiver Enrollment Formsi. Authorization of Services Letterii. Notice of Participant Rightsiii. Freedom of Choiceiv. Provider Selection Formv. Participant Agreement

c. Continue Wraparound Processi. Modify Wraparound Plan to include YES Waiver Servicesii. Submit Initial Individual Plan of Care to CMBHS

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HOW TO APPLY FOR MEDICAIDFor complete instructions on how to apply for Medicaid and links to application forms, please refer to links on the online MEPD Tip Sheet.

FREQUENTLY ASKED QUESTIONSQ: What do we do when a client loses Medicaid in the middle of services?A: Continue providing TRR services through the Wraparound process. However, all YES Waiver services are to be stopped immediately while the LMHA/LBHA assists the LAR to secure Medicaid coverage. Continue requesting LOC-YES. Though YES Waiver services cannot be paid until Medicaid is restored, the Clinical Eligibility and IPC will remain active until YES Waiver renewal date. The LMHA/LBHA, WPO, and CWP must be aware that the participant cannot receive YES Waiver specific services while Medicaid is inactive. The WPO and CWP must verify Medicaid eligibility each month prior to rendering YES Waiver services. If the WPO or CWP provide a YES Waiver service on any day that the participant does not have active Medicaid, the provider will not be reimbursed.

Q: What documentation does Medicaid consider when reviewing applications?A: Types of supporting documentation include:

Documentation of diagnosis by licensed professional or physician School records (i.e. IEP, 504 plan, recommendations) Psychological evaluations Hospital discharge summaries Assessments Progress Notes Doctor recommendation letters

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CLINICAL CONSIDERATIONS

TRAININGSYES Waiver serves the highest safety risk population among children and youth. As such, certain clinical elements are essential to the well-being of the YES Waiver Participants. It is the responsibility of all parties involved with YES Waiver to provide quality care. Trainings are therefore an essential element to ensure that staff are equipped with the right skills. Trainings required to be completed include:

Identifying and reporting of abuse, neglect, and exploitation Confidentiality and Encryption Capability Critical Incident Reporting National Wraparound Initiative (Intro to Systems of Care)

o What’s this thing called Wraparound?o Team Roles in Wraparoundo Overview of the Youth Empowerment Services

Service Documentation Crisis and Safety Planning Safe management of verbally and physically aggressive behavior (restraint

training) CPR First Aid

CRISIS AND SAFETY PLANNINGCrisis and safety planning is crucial to quality service delivery with the YES Waiver population. The Crisis and Safety plan development begins at the very first face-to-face meeting with the participant and his/her respective LAR. The plan includes steps to take during a crisis, warning signs that a crisis may occur, potential triggers that increase the likelihood of a crisis, and steps for intervention to prevent a crisis. The plan is a living document, therefore is modified on an on-going, as-needed basis. At a minimum, it is reviewed every month at the Child Family Team meeting. If a crisis occurs, the team shall review the crisis plans and make appropriate modifications to attempt to prevent the crisis from re-occurring. For further tips on Crisis and Safety Planning, please refer to Quick Guide for Developing a Crisis and Safety Plan.

CRITICAL INCIDENTSThe YES Waiver Policy Manual outlines what qualifies as a critical incident. Should one of these incidents occur, it is the responsibility of the staff person (wraparound coordinator or provider) who first hears of the incident to complete a Critical Incident Report and submit it to YES Waiver HHSC staff within forty-eight hours of hearing of the incident. The form shall be sent to [email protected]. If the critical incident qualifies as a crisis, the Child and Family Team shall meet within seven business days to update the Crisis and Safety Plan and Wraparound Plan. If the family and CFT determines that

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mailto:[email protected]


strategies must be adjusted, it is also possible that the IPC will need to be updated to reflect the changes.

TRANSITION AGE YOUTHThose participants who are within six months of their 19th birthday require appropriate transition planning. The development of the plan shall begin at least six months prior to their birthday but can begin sooner if appropriate. A preliminary plan must be submitted to HHSC YES Waiver staff via email six months prior to 19th birthday and then the final plan at least 30 days prior to termination from YES Waiver.

The plan must include:o Summary of mental health services

Past services received Preferences for mental health community services Responsiveness to past interventions

o Current status of: Diagnosis Medication Level of functioning

o Unmet needso Strengthso Planned Services after discharge:

Upcoming scheduled appointments Name of services referred to Any additional information regarding actions taken to assist client to

function without YES Services

Transition funding can be requested one time. The request can be made on the IPC by including in the request a brief itemized list of what will be purchased. The Transition Plan must be attached to the IPC in order for the request of funds to be considered. YOUTH IN CONSERVATORSHIPAs of July 2016, youth who are in Department of Family Protective Services (DFPS) conservatorship are allowed to receive YES Waiver services. They are assessed based on the same criteria. If found clinically eligible, they also receive wraparound services and access to YES Waiver services just as a participant not in conservatorship. Please refer to the Youth in Conservatorship FAQs.

FORMS IN THIS SECTION Critical Incident Report Youth in Conservatorship FAQs

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http://www.dshs.texas.gov/mhsa/yes/2016updates/CriticalIncidentReportFormRevision101916.doc

Youth in Conservatorship FAQs

Q: What steps should be taken to enroll a foster youth?A: If someone wants to enroll a foster youth, the same steps will be followed as someone who is not in foster care. This includes:

1. An LAR calls the inquiry line 2. The LMHA returns the call within 24 hours/one business day 3. The youth is placed on the inquiry list 4. The youth will be scheduled for a Clinical Eligibility assessment within seven business days of the call5. The youth will be assessed and if approved, enrolled in YES Waiver

Q: What should be discussed over the phone during that initial contact?A: For foster care youth, it is important to identify who is making the call versus who should be at the Clinical Eligibility Assessment. In addition, it is important to gather the case workers name and contact information so that the LMHA may obtain the YES Waiver Enrollment Sheet from DFPS.

Q: Who is considered the LAR?A: In the case of a foster care youth, anyone who is a Managing Conservator and/or medical consenter can be considered the LAR.

Q: How do we know who is a medical consenter? What proof can be provided? A: A medical consenter will have a completed 2085-B form which designates them as a medical consenter. A list of medical consenters can also be found in the child’s Health Passport at www.fostercaretx.com under the Contacts tab. As a Star Health provider, LMHA staff should have access to the Health Passport.

Q: What is the YES Waiver Enrollment Sheet?A: This is a form that was created by DFPS to assist in identifying important information regarding the youth. Information will include important contact, important familial information, and limited details on the permanency plan for the youth.

Q: When should the Enrollment Sheet be completed?A: The form should be completed after the child has completed the intake and been approved for YES Waiver.

Q: Who is considered family? Who can participate?A: Family is defined by the participant, and anyone may participate unless there are legal restrictions. The child or youth may choose anyone to join the wraparound team that they feel are important to the process and are important to their success. Biological family and natural supports are highly encouraged to participate for multiple reasons: with regards to the biological family, reunification may be a goal, but even if it is not a goal, often these children have some level of contact or relationship with their families at some point, so the wraparound process is a great place to help navigate and strengthen those relationships. The biological family is also a part of the family story and often play a role in the “initial conditions” that led to the referral, so it may be beneficial that they are also a part of the participant’s journey towards success. And as for natural supports, they are equally as important to help build a support network that the participant can continue relationships with past the YES waiver services.

Q: Will the biological parents be allowed to participate?A: If there are no legal restrictions, participation of biological parents is encouraged.

Q: Who needs to be at the Eligibility Assessment? of 74

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A: A Medical Consenter (someone who has the legal authorization to sign for treatment) must be present. The case worker is also strongly encouraged to participate.

Q: Can YES services be court ordered?A: A court order cannot override Clinical Eligibility.

Q: What should we expect of the DFPS case worker?A: The DFPS caseworker should participate in the initial and ongoing Child and Family Team meetings.

Q: What do we do if the case worker works out of the region and cannot attend the meetings?A: Consider an invitation to have the caseworker participate by phone.

Q: What do we do if the youth gets placed in an RTC?A: TRR services can be provided, but YES services will be placed on hold until the youth discharges.

Q: When I select “Foster Care” on the Child and Adolescent Uniform Assessment, it will not allow me to deviate to YES Waiver. What should I do?A: You will not check the box labeled “Foster Care.” You can instead select “Foster Care” under Primary Residence and then note in the text box that that youth is in foster care, but this is not required.

Q: When completing financials to open a participant to our agency, who’s information are we placing in our system?A: The child’s financial information is placed in the system.

Q: What if a youth already has a provider for Targeted Case Management? A: The child’s behavioral health services will need to be transferred to the LMHA/LBHA providing the YES Waiver services unless the current TCM provider is also an approved Non-CMHC Comprehensive Service provider of TCM.

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