The YES Waiver User GuideThe YES Waiver Service Note documents services delivered to a participant. Tips: •Review the participant’s Client Workspace to confirm the participant

The YES Waiver User Guide & YOU!

Using CMBHS

May 2019

Purpose

• Strengthen compliance with contractual requirements

• Align with best practices

• Accelerate onboarding of CMBHS

• Drive feature adoption

5/20/2020 2

Overview

5/20/2020 3

• Medicaid Eligibility Verification

• Clinical Eligibility

• Individual Plan of Care

• Transfer Process

• YES Waiver Service Note

Medicaid Eligibility Verification

The Medicaid Eligibility Verification (MEV) feature verifies a participant’s Medicaid coverage.

Tips:

• Always submit an MEV request before submitting a Clinical Eligibility document

• Review the participant’s MEV on a monthly basis prior to providing services

5/20/2020 4

Medicaid Eligibility Verification

Tips:

• Participants should have only one Medicaid Identifier listed in their profile

• A valid Medicaid Identifier has a Begin Date and End Date

5/20/2020 5

Medicaid Eligibility Verification

5/20/2020 6

Medicaid Eligibility Verification

5/20/2020 7

Medicaid Eligibility Verification

5/20/2020 8

Clinical Eligibility

Clinical Eligibility (CE) document is a multi-purpose document which contains information related to an individual’s clinical eligibility for or enrollment in YES Waiver.

This document summarizes the individual’s clinical history and is used to:

• determinate clinical eligibility;

• transfer an enrolled participant’s services; and

• end a participant’s enrollment.

5/20/2020 9

CE Document Types

5/20/2020 10

DOCUMENT TYPE PURPOSE

Pending Initial assessment of individual without Medicaid

Initial Initial assessment of individual withMedicaid

Annual Renewal Annual re-assessment of enrolled participants

LMHA Transfer Out/LMHA Transfer In

Transfer of an enrolled participant’s eligibility to a new service region

Termination Termination of a participant’s enrollment

Creating a Clinical Eligibility Document

Submitting a YES Assessment (CANS)

5/20/2020 12

https://www.youtube.com/watch?v=M777r6VbWnk&feature=youtu.be

Submitting a CE

5/20/2020 13

https://www.youtube.com/watch?v=Q3KcpsaOgaA&feature=youtu.be

Individual Plan of Care

• The Individual Plan of Care (IPC) document is a multi-purpose document which allows users to submit a request for YES Waiver services.

• Services must:

• Be developed through the Child and Family Team meeting;

• Support the participant’s mental health needs; and

• Be documented on the participant’s Wraparound Plan of Care.

5/20/2020 14

IPC Document Types

5/20/2020 15

DOCUMENT TYPE PURPOSE

Initial Initial request for services. Services must be necessary to support participant’s Crisis and Safety Plan

Revision Request for change(s) to aparticipant’s service(s)

Annual Renewal Request for continued service(s) at annual re-enrollment

LMHA Transfer Out/LMHA Transfer In

Transfer of an enrolled participant’s services to a new service region

Outgoing Estimate/Incoming Estimate

Transfer of an enrolled participant’s services to a new service provider

Creating an IPC Document

Submitting an IPC

5/20/2020 17

https://www.youtube.com/watch?v=OM2jGN4z_o0&feature=youtu.be

Transfer Process

• The Transfer Process allows a YES Waiver participant to transfer their YES Waiver services to a new provider.

• If the participant has moved to a different Local Service Area (LSA), this is considered an LMHA to LMHA Transfer.

• If the participant chooses a different service provider, this is considered a Comprehensive Waiver Provider (CWP) Transfer.

5/20/2020 18

LMHA to LMHA Transfer

• The LMHA to LMHA Transfer requires the submission of the LMHA Transfer CE and LMHA Transfer IPC documents.

• These documents must be submitted in the following order:

1. LMHA Transfer Out CE

2. LMHA Transfer Out IPC

3. LMHA Transfer In CE

4. LMHA Transfer In IPC

5/20/2020 19

Submitting an LMHA Transfer Out CE

5/20/2020 20

https://www.youtube.com/watch?v=Bs4T8Yx5im0&feature=youtu.be

Submitting an LMHA Transfer In CE

5/20/2020 21

https://www.youtube.com/watch?v=R05A00Hv-1A&feature=youtu.be

Comprehensive Waiver Provider Transfer

• The Comprehensive Waiver Provider (CWP) Transfer process applies to LMHA with more than one Comprehensive Waiver Provider.

• The CWP Transfer requires the submission of the Outgoing Estimate IPC and Incoming Estimate IPC documents.

5/20/2020 22

Submitting an Outgoing Estimate

5/20/2020 23

Submitting an Incoming Estimate

5/20/2020 24

YES Waiver Service Note

The YES Waiver Service Note documents services delivered to a participant.

Tips:

• Review the participant’s Client Workspace to confirm the participant has a YES Waiver IPC authorized by TMHP.

• Some organizations may have developed a batch process to submit YES Waiver Service Notes and claims. Speak to your organization to learn more.

5/20/2020 25

Submitting a YES Waiver Service Note

5/20/2020 26

Thank youYES Waiver

[email protected]

5/20/2020 27

mailto:[email protected]

Structure BookmarksThe YES Waiver The YES Waiver The YES Waiver The YES Waiver User Guide & YOU!

Using CMBHSUsing CMBHSUsing CMBHS

May 2019May 2019

PurposePurposePurposePurpose

•••••Strengthen compliance with contractual requirements

•••Align with best practices

•••Accelerate onboarding of CMBHS

•••Drive feature adoption

OverviewOverviewOverviewOverview

•••••Medicaid Eligibility Verification

•••Clinical Eligibility

•••Individual Plan of Care

•••Transfer Process

•••YES Waiver Service Note

Medicaid Eligibility Medicaid Eligibility Medicaid Eligibility Medicaid Eligibility Verification

The The The Medicaid Eligibility Verification (MEV) feature verifies a participant’s Medicaid coverage.

Tips:Tips:

••••AlwaysSpansubmit an MEV request before submitting a Clinical Eligibility document

•••Review the participant’s MEV on a monthly basis priorSpanto providing services

Medicaid Eligibility Medicaid Eligibility Medicaid Eligibility Medicaid Eligibility Verification

Tips:Tips:Tips:

••••Participants should have only oneMedicaid Identifier listed in their profile

•••A valid Medicaid Identifier has a Begin Date and End Date

Figure

Medicaid Eligibility Medicaid Eligibility Medicaid Eligibility Medicaid Eligibility Verification

Figure

Medicaid Eligibility Medicaid Eligibility Medicaid Eligibility Medicaid Eligibility Verification

Figure

Medicaid Eligibility Medicaid Eligibility Medicaid Eligibility Medicaid Eligibility Verification

Figure

Clinical EligibilityClinical EligibilityClinical EligibilityClinical Eligibility

Clinical Eligibility (CE) document Clinical Eligibility (CE) document Clinical Eligibility (CE) document is a multi-purpose document which contains information related to an individual’s clinical eligibility for or enrollment in YES Waiver.

This document summarizes the individual’s This document summarizes the individual’s clinical history and is used to:

••••determinate clinical eligibility;

•••transfer an enrolled participant’s services; and

•••end a participant’s enrollment.

CE Document TypesCE Document TypesCE Document TypesCE Document Types

DOCUMENT TYPEDOCUMENT TYPEDOCUMENT TYPEDOCUMENT TYPEDOCUMENT TYPEDOCUMENT TYPE

PURPOSEPURPOSEPURPOSEPURPOSE

PendingPendingPendingPendingPending

InitialInitialInitialInitialassessment of individual withoutMedicaid

InitialInitialInitialInitialInitial

Initial assessment of individual Initial assessment of individual Initial assessment of individual Initial assessment of individual withMedicaid

AnnualAnnualAnnualAnnualAnnualRenewal

Annual reAnnual reAnnual reAnnual re-assessment ofenrolled participants

LMHA Transfer Out/LMHA Transfer Out/LMHA Transfer Out/LMHA Transfer Out/LMHA Transfer Out/

LMHA Transfer InLMHA Transfer In

Transfer of an enrolled participant’s Transfer of an enrolled participant’s Transfer of an enrolled participant’s Transfer of an enrolled participant’s eligibility to a new service region

TerminationTerminationTerminationTerminationTermination

Termination of aTermination of aTermination of aTermination of aparticipant’s enrollment

Creating a Clinical Creating a Clinical Creating a Clinical Creating a Clinical Eligibility Document

Submitting a YES Submitting a YES Submitting a YES Submitting a YES Assessment (CANS)

FigureLinkSpan

Submitting a CESubmitting a CESubmitting a CESubmitting a CE

FigureLinkSpan

Individual Plan of CareIndividual Plan of CareIndividual Plan of CareIndividual Plan of Care

•••••The Individual Plan of Care (IPC) document is a multi-purpose document which allows users to submit a request for YES Waiver services.

••••Services must:

••••Be developed through the Child and Family Team meeting;

•••Support the participant’s mental health needs; and

•••Be documented on the participant’s Wraparound Plan of Care.

IPC Document TypesIPC Document TypesIPC Document TypesIPC Document Types

DOCUMENT TYPEDOCUMENT TYPEDOCUMENT TYPEDOCUMENT TYPEDOCUMENT TYPEDOCUMENT TYPE

PURPOSEPURPOSEPURPOSEPURPOSE

InitialInitialInitialInitialInitial

InitialInitialInitialInitialrequest for services. Services must be necessary to support participant’s Crisis and Safety Plan

RevisionRevisionRevisionRevisionRevision

Request for change(s) to aRequest for change(s) to aRequest for change(s) to aRequest for change(s) to aparticipant’s service(s)

AnnualAnnualAnnualAnnualAnnualRenewal

Request for continued service(s) at Request for continued service(s) at Request for continued service(s) at Request for continued service(s) at annual re-enrollment

LMHA Transfer Out/LMHA Transfer Out/LMHA Transfer Out/LMHA Transfer Out/LMHA Transfer Out/

LMHA Transfer InLMHA Transfer In

Transfer of an enrolledTransfer of an enrolledTransfer of an enrolledTransfer of an enrolledparticipant’s services to a new service region

OutgoingOutgoingOutgoingOutgoingOutgoingEstimate/

Incoming EstimateIncoming Estimate

Transfer of an enrolledTransfer of an enrolledTransfer of an enrolledTransfer of an enrolledparticipant’s services to a new service provider

Creating an IPC Creating an IPC Creating an IPC Creating an IPC Document

Submitting an IPCSubmitting an IPCSubmitting an IPCSubmitting an IPC

FigureLinkSpan

Transfer ProcessTransfer ProcessTransfer ProcessTransfer Process

•••••The Transfer Process allows a YES Waiver participant to transfer their YES Waiver services to a new provider.

•••If the participant has moved to a different Local Service Area (LSA), this is considered an LMHA to LMHA Transfer.

•••If the participant chooses a different service provider, this is considered a Comprehensive Waiver Provider (CWP) Transfer.

LMHA to LMHA TransferLMHA to LMHA TransferLMHA to LMHA TransferLMHA to LMHA Transfer

•••••TheLMHA to LMHA Transfer requires the submission of the LMHA Transfer CE and LMHA Transfer IPCdocuments.

••••These documents must be submitted in the following order:

1.1.1.1.1.LMHA Transfer Out CE

2.2.2.LMHA Transfer Out IPC

3.3.3.LMHA Transfer In CE

4.4.4.LMHA Transfer In IPC

Submitting an LMHA Submitting an LMHA Submitting an LMHA Submitting an LMHA Transfer Out CE

FigureLinkSpan

Submitting an LMHA Submitting an LMHA Submitting an LMHA Submitting an LMHA Transfer In CE

FigureLinkSpan

Comprehensive Waiver Comprehensive Waiver Comprehensive Waiver Comprehensive Waiver Provider Transfer

•••••The Comprehensive Waiver Provider (CWP) Transfer process applies to LMHA with more than one Comprehensive Waiver Provider.

•••The CWP Transfer requires the submission of the Outgoing Estimate IPC and Incoming Estimate IPCdocuments.

Submitting an Outgoing Submitting an Outgoing Submitting an Outgoing Submitting an Outgoing Estimate

Figure

Submitting an Incoming Submitting an Incoming Submitting an Incoming Submitting an Incoming Estimate

Figure

YES Waiver Service NoteYES Waiver Service NoteYES Waiver Service NoteYES Waiver Service Note

The The The YES Waiver Service Note documents services delivered to a participant.

Tips:Tips:

••••Review the participant’s Client Workspace to confirm the participant has a YES Waiver IPC authorized by TMHP.

•••Some organizations may have developed a batch process to submit YES Waiver Service Notes and claims. Speak to your organization to learn more.

Submitting a YES Waiver Submitting a YES Waiver Submitting a YES Waiver Submitting a YES Waiver Service Note

Figure

Thank youThank youThank youThank you

YES WaiverYES WaiverYES Waiver

[email protected]@[email protected]