Post on 04-Feb-2021
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
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Overview
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• 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
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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
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Medicaid Eligibility Verification
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Medicaid Eligibility Verification
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Medicaid Eligibility Verification
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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.
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CE Document Types
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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)
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https://www.youtube.com/watch?v=M777r6VbWnk&feature=youtu.be
Submitting a CE
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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.
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IPC Document Types
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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
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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.
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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
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Submitting an LMHA Transfer Out CE
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https://www.youtube.com/watch?v=Bs4T8Yx5im0&feature=youtu.be
Submitting an LMHA Transfer In CE
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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.
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Submitting an Outgoing Estimate
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Submitting an Incoming Estimate
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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.
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Submitting a YES Waiver Service Note
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Thank youYES Waiver
yeswaiver@hhsc.state.tx.us
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mailto:yeswaiver@hhsc.state.tx.us
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
yeswaiver@hhsc.state.tx.usyeswaiver@hhsc.state.tx.usyeswaiver@hhsc.state.tx.usSpan