Youth Empowerment Services (YES) Waiver
Policies and Procedures Manual
Change Log
Notes:
Minor formatting and content revisions such correcting grammatical / spelling errors, or consistency in terminology as are not outlined in the Change Log. Track Changed versions are available upon request ().
Sections and Topics that have been revised are outlined below, with general guidance to key changes. Not all details describing each and every revision with the identified section / topic are included in this change log and you are encouraged to review each identified area in full.
Introduction
- Program Overview
iii) Service Array; clarifications on respite services and professional services, and added targeted case management to list of State Plan Services.
- DSHS Contact Information
Added Sharon Newcomb-Kase, Program Specialist
- Definitions
Capacity
Eligible
Enrolled
Enrolled and Receiving Services
Interested
Interest List
Service Area
YES Waiver slot
Participating Agencies/Individuals
- Texas Medicaid & Healthcare Partnership
Clarified reimbursement mechanisms for participants related to enrollment in managed care plans, mental health targeted case management, and mental health rehabilitative services. Added information about transition to using TMHP in the future for YES Waiver service claims payment.
- Department of State Health Services
Changed “monitoring” to “managing” in #3 and #4
Changed “review” to “approval” in #6
Updated #9 and #10
- Waiver Provider
Updated #6, #7, #8
- Waiver Participant and Legally Authorized Representative
Additional information regarding the Waiver participant and LAR’s rights, agreements and responsibilities are identified in the Notification of Participant Right Form and the Consumer Choice Consent Form.
Policies and Procedures
b.Marketing and Outreach
Added Participant Handbook and Provider Directory to Forms Section and reference to Youth and Family Brochures available at YES Waiver webpage.
c.Waiver ProviderCredentialing
Added reference to Notice of Open Enrollment online posting and eligibility requirements.
Referred to Appendix C for Waiver Provider Credentialing process flow.
Revised Subheadings to include:
1.Desk and On-Site Reviews – updated list of required items.
2.Training – New section that includes YES Waiver overview, and Systems of Care & Wraparound.
3.Criminal History and Background Checks – unchanged.
d.Interest List
This section has been expanded to include the Subheadings listed below. Each Subheading includes reference to the corresponding form (if applicable) and provides additional process information.
1.Interest List Management
2.Interest List Registration
3.First-Come, First-Served Policy
4.YES Waiver Slots
5.Extending an Offer for YES Waiver Services
6.Withdrawing an Offer for YES Waiver Services
7.Removing an Individual from the Interest List
8.Denial of Eligibility
E.Eligibility Criteria and Evaluation of Level of Care
Added Co-Occurring Diagnoses Needs Assessment form
Split Eligibility Criteria into the categories listed below:
1.Demographic Criteria
2.Clinical Criteria
Child or Adolescent must be present for TRAG Assessment.
Texas Inpatient Guidelines are numbered to correspond with the Clinical Eligibility Determination form.
Co-Occurring Diagnoses Needs Assessment
Financial Criteria
Added that special waiver income group will be enrolled in Medicaid Type Program (TP) 14 Base Plan (BP) 13, ME Waiver. TP14/BP13 is traditional, fee-for-service Medicaid.
Individuals that meet YES Waiver financial eligibility under their current Medicaid benefit (See financial eligibility screening tool for list of TP/BP’s) will continue under that Medicaid benefit and may be either fee-for-service or managed care while enrolled in the YES Waiver.
Disability Determination requirement.
Medicaid Effective Date.
Level of Care Evaluation and Updates
See LMHA, Waiver Provider, and DSHS Sections
Temporary Inpatient Services
Added Notice of Hospitalization and Participant Absence Form
F.Waiver Participant Eligibility and Enrollment
1.Status of Individual (Interested, Eligible, Enrolled, Enrolled In Service)
2.Process Flow (Steps 1-12)
H.Consumer Rights
2.Fair Hearings
Added process information on how fair hearings are requested, relevant timeframes, and withdrawals of fair hearing requests.
3.Abuse, Neglect, and Exploitation
Added requirement to report any incidents, including ANE to DSHS YES Waiver staff within 72 hours.
4.Critical Incident Reporting
I.Treatment Planning Process
This section has been expanded to include the Subheadings listed below. Each Subheading includes additional process information.
1.Treatment Team
2.Wraparound Approach to Service Delivery
3.Safety Plans and Crisis Plans
4.Individual Plan of Care
5.Individual Plan of Care Projection
6.Individual Plan of Care Revisions
7.Individual Plan of Care Dates
J.Service Provision
This section has been expanded to include the Subheadings listed below. Each Subheading includes additional process information.
1.YES Waiver Service Array
2.Case Management
3.State Plan Services
4.Flexible Funds – DSHS General Revenue
5.DADS Funded Supported Services
6.Service Rates
7.Participant Termination of Services
L.Encounter Data Reporting
Added use of Sharepoint for transmitting data to DSHS.
Revised monthly report due date to the 15th of each month for the prior month.
M.Billing Guidelines
1.Schedule of Billable Events
Added reimbursement methodology for use of bus passes or cab vouchers for non-medical transportation.
Clarification on group services formula and examples.
2.Service Rates and Requisition Fees
Clarification on the use of the Mandated Family Rate and the administrative portion from the Child Placing Agency Rate for DFPS Residential Child Care and Supportive Family-based Alternatives.
3.Annual Cost Limits
Revised the $5,000 ceiling to only include Adaptive Aids and Supports and Minor Home Modifications.
N.Invoicing and Payment
Updated Encounter and Invoicing Template.
Clarification on submitting State Plan Service claims to TMHP.
Revised monthly report due date to the 15th of each month for the prior month and use of Sharepoint.
U.Record Keeping
3.Operating Guidelines – revised list of policies and procedures for Waiver Providers.
V.WebCARE
1.Uniform Assessments
CA-TRAG updates every 90 days
2.LOC-A = Y Authorization
Initial LOC-A = Y authorization date = Annual IPC Begin Date
90 day updates will change the LOC-A – Y authorization date in WebCARE but does not change the Annual IPC Begin Date.
Appendix
- YES Waiver Service Codes, Descriptions, and Provider Qualifications
- Eligibility and Enrollment Process Flow
- Billing Guidelines
Forms
- Clinical Eligibility Determination Form
- Co-Occurring Diagnoses Needs Assessment
- Denial of Eligibility Letter – BexarCounty (English and Spanish)
- Denial of Eligibility Letter – TravisCounty (English and Spanish)
- Encounter and Invoicing Template
- Individual Plan of Care Form
- Letter of Withdrawal (English & Spanish)
- Notification of Hospitalization and Participant Absence Form
- Notification of Participant Rights Form (English and Spanish)
- Optional Eligibility Screening Tool (Referral Source)
- Participant Handbook and Provider Directory (English and Spanish)
- Signature Page