YES Waiver YES. Youth Empowerment Services A Medicaid Waiver Program for Children with Severe Emotional Disturbance

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1 YES Waiver YES Youth Empowerment Services A Medicaid Waiver Program for Children with Severe Emotional Disturbance July 8, 2010 YES Overview for CRCG Webinar Texas Department of State Health Services Mental Health and Substance Abuse YES Waiver Background & Basics Instances where parents have turned to state custody for care when they feel they have reached or exceeded their financial, emotional or health care support resources and are unable to cover the costs of their child or adolescent s mental health treatment. Legislative direction to HHSC prevent custody relinquishment of children with Severe Emotional Disturbance (SED) HHSC / DSHS received CMS approval to implement a 1915(c) Medicaid Home and Community-Based Services (HCBS) Waiver, called Youth Empowerment Services (YES) in February,

2 YES Waiver Background & Basics Provides home and community-based services to youth who otherwise need institutional care (e.g., psychiatric inpatient care) or whose parents would turn to state custody for care Must be cost neutral to Medicaid (average. Medicaid cost of Waiver services less than or equal to average. Medicaid cost w/o waiver / Inpatient stays) Allows Texas to include youth who are not otherwise Medicaid-eligible when living in the community (parental income is not included in financial eligibility calculation). YES Waiver Background & Basics Goals of the YES Waiver 1. Provide a more complete continuum of flexible communitybased services and supports for children and adolescents with SED and their families 2. Ensure access to other flexible non-traditional support services, including the parent partners 3. Develop individualized plans of care (IPC) through a familycentered planning process 4. Prevent or reduce inpatient psychiatric admissions for children and adolescents with SED 5. Reduce and prevent out-of-home placements by all childserving agencies 6. Improve the clinical and functional outcomes of children and adolescents 4

3 YES Waiver Background & Basics Waiver request submitted June, 2008 and approved by CMS in February, Pilot Phase (3 years from implementation 4/1/2013) Initial Waiver sites in Bexar and Travis counties 150 slots allocated in each County = maximum of 300 youth at any given time Expand to Harris and Tarrant counties if waiver is determined to be cost neutral in its first two years of operation Waiver Provider Open Enrollment Initiated in May 2009 Waiver Provider must ensure provision of all YES Waiver Services and shall provide services directly or indirectly by entering into and managing subcontracts with external providers (Subcontractors) LMHAs to serve as Waiver Providers (con t Open Enrollment) YES Waiver Background & Basics Wraparound approach to service delivery Individualized, family driven, strengths based The Targeted Case Manager at the LMHA will be the service care coordinator for Waiver participants. Consumer Choice Choose to participate in the YES Waiver in lieu of other available alternatives (inpatient, other 1915c waivers, RDM) Choice of Waiver Provider

4 YES Waiver Services Respite Community Living Supports Family Supports Transitional Services Adaptive Aids & Supports Minor Home Modifications Non-Medical Transportation Paraprofessional Services Professional services Supportive Family Based Alternatives 7 YES Waiver Services Service Descriptions and Provider Qualifications can be accessed online at Appendix A of the Policies and Procedures Manual The Individual Plan of Care for each Waiver participant has an annual cost ceiling of approximately $35,000 (for YES Waiver services only), some services have individual cost limits.

5 Organizational Chart Centers for Medicare & Medicaid Services Health and Human Services Commission MOU Department of State Health Services Waiver Provider Agreement Local Mental Health Authority Case Manager Plan of Care Waiver Provider State Plan Services Waiver Participant Waiver Services Waiver Provider Agencies DSHS contracts directly with Waiver Provider Agencies Credentialing Process Medicaid Waiver Provider Agreement Waiver Provider Agency must be able to provide the entire array of services (directly and/or through subcontracted providers).

6 Waiver Provider Agencies Travis County Austin Travis County Integral Care (LMHA) Utilizing existing network of providers (subcontractors) to provide YES Services and actively recruiting additional providers to expand capacity. Bexar County The Center for Health Care Services (LMHA) Providing services directly and through network of providers (subcontractors) and actively recruiting additional providers to expand capacity. Waiver Provider Agencies DSHS Provider Open Enrollment application and credentialing process remains in effect to recruit additional Waiver Provider Agencies. Individuals or agencies interested in being a subcontractor for particular services or sets of services are referred to the Waiver Provider Agencies.

7 LMHA Administrative Functions Maintain a local Waiver participant Interest List Determine Clinical Eligibility and Recommend a Level of Care Recommend an Individual Plan of Care for each Waiver participant Coordinate with DSHS to obtain Medicaid eligibility for individuals not already eligible Facilitate Transition Planning Provide Targeted Case Management 13 Identify Needed Waiver and Non-Waiver Services /Supports Present Options to potential participant Waiver Services Institutional Services Other Non-Waiver Services Collaborate on Utilization Management, Quality Assurance & Improvement Activities Coordinate with the Waiver Provider on the development of the IPC and implementation of services YES Waiver Eligibility To participate in the YES Waiver, the child or adolescent must meet the following eligibility criteria: Age 3-18; Reside in Bexar or Travis County, and in a non-institutional setting with the individual s legally authorized representative (LAR); or in the individual s own home or apartment, if legally emancipated Be eligible for Medicaid, under a Medicaid Eligibility Group included in the approved waiver. Parental income is not included in financial eligibility determination. Meet DSHS clinical guidelines and be reasonably expected to qualify for inpatient care under the Texas Medicaid inpatient psychiatric admission guidelines, as defined in the waiver, in the absence of waiver services Choose, or have the LAR choose, the waiver program services as an alternative to care in an inpatient psychiatric facility, in accordance with the provisions of the waiver 14

8 Referrals Individuals requesting services under the YES Waiver may or may not be current clients of the LMHA. Individuals may make a self referral or be referred to the YES Waiver by outside agencies, organizations or providers. Youth and Family Brochure / Directory (YES Website) Optional Screening Tool (YES Website) Interest List The LMHA registers each individual whose parent or Legally Authorized Representative requests the YES Waiver on the Interest List phone line. LMHA will assess next individual on Interest List when vacancy is available. Vacancies are offered to eligible individuals on a first come, first served basis according to individuals' registration date on the Interest List. Number of vacancies will be determined by provider capacity up to 150.

9 Interest List Phone Numbers Bexar County: (210) extension 259 Travis County: (512) Current Status Interest List Travis County: 57 registered, 31 waiting to be assessed, 10 eligible, 6 currently enrolled in services Of 10 eligible, 4 non-medicaid Bexar County: 36 registered, 18 waiting to be assessed, 7 eligible (2 declined participation), 1 currently enrolled in services Of 7 eligible, 2 non-medicaid

10 Challenges to Implementation New program Requirement for Waiver Provider Agency to provide or arrange for all services (bundling of services). Non-Automated Processes (eligibility and service plan approvals, claims payment, service data reporting). Rates Provider Qualifications, Waiver language revisions YES Waiver Website and Resources Program News & Information Interest List Information Information Forum Announcements Brochures for Youth and Families Waiver Application Policies and Procedures Manual Rates Yes.html Provider Enrollment 20

11 Contact Information Jodi Christianson, Program Specialist, Connie Jimenez, Administrative Assistant, Matthew Ferrara, Unit Manager, YES Waiver Program YES Waiver Website 22