The Individual Plan of Care (IPC) is a document in CMBHS which allows users to submit a request for YES Waiver services for a participant. Services on the IPC, as developed through the Child and Family Team meeting, are intended to support a participant’s mental health needs, and must be documented on the participant’s Wraparound Plan. For more information, see the HHSC YES Waiver Policy manual on the YES Waiver website .
IPCs are reviewed by HHSC to verify that submissions follow policy requirements. Services should not be provided to a participant until they have been approved by HHSC and an authorization number provided by Accenture/Texas Medicaid and Healthcare Partnership (TMHP).
There are several types of IPC documents. The following types of documents are described below.
Submit an Initial IPC after the Wraparound Facilitator has met with the participant and their family at the Intake meeting. Services requested on this IPC should be appropriate to support the participant until the initial Child and Family Team meeting is held. Services requested on the initial IPC should reflect the Wraparound Plan of Care and must be necessary to support the participant’s Crisis and Safety Plan.
Revision IPC
Submit a Revision IPC to request a change to services. Any change in service should be documented in the Wraparound Plan of Care. At minimum, a Revision IPC should be created and submitted every 90 days.
Annual Renewal IPC
Submit an Annual Renewal IPC when a participant has been authorized at least once before for ongoing enrollment in YES Waiver. The previous authorization must have been immediately before and without a gap in eligibility.
LMHA Transfer Out IPC (bring here when user clicks on #4)
Submit an LMHA Transfer Out IPC when a participant chooses to permanently relocate to a county outside the LMHA Local Service Area.
Complete this document only when the participant’s relocation is not expected to be temporary . Coordination must occur between the participant’s current, or sending, LMHA and the new, or receiving, LMHA to ensure continuity of care.
When submitting an LMHA Transfer Out IPC, the Notes on Clinical Eligibility should identify:
LMHA Transfer in IPC
Submit an LMHA Transfer in IPC when a participant, who has been authorized to receive YES Waiver services, has permanently relocated from a different LMHA catchment area.
This document type can only be created when there is an authorized LMHA Transfer Out IPC. Coordination must occur between the participant’s previous, or sending, LMHA and the new, or receiving, LMHA to ensure continuity of care. Services requested on this IPC should be services that are appropriate to support the participant until the first Child and Family Team meeting is held with the participant’s new Wraparound Facilitator. The LMHA should always make sure that services the participant has previously received through the sending LMHA are continued to the greatest extent possible.
IPC Outgoing Estimate
Create an Outgoing Estimate IPC when a participant chooses to End Services being provided by one Comprehensive Waiver Provider (CWP) and receive services from a new CWP.
NOTE: An Outgoing Estimate IPC is Step One (1) and must be completed before an Incoming Estimate Step Two IPC (2) is attempted by the new provider.
IPC Incoming Estimate
Create an Incoming Estimate IPC after a participant and family has their first Child and Family Team meeting with the new CWP. This document type can only be created when there is an authorized Outgoing Estimate IPC. Services requested on this IPC should reflect the services that will be provided by the new CWP.
NOTE: An Outgoing Estimate IPC is Step One (1) and must be completed before an Incoming Estimate Step Two IPC (2) is attempted by the new provider.
Termination IPC (Automatically Created by CMBHS)
A Termination IPC is automatically created by CMBHS.
The YES Waiver IPC document has the following Data Fields, which are described below.
The Wraparound Facilitator submits a request for comprehensive waiver services by using the Individual Plan of Care (IPC) document in CMBHS. HHSC must approve the request before services are delivered to the participant.
After authorization, the Comprehensive Waiver Provider delivers the services to the participant. Services must be delivered as outlined on the Wraparound Plan of Care.
The Individual Plan of Care (IPC) document in CMBHS allows users to submit a request for YES Waiver services for a participant.
IPCs are reviewed by HHSC to verify submissions are in compliance with policy requirements. Services should not be provided to a participant until they have been approved by HHSC and authorized by the Texas Medicaid and Healthcare Partnership (TMHP).
IPC Type (Required)
The IPC Type section is a required field.
Performed on Date (Required)
This refers to the day that services were agreed upon in the Child and Family Team meeting.
Notes on IPC Type (Optional)
Information in this field should include detail about changes to services, IPC start and end dates as applicable, and changes to service providers.
Begin Date (Required)
For Initial, Revision, Annual Renewal, Outgoing Estimate, and LMHA Transfer Out IPC types, this field will automatically populate to the Clinical Eligibility Start Date.
For Incoming Estimates and LMHA Transfer In IPC types, this field must be updated to reflect the first date services were transferred to the new LMHA or Comprehensive Waiver Provider.
End Date (Required)
For Initial, Revision, Annual Renewal, Incoming Estimate, and LMHA Transfer In IPC types, this field will automatically populate to the Clinical Eligibility End Date.
For Outgoing Estimate and LMHA Transfer Out IPC types, this field must be changed to reflect the last date of services provided by the LMHA or the Comprehensive Waiver Provider.
Annual Total Summary for All Waiver Services (Auto-populated)
The Annual Total Summary for All Waiver Services is a table which provides an overview of the annual cost of YES Waiver services used by the participant during their eligibility year. Monitor the participant’s estimated cost for services throughout their eligibility year. An LMHA or CWP may not exceed the Total Billable Amount for a participant.
YES Provider Name (Required)
The YES Provider Name is a dropdown menu listing the names of all YES Waiver service providers. A YES Provider Name must be listed on the IPC when at least one service is requested on the participant’s IPC. The selected provider should be the organization that will be providing services to the participant.
TMHP Authorization Number (Auto-populated)
The Texas Medicaid Healthcare Partnership (TMHP) Authorization Number is an auto-populated field that is generated when YES Waiver services have successfully been transmitted to TMHP.
A separate TMHP authorization number will be received for each of the following sections:
NOTE: Review the IPC document to make sure that a TMHP authorization number has been received. Services should not be provided to a participant if the IPC does not have a TMHP authorization number. This number should generate on the IPC document within 24 hours of approval by HHSC. If a number does not display, review the participant’s Medicaid Eligibility Verification document in the Client Workspace.
YES Waiver Services (Required)
YES Waiver Services are services that are provided through the YES Waiver and delivered by the Comprehensive Waiver Provider.
Non-Waiver Services (Optional)
Non-Waiver services are services that are provided through the Medicaid State Plan or through other funding sources.
Treatment Team Signatures (Required)
The Treatment Team signatures section is a required field based on the type of assessment.
Signatures from the Client (YES Participant) and the Legally Authorized Representative are always required unless there are extenuating circumstances. Anytime the Client and/or LAR are unable to sign, the reason must be listed in the comments section.
SIGNATURE TYPE |
REQUIRED |
Case Manager |
Yes |
Licensed Practitioner of the Healing Arts |
Yes |
Physician |
Conditionally Optional |
Client |
Yes |
Legally Authorized Representative (LAR) |
Yes |
Comprehensive YES Waiver Provider |
Yes |
DSHS Review and Approval (Required)
The HHSC Review and Approval section is a read-only section. The LMHA/LBHA cannot change this. After an IPC document has been submitted to HHSC for review, HHSC will update this section to reflect the participant’s eligibility status as follows:
Documenting an Individual Plan Of Care (IPC)
Before creating any IPC, be sure to review the participant’s Client Workspace. An IPC cannot be created for any participant who does not have a:
Additionally, no IPC should be created for a participant who is not actively enrolled in Medicaid. Use the CMBHS Medicaid Eligibility Verification ( MEV) process to verify the client’s Medicaid enrollment.
To submit an Initial, Annual Renewal, or Revision IPC document:
NOTE: Review the IPC to make sure that a TMHP authorization number has been received. Services should not be provided to a participant if the participant’s IPC does not have a TMHP authorization number.
The TMHP authorization number should be generated within 24 hours after the IPC document has been approved by HHSC. When an Annual Renewal IPC is submitted early, the IPC will not generate an authorization number until after the participant’s annual renewal period starts.
To submit a request for Adaptive Aids and Support Minor Home Modifications, or Transitional Services funding:
NOTE: Request(s) for Adaptive Aids and Supports, Minor Home Modifications, or Transitional Funding may only be entered in CMBHS after formal approval by HHSC.
The Service Transfer Process allows a YES Waiver participant to transfer their YES Waiver services to a new provider. A participant’s services can be transferred if the participant has moved to a different LMHA/LBHA catchment area or if a participant chooses to change their Comprehensive Waiver Provider (CWP).
An LMHA to LMHA Transfer is a multi-step process that requires the submission of LMHA Transfer Clinical Eligibility and IPC Transfer IPC documents in the following order.
Before beginning the transfer process, be sure to review the participant’s Client Workspace. A transfer cannot be created for any participant who has an IPC or Clinical Eligibility document in Draft or Ready for Review status.
NOTE: A participant’s Clinical Eligibility cannot be transferred if the participant is not within his/her current eligibility year.
To begin the LMHA to LMHA transfer out process, first submit an LMHA Transfer Out Clinical Eligibility document .
Navigate to the YES Waiver IPC Authorization page by using the Client Services toolbar.
Before you start the LMHA Transfer In process, review the participant’s Client Workspace. A Clinical Eligibility cannot be created or submitted for a participant when:
To begin the Transfer In process, first submit an LMHA Transfer In Clinical Eligibility document.
Next, submit an IPC Transfer In document.
A Comprehensive Waiver Provider (CWP) transfer requires the submission of an IPC Outgoing Estimate and an IPC Incoming Estimate. This section applies to LMHAs with more than one Comprehensive Waiver Provider.
First, submit an IPC Outgoing Estimate IPC document.
After the Outgoing Estimate IPC has been approved and placed in Closed Complete by HHSC, a TMHP authorization number should generate on the IPC within 24 hours of IPC approval. An Incoming Estimate IPC cannot be created without this.
Next, submit an Incoming Estimate IPC document.
A YES Waiver Service Note is used by service providers to document services delivered to a YES Waiver participant. CMBHS creates a claim from the Service Note to be submitted to TMHP. The following fields of the Service Note are described below:
You must have a YES Waiver Service Provider role in CMBHS to document a YES Waiver Service Note.
You must be logged into a CMBHS YES Waiver Service Provider location in CMBHS to document a YES Waiver Service Note.
Before creating a YES Waiver Service Note, go to the client’s Client Workspace and confirm the participant has a YES Waiver IPC with a TMHP authorization.
Click here for a list of Page Rights by Role in CMBHS.
Enter the date the YES Waiver service was provided to the client.
If the same service was provided more than one time in the same day, write 2 separate notes.
CMBHS will automatically populate the Date/Number of the most recent authorized IPC based on the Start and End Dates entered.
If there is no Authorized IPC displayed in this field, go to the Client’s Workspace to verify that there is an IPC in Closed Complete status with an Authorization Number that is not expired.
Select the Service Type you want to document from the drop-down list. The choices are based on the most recent authorized IPC.
If the Service Type you need does not display in this field, go to the Client’s Workspace to verify that there is an IPC in Closed Complete status that includes this Service Type and that sufficient Service Units are available.
Select the Service Description from the options provided in the drop-down list.
The TMHP Authorization number will automatically populate to include the information from the authorized IPC.
If there is no Authorization Number displayed in the Service Note, go to the Client’s Workspace to verify that there is an IPC in Closed Complete status with an Authorization Number that is not expired.
Select the Service Location from the options provided in the drop-down list.
Enter the Start Time in hours and minutes.
Enter the End Time in hours and minutes.
After entry of the Start and End Times in the YES Waiver Service Note the following fields will automatically populate:
Enter remarks relevant to the delivery of this service in the Comments field as needed.
Select Performed By from the drop-down menu. This should be the provider who delivered services.
If the appropriate person’s name does not display in this drop-down list, contact your organization’s CMBHS Security Administrator.
Select Closed Complete from the Document Status and Select Save.
The following services are documented in a YES Waiver Service Note when delivered to a client.
When a Requisition Fee is associated with a service you have documented in a YES Waiver Service Note, CMBHS will automatically create a Service Note for the Requisition fee. It is visible in the Client Workspace.