YES Waiver Individual Plan of Care and Service Authorization

Individual Plan of Care Overview

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.

  1. Initial
  2. Revision
  3. Annual Renewal
  4. LMHA Transfer Out
  5. LMHA Transfer In
  6. Outgoing Estimate
  7. Incoming Estimate.
  8. Termination IPC (Automatically Created by CMBHS)

 

Initial IPC

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.


YES Waiver Individual Plan Of Care Data Fields

The YES Waiver IPC document has the following Data Fields, which are described below.

 

  1. IPC Type
  2. Performed On date
  3. Notes on IPC Type
  4. Annual IPC Begin Date
  5. Annual IPC End Date
  6. Annual Total Summary for All Waiver Services
  7. YES Provider Name
  8. TMHP Authorization Number
  9. YES Waiver Services
    1. General
    2. Adaptive Aid and Supports
    3. Minor Home Modification
    4. Transitional Services
  10. Non-Waiver Services
    1. Other Medicaid State Plan Services
    2. Services Provided by Other Funding Sources
  11. Treatment Team Signatures
  12. DSHS Review and Approval

 

The Individual Plan Of Care And Service Authorization

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).

 

Individual Plan of Care Data Fields Detail

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.

 


Initial, Annual Renewal, and Revision IPC Document

To submit an Initial, Annual Renewal, or Revision IPC document:

  1. Navigate to the YES Waiver IPC Authorization page by using the Client Services toolbar.
    1. Select Special Services Documentation
    2. Select YES Waiver Services
    3. Select YES Waiver IPC Authorization
  2. Once the IPC document is open, select the appropriate IPC Type from the list of options provided in the drop-down menu.
  3. Enter the Performed On date. This date is the date services were agreed upon in the Child and Family Team meeting.
  4. Enter comments in Notes on IPC Type. Comments should indicate any change to services.
  5. The Annual IPC Begin Date and Annual IPC End Date will automatically populate to reflect Clinical Eligibility Start and End dates. (NOTE : If the Initial or Annual Renewal IPC is created before the Clinical Eligibility document has been approved, this date will state “Waiting for YES Clinical Eligibility to be approved by DSHS”.)
  6. The Annual Total Summary For All Waiver Services section will automatically populate to reflect the annual total billable amount of $35,804. (NOTE : For Initial and Annual Renewal IPC documents, all other amounts should be “0.00” For Revision IPC documents, all other amounts will be updated to reflect estimated cost of services paid for and remaining balance.)
  7. Select YES Provider Name from the list of options provided in the drop-down menu.
  8. Enter YES Waiver Services: General as needed
    1. Select Edit next to the service requested. A text box will appear under the Requested Units column.
    2. Enter the amount of requested units. The Estimated Annual Cost will update to reflect the request. (NOTE : Service request(s) should reflect the amount, type, and frequency of services agreed upon in the Child and Family Team meeting and documented on the Wraparound Plan of Care.)
  9. Enter Adaptive Aids and Support, Minor Home Modification, and/or Transitional Services.
  10. Enter Non-Waiver Services: Other Medicaid State Plan Services. List services provided to the participant or to the LAR (for the benefit of the youth) that are paid through the Medicaid State Plan. Enter the total number of hours per year that the participant will likely receive the listed service. All participants should receive services for intensive case management.
  11. Enter Non-Waiver Services: Services Provided by Other Funding Sources. List services provided to the participant or to the LAR (for the benefit of the youth) that are paid by non-Medicaid sources.
  12. Complete Treatment Team Signatures section. Signatures should match the Performed On date. Refer to the Individual Plan of Care section for guidance.
  13. Review Annual Total Summary. This has been updated to reflect the estimated cost of submitted units. The Total Estimated Cost should not exceed Total Billable Amount. If so, review and revise the IPC request.
  14. Verify information is correct and that all requested units are documented.
  15. Select Ready for Review from the options provided in the drop-down menu.
  16. Select Save.

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.

 


IPC Service Authorization Request Process

Adaptive Aids, Minor Home Modifications, and Transitional Funding

To submit a request for Adaptive Aids and Support Minor Home Modifications, or Transitional Services funding:

  1. Select Edit in the appropriate section: Adaptive Aids and Supports, Minor Home Modifications, or Transitional Funding.
  2. Enter the total cost of the approved request in the Unit Rate. The Estimated Annual Cost will update to reflect the cost of the request.
  3. The associated Requisition Fee will be automatically calculated at a pre-determined rate.
  4. Enter comments in the Justification Box. Comments should include a brief justification of the approve request as well as the date of approval by HHSC.
  5. Attach the approved request to the IPC.

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.

 


Transfer Process

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).

  1. If the client has moved to a different Local Mental Health Authority (LMHA), this is a LMHA to LMHA transfer. The LMHA should follow the LMHA Transfer process.
  2. If a client chooses a different service provider, this is a Comprehensive Waiver Provider (CWP) transfer. The LMHA should follow the CWP Transfer process.

Detail for Documenting the LMHA to LMHA Transfer Process

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.

  1. LMHA Transfer Out
  2. IPC Transfer Out
  3. LMHA Transfer In
  4. IPC Transfer In

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.

 

LMHA Transfer Out Process Detail – Step One – YES Waiver Clinical Eligibility

To begin the LMHA to LMHA transfer out process, first submit an LMHA Transfer Out Clinical Eligibility document .

  1. Navigate to the YES Waiver Clinical Eligibility page by using the Client Services toolbar.
    1. Select Special Services Documentation.
    2. Select YES Waiver Services.
    3. Select YES Waiver Clinical Eligibility.
  2. Once the Clinical Eligibility document is open, select the LMHA Transfer Out Clinical Eligibility Type from the options provided in the drop-down menu. The Clinical Eligibility document will auto-populate with information from the Initial Clinical Eligibility and cannot be changed.
  3. Enter the Performed On date. This date is the day of the last Child and Family Team meeting.
  4. Enter comments in Notes on Eligibility Type. Include the name of the receiving LMHA, Wraparound Facilitator, and case manager, if known.
  5. Select Ready for Review from the options provided in the drop-down menu.
  6. Select Save.

 

LMHA Transfer Out Process Detail – Step Two – YES Waiver Individual Plan of Care (IPC)

Navigate to the YES Waiver IPC Authorization page by using the Client Services toolbar.

  1. Select Special Services Documentation
  2. Select YES Waiver Services
  3. Select YES Waiver IPC Authorization
  4. Once the IPC document is open, select the LMHA Transfer Out IPC Type from the list of options provided in the drop-down menu.
  5. Enter the Performed On date. This date is the last day of services.
  6. Enter comments in Notes on Clinical Eligibility. Comments should include the name of the receiving LMHA and the anticipated start date of services, if known.
  7. Enter the Annual IPC End date. This date is the last date of services that will be provided to the participant.
  8. Edit YES Waiver Services: General. Reduce all pre-approved YES Service Units to include only those services that the client will receive before the Annual IPC End date. (NOTE: Include any services that have been provided but have not yet been billed through a service note. Do not include extra units that the client will not use before the Annual IPC End date.)
  9. Edit YES Waiver Services: Adaptive Aids and Supports, Minor Home Modifications. Revoke any requests that have been approved but not yet purchased.
  10. Complete Treatment Team Signatures section. Signatures should match the Performed On date. Refer to the Individual Plan of Care section for guidance required based on Clinical Eligibility type.
  11. Verify all information is correct and units accurately reflect the participant’s utilization.
  12. Select Ready for Review from the options provided in the drop-down menu and Select Save.
  13. After the IPC Transfer Out has been approved and placed in Closed Complete by HHSC, create a Discharge CANS. The Discharge CANS will ensure that the receiving LMHA is able to transfer the client into their program.

 

LMHA Transfer In Process Detail – Step Three – YES Waiver Individual Plan of Care (IPC)

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.

  1. Navigate to the YES Waiver Clinical Eligibility page by using the Client Services toolbar.
    1. Select Special Services Documentation
    2. Select YES Waiver Services
    3. Select YES Waiver Clinical Eligibility
  2. Once the Clinical Eligibility document is open, select the LMHA Transfer In Clinical Eligibility type from the options provided in the drop-down menu. The Clinical Eligibility document will automatically populate with information from the Initial Clinical Eligibility and cannot be changed.
  3. Enter the Performed on Date. This date is the date of the first in-person meeting with the participant and the LAR.
  4. Select Ready for Review from the options provided in the drop-down menu.
  5. Select Save.

Next, submit an IPC Transfer In document.

  1. Navigate to the YES Waiver IPC Authorization page by using the Client Services toolbar.
    1. Select Special Services Documentation
    2. Select YES Waiver Services
    3. Select YES Waiver IPC Authorization
  2. Once the IPC document is open, select the LMHA Transfer In IPC type from the list of options provided in the drop-down menu.
  3. Enter the Performed on Date. This date is the date of the first in-person meeting with the participant and the LAR.
  4. Enter comments in Notes on Clinical Eligibility. Comments should include the date the participant arrived at the LMHA.
  5. Enter the Annual IPC Begin Date. This date refers to the first date of service.
  6. Review the participant’s Annual Total Summary for All Waiver Services. This section will reflect the participant’s remaining billable amount for services.
  7. Enter YES Waiver Services: General as needed.
  8. Complete Treatment Team Signatures section. Signatures should match the Performed on Date. Refer to the Individual Plan of Care section for guidance.
  9. Review Annual Total Summary. This has been updated to reflect the estimated cost of submitted units. The Total Estimated Cost should not exceed Total Billable Amount. If so, review and revise the IPC request.
  10. Verify information is correct and that all requested units are documented.
  11. Select Ready for Review from the options provided in the drop-down menu.
  12. Select Save.

 

Detail for Documenting the Comprehensive Waiver Provider Transfer Process

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.

  1. Navigate to the YES Waiver IPC Authorization page by using the Client Services Toolbar.
    1. Select Special Services Documentation
    2. Select YES Waiver Services
    3. Select YES Waiver IPC Authorization
  2. Once the IPC document is open, select the Outgoing Estimate IPC type from the list of options provided in the drop-down menu.
  3. Enter the Performed on Date. This date is the last day of services.
  4. Enter comments in Notes on Clinical Eligibility. Comments should include the name of the new CWP and the anticipated start date of services, if known.
  5. Enter the Annual IPC End Date. This date refers to the last date of service.
  6. Edit YES Waiver Services: General. Reduce all pre-approved YES Service Units to include only those services that the client will receive before the Annual IPC End Date. (NOTE: Include any services that have been provided but have not yet been billed through a service note. Do not include extra units that the client will not use prior to the Annual IPC End date.)
  7. Edit YES Waiver Services: Adaptive Aids and Supports, Minor Home Modifications. Revoke any requests that have been approved but not yet purchased. 
  8. Complete Treatment Team Signatures section. Signatures should match the Performed on Date. Refer to the Individual Plan of Care section for guidance.
  9. Verify all information is correct and units accurately reflect the participant’s utilization.
  10. Select Ready for Review from the options provided in the drop-down menu.
  11. Select Save.

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.

  1. Navigate to the YES Waiver IPC Authorization page by using the Client Services toolbar.
    1. Select Special Services Documentation
    2. Select YES Waiver Services
    3. Select YES Waiver IPC Authorization
  2. Once the IPC document is open, select the Outgoing Estimate IPC Type from the list of options provided in the dropdown list.
  3. Enter the Performed on Date. This date is the first day of service.
  4. Enter comments in Notes on Clinical Eligibility. Comments should include the date the participant started services and services to be received.
  5. Enter the Annual IPC Begin Date. This date refers to the first date of service.
  6. Review the participant’s Annual Total Summary for All Waiver Services. This section will reflect the participant’s remaining billable amount for services.
  7. Enter YES Waiver Services: General as needed.
  8. Complete Treatment Team Signatures section. Signatures should match the Performed on Date. Refer to the Individual Plan of Care section for guidance.
  9. Review Annual Total Summary. This has been updated to reflect the estimated cost of submitted units. The Total Estimated Cost should not exceed Total Billable Amount. If so, review and revise the IPC request.
  10. Verify information is correct and that all requested units are documented.
  11. Select Ready for Review from the options provided in the drop-down menu.
  12. Select Save.

 


YES Waiver Service Note Overview

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:

 

  1. Service Date
  2. Authorized IPC
  3. Service Type
  4. Service Description
  5. TMHP Authorization number
  6. Service Location
  7. Start Time
  8. End Time
  9. Duration
  10. Authorized Units
  11. Remaining Units
  12. Service Units
  13. Billing Unit
  14. Comments
  15. Performed By
  16. Document Status

Before You Start

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.

How to Document a YES Waiver Service Note:

  1. Use Find/Add in the Client Services toolbar to locate the client’s record in CMBHS and go the the Client Workspace.
  2. From the toolbar on the left, select Special Services Documentation > YES Waiver Services and then > YES Waiver Service Note.
  3. Complete the following data fields:

 

Service Date (Required)

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.

 

Authorized IPC

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.

 

Service Type (Required)

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.

 

Service Description (Required)

Select the Service Description from the options provided in the drop-down list.

 

TMHP Authorization number (Auto-populated by CMBHS)

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.

 

Service Location (Required)

Select the Service Location from the options provided in the drop-down list.

 

Start Time (Required)

Enter the Start Time in hours and minutes.

 

End Time (Required)

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:

 

Comments (Required)

Enter remarks relevant to the delivery of this service in the Comments field as needed.

 

Performed By (Required)

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.

 

Document Status (Required)

Select Closed Complete from the Document Status and Select Save.

 

YES Waiver Services

The following services are documented in a YES Waiver Service Note when delivered to a client.

YES Waiver Service Notes for Requisition Fees

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.