YES_Waiver_Overview
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YES_Waiver_Overview
Click here to see this page in full context

 

YES Waiver Overview

The Youth Empowerment Services (YES) Waiver provides comprehensive home and community-based mental health services to children and youth between the ages of 3 and 18 who are at risk of institutionalization or out-of-home placement due to a serious emotional disturbance (SED).

The current HHSC YES Waiver Policy manual can be found on the YES Waiver website. Each person who works with YES Waiver participants should read the manual and reference it as needed.

CMBHS is the mechanism by which HHSC receives, reviews, and authorizes YES Waiver documents. CMBHS online Help will assist you in navigating CMBHS for YES Waiver documentation.

 

How to verify Medicaid Eligibility in CMBHS

Before creating an MEV request, review the client’s Client Profile to confirm:

  • The participant has only one Medicaid Identifier listed in his/her Client Profile.
  • The Medicaid Identifier is valid. A valid Medicaid Identifier will list a Begin Date and End Date.

Ultimately, a Medicaid Identifier is valid when the number listed in CMBHS matches the Medicaid number listed in the Texas Integrated Eligibility Redesign System (TIERS).

The results of the MEV process are maintained in the CMBHS client record and available for each client in the Client Workspace.

 

 

YES Assessment (CANS)

The LMHA/LBHA must submit an MH Diagnosis and a YES Assessment (CANS) into CMBHS, either online or by batch data transfer as the first step of the YES Waiver eligibility verification process. A YES Assessment (CANS) must be created before a YES Clinical Eligibility document can be created.

The YES Assessment (CANS) includes the Child and Adolescent Needs and Strengths (CANS) Assessment and a community data questionnaire. It does not include the authorization tab found in the MH Child Uniform Assessment (CANS). For the most part, the functions and business rules for the YES CANS are the same as those for the MH Child Uniform Assessment (CANS). Differences are identified below.

 

What if there is an MH Child Uniform Assessment (CANS) already completed that is less than 30 days old?

If there is an MH Child Uniform Assessment (CANS) already completed that is less than 30 days old for the youth, you can transfer that data automatically to the YES Assessment (CANS). Make sure the MH Child Uniform Assessment (CANS) is in CMBHS and in your local Electronic Health Record (EHR), and that they are identical for clinical and technical reasons.

  • Log in to a YES Waiver LMHA location in CMBHS.
  • Search for the client’s record using Find/Add Client and go to the Client Workspace.
  • From the menu on the left, select Special Services Documentation > YES Waiver Services > YES Assessment CANS.
  • The YES Assessment CANS will open with data from the MH Child Uniform Assessment (CANS) populated within.
  • Review the document, making edits to reflect anything in the youth’s condition that may have changed.
  • Save the document in Closed Complete.

 

Before You Start a YES Assessment (CANS)

Make sure that:

  • there is a Local Case Number entered into the first tab of the Client Profile.
  • there is a valid MH Diagnosis documented in CMBHS within the past year.
  • the client's Medicaid status has been verified. Click here for instructions on how to validate a YES Waiver client's Medicaid status.

 

How to Enter a YES Assessment CANS in CMBHS

  1. Log in to a YES Waiver LMHA location in CMBHS.
  2. Search for the client’s record using Find/Add Client and go to the Client Workspace.
  3. Navigate to the YES Assessment (CANS) page by using the Client Services Toolbar on your left.
  4. Select Special Services Documentation > YES Waiver Services > YES Assessment (CANS).
  5. Select Referral Source from the options provided in the dropdown menu.
  6. Enter the CANS Assessment Date. This date is the date the CANS was completed with the client.
  7. Enter the CANS Assessment Time.
  8. Complete all the CANS questions.
  9. Select Calculate LOC-R. Deviation to LOC YES is not required on this document. (NOTE: Although the YES Assessment (CANS) will show LOC-R, this will not affect authorization. The LOC-R is displayed for informational purposes only.)
  10. If there is a previous YES Assessment (CANS), the Community Data information will automatically populate by selecting Populate Community Data.
  11. Enter relevant Notes.
  12. Select Performed By from the options provided in the dropdown list. (NOTE: It is the responsibility of the LPHA to ensure information submitted on the YES Assessment (CANS) is accurate and reflects the needs of the individual.)
  13. Select Next or Save and Continue to continue with the assessment.
  14. Complete the Community Data section.
  15. Select Closed Complete from the options provided in the dropdown menu.
  16. Select Save.

NOTE: If there is a recent Uniform Assessment, the CANS information will automatically populate by selecting Populate CANS Scores. Review the CANS scores and the CANS Assessment Date to verify that the most recent one has popped up.

 

 

Additional YES Assessment (CANS) Considerations

To be eligible for YES Waiver, a primary mental health (MH) diagnosis is required. However, even when there is no MH diagnosis or when the MH diagnosis is not considered primary, a Clinical Eligibility (CE) is still required to be submitted to HHSC.

The MH Uniform Assessment (MH UA) will accept any diagnosis. If there is no MH diagnosis, the MH Uniform Assessment will calculate LOC-9 Ineligible. At this point, MH services are typically denied. However, a CE should still be submitted because only HHSC can deny enrollment.

To submit a CE, deviate the MH UA to LOC-YES. Comments in the MH UA can indicate the reason for deviation is to assess for mental health medical necessity and eligibility for YES Waiver. Move forward with completing the Clinical Eligibility in CMBHS. Upon notification of denial, deviate the MH UA back to LOC-R.

 

For Young Children (3-5)

The Young Child CANS (3-5) cannot be used to determine clinical eligibility for the YES Waiver. For children younger than 5, a CANS (6-17) must be manually entered at the YES Waiver LMHA location.

Information from the Young Child CANS (3-5) cannot be auto-populated into the YES Assessment (CANS). The LMHA/LBHA must manually enter information into the YES Assessment (CANS). Later, the YES Assessment (CANS) should automatically populate from the previous YES Assessment (CANS).

 

For Young Adults (18+)

The Adult Needs and Strengths Assessment (ANSA) cannot be used to determine clinical eligibility for the YES Waiver. For a young adult who is 18, a CANS (6-17) must be manually entered at the YES Waiver LMHA location. Information from the ANSA cannot be auto-populated into the YES Assessment (CANS). The LMHA/LBHA must manually enter information into the YES Assessment (CANS). Later, the YES Assessment (CANS) should automatically populate from the previous YES Assessment (CANS).