FREQUENTLY ASKED QUESTIONS
Youth Empowerment Services (YES)
The Youth Empowerment Services Project (YES) has been authorized by the Department of Health & Welfare (DHW) as part of the Jeff D. Settlement Agreement resulting from the Jeff D. Class Action lawsuit.
The State of Idaho is in the process of developing a new children’s mental health system of care called YES – Youth Empowerment Services. It will provide a new way for families to find the mental health help they need for their children and youth. It will be strengths-based and family-centered, and it will incorporate a team approach that focuses on providing individualized care for children.
The section below is designed to help answer frequently asked questions. Should you need additional information, please email us at email@example.com
General Youth Empowerment Services (YES) Questions
The Medicaid SED Program refers to services available under or accessed via the 1915(i) State Plan option. Currently, the available services include all behavioral health services in the Idaho Behavioral Health Plan (IBHP) and non-crisis respite. Medicaid SED Program Members are Medicaid Members who have gone through the Independent Assessment process, have a qualifying DSM-V Mental Health Diagnosis and substantial functional impairment, and have or are in the process of developing a Person Centered Plan. The Medicaid SED Program is part of the YES System of Care.
A Person Centered Service Plan, frequently referred to as simply a “Person Centered Plan,” is required for participants to access Medicaid home and community-based services (HCBS). The Person Centered Plan includes information about the child, including preferences, strengths and needs as identified in the Child and Adolescent Needs and Strength (CANS) assessment, and goals. It also includes a list of all of the formal and informal services and supports needed to achieve the identified goals, whether or not they are reimbursable by Medicaid. Care is taken to make sure there is no duplication of services delivered through other agencies or programs. Person Centered Planning is consistent with YES Principles of Care and engages the youth and family in all aspects. A Person Centered Plan is different from an individualized treatment plan and providers should coordinate and inform through the Child and Family Team process.
Beginning January 1, 2018 - Members and families seeking the services under the 1915(i) State Plan option (only non-crisis Respite care at this time) or Medicaid eligibility up to 300% of the Federal Poverty Level must go through the Person Centered Planning process.
The Person Centered Plan is a collaborative effort by all Members of the Child and Family Team (CFT). The Division of Behavioral Health (DBH) Care Plan Coordinator who facilitates the formal CFT Meetings creates and finalizes the document with the input of the team. FACS-DD will facilitate the creation of the plans for children and youth who meet dual (behavioral and developmental) eligibility. Optum reviews the finalized Person Centered Plan to ensure adherence to the Code of Federal Regulations.
One of the key criteria for the Person Centered Plan is that a formalized and agreed upon negotiation process is in place for the CFT to determine appropriate services. The CFT must take into account the results of the Comprehensive Diagnostic Assessment (CDA) and CANS and must identify goals and select services and supports based on the youth/family’s needs and strengths. As the lead for the development of the Person Centered Plan, the DBH Clinician or FACS-DD facilitator will have the responsibility to ensure that there is collaboration and agreement for the services that will be documented on the Person Centered Plan. The CFT will also develop conflict resolution guidelines to help the team work through disagreements
that may arise during the planning process.
Rules have been published. See IDAPA 16.03.10 and 635 and 636.
No specific registration is required. All YES services will be added to the regular fee
schedule and be billable by qualified Providers in Optum’s Network, assuming they
have met all requirements by the respective services as described in the Level of
Care Guidelines and Provider Manual. Please also see Provider Alerts for
announcements regarding specific services at, optumidaho.com>For Network
Providers>Alerts & Announcements. If you have further questions about your ability
to provide specific services, please contact your Regional Network Manager at
optumidaho.com>contact us>regional representation flyer.
YES Service Accessibility
The Department of Health & Welfare will ensure that services and supports are made
available to all children who are determined to have serious emotional disturbance
(SED) and substantial functional impairment, with the goal to utilize Medicaid
reimbursement when the child is a Medicaid participant. Children and youth who
qualify for Medicaid, and have access to the Idaho Behavioral Health Plan (IBHP),
operated by Optum Idaho, can receive YES services based on their eligibility and
benefit plan. Children and youth who are not Medicaid participants can access
resources available through the local Children’s Mental Health (CMH) office. These
resources may be available to the child or youth even if they have private insurance.
Beginning January 1, 2018 youth/families seeking access to non-crisis Respite care
or are seeking Medicaid coverage with a household income up to 300% Federal
Poverty Level may be referred to Liberty Healthcare, the contracted Independent
Assessor. Referrals may be made by a Provider, family Member, probation officer,
attorney, another involved party, or self-referral by the youth and/or family. All
requests for assessments will be honored. Once a referral has been received, the
Independent Assessor will conduct a Comprehensive Diagnostic Assessment (CDA)
to assess whether the child or youth has a serious emotional disturbance (SED) and
will conduct a Child and Adolescent Needs and Strengths (CANS) assessment to
identify the functional impairments, strengths, and needs of the youth and family.
Once SED and substantial functional impairment(s) have been established,
individuals that do not have Medicaid eligibility will be referred to Medicaid’s Self
Reliance unit to complete the eligibility process. Children and youth who do not
qualify, or those who choose to not accept YES services may be referred and
connected to other community services.
Liberty Healthcare: 1-877-305-3426
Self Reliance: 1-877-456-1233
Once a child or youth has been determined to meet diagnostic and substantial functional impairment criteria and has become Medicaid eligible, the Independent Assessor, Liberty Healthcare, will provide the Member with a letter confirming their eligibility. Members can call the Optum Member line at 855-202-0973 for referrals. This number is included in the Member Handbook. If a child or youth is determined to not meet diagnostic and functional impairment criteria, the Independent Assessor will identify community referrals. The child or youth and their family always retain the right to choose their service Provider.
The 1915(i) State Plan option allows individuals to seek Medicaid eligibility up to 300% Federal Poverty Level (FPL). It also allows Medicaid the ability to reimburse Providers for services that are not included in the state plan, such as non-crisis Respite. The 1915(i) state plan amendment went into effect on January 1, 2018.
The Division of Behavioral Health has contracted with Boise State University (BSU) to conduct a workforce capacity analysis as part of the Jeff D. Settlement Agreement. The data from this comprehensive survey will provide information to help the Idaho Department of Health and Welfare to work collaboratively to develop a workforce development strategy to support the YES implementation. Medicaid continues to work with Optum regarding their role in assisting with workforce development and will monitor Optum’s work with the Provider Advisory Committee (PAC) to create a workforce development strategy. Optum Idaho also has a Children’s Advisory Subcommittee in place to work specifically on the care approach for our child and adolescent Members.
The YES continuum of care was defined in the Appendix C, as part of the Jeff D. Settlement Agreement. Appendix C outlines existing services, as well as new services to be implemented, and additional services will not be implemented at this time. The Department of Health and Welfare is working diligently to develop the services to be rolled out over the next few years. This is a huge undertaking for the system of care and will have a significant impact on the Provider network.
Starting January 1, 2018, non-crisis Respite was the first service available to individuals who qualified under the 1915(i) process.
Liberty HealthCare Corporation is the contracted Independent Assessor.
Yes. The Liberty Healthcare and Optum contracts are two separate contracts.
Liberty Healthcare began rendering the CANS and CDA on January 2, 2018.
You may refer Members to call 877-305-3469 to schedule an Independent Assessment.
The Independent Assessment process has some similarities to the DD Independent Assessment process. However, they are two different populations and contracts, and have separate requirements.
The Independent Assessor through Liberty Healthcare and staff at the Division of Behavioral Health (DBH) currently conduct the CANS. Network Providers who are CANS certified through the Praed Foundation can begin conducting CANS assessments July 1, 2018. The CANS assessment will be conducted by a Master’s level clinician (LCPC, LPC, LCSW or LMFT) or individuals with a Master’s degree who are able to provide therapy in their group agency under Optum’s supervisory protocol. It must be completed through the ICANS platform managed by DBH.
The CANS was identified in the Jeff D. Settlement Agreement as the functional assessment tool to be used in the State of Idaho. The CANS is currently used in all 50 states and helps ensure a solid foundation for treatment planning as well as measuring outcomes.
The time to complete a CANS assessment will vary depending on multiple factors such as the complexity of the needs of the child or youth and family, Provider training, and other variables.
The CANS-50 is a sub-set of the full CANS assessment tool that determines functional impairment. The Independent Assessor may complete the CANS-50 to determine YES Class Membership if requested, but will otherwise complete the full CANS. The full CANS contain additional questions that are critical to assist the Provider and family in developing a comprehensive treatment plan and goals.
The cost for a provider to complete the CANS certification online is $12.00. Additional information on the CANS can be found on the Praed Foundation website at www.Praedfoundation.org. Individuals should allow approximately 8 hours to complete the certification.
Beginning July 1, 2019, the CANS will be the state-required functional assessment tool for all child and adolescent Members, regardless of SED diagnosis or functional impairment.
No, both the CDA and CANS are required. The CDA determines the diagnosis of a potential Medicaid SED Program Member and the CANS determines the functional impairment which, in turn, will inform treatment planning. The CANS will replace the current assessment tools used in the State of Idaho, including the CAFAS, PECFAS, and CALOUCUS. The reimbursement structure includes methodology to reimburse for both a CDA and a CANS.
The CANS will need to be updated at a minimum of every 90 days, or when it’s requested by the individual or when there is a substantial change to the child or youth that would indicate the need for re-assessment.
The CANS will inform Providers and families of functional needs and strengths that can be incorporated into a robust treatment planning process. The CANS is a reliable tool that provides baseline information, progress (or lack thereof), and will be updated as needed throughout the care of the Member. The information provided in the CANS will allow the Child and Family Team to work together in a transparent manner specific to both the strengths and needs for the Member and family. Beginning at the Member level up to the Provider level, the data and outcomes from the CANS will be utilized to continuously improve Idaho’s system of care. Certification through the Praed Foundation is required for Providers to utilize the CANS in the new system of care.
We encourage all network Providers to become CANS certified. Beginning July 1, 2019, the CANS will be the state-required functional assessment tool for all child and adolescent Members.
Yes, if the Member is not going through the Independent Assessor (Liberty Healthcare), the network Provider will administer the initial CANS and the subsequent (90 day) updates.
The CANS tool will provide continuous data that will be available to network Providers to assess the well-being of Members throughout the State of Idaho as well as provide comparative data for individual Members in their care. Additional information will be provided to the network as outcomes and reports are developed and how to access them.
Skills Building/ CBRS
In compliance with the Yes Principles of Care as a result of the Jeff D. Settlement agreement, CBRS has been renamed Skills Building/CBRS. The service now requires a teaming approach between the Licensed Clinician and the Skills Building/CBRS worker. Please consult the Level of Care Guidelines and Provider Manual at www.optumidaho.com for more information.
The current CBRS benefit is being enhanced to become Skills Building/CBRS, and is for all Members, adults and youth, regardless of their YES eligibility.
Yes, providers should be applying this approach effective July 1 , 2018 and updating existing treatment plans accordingly. In addition, new service request forms submitted to Optum should reflect this approach as well. This applies to all Members. Additional information about the teaming approach can be found in the Skills Building/CBRS Level of Care Guidelines and the Provider Manual, in the Individualized BH Treatment Plan – Teaming Approach section.
Treatment planning for the provision of Skills Building should be completed with the Member’s Clinician, the Skills Building Paraprofessional, with the Member & their family or other natural support present. Prior to the Skills Building treatment planning, the Member’s Clinician will have completed their clinical assessment of the Member to assist in developing the treatment plan. In addition, in order to bill for Skills Building/CBRS, the teaming approach is required, and should represent the interaction between both providers and the Member as they address the goals and methods for the support.
When Skills Building services are being requested for a Member discharging directly from inpatient care or incarceration to the service, Optum will work with providers to assure that such Members are able to receive medically necessary services in a timely way. Optum will allow the following related to submission of Service Request Forms (SRFs): Members accessing services directly from a facility discharge. We understand that you will not be able to “Team” on these Members until you are able to schedule a treatment planning meeting and that you need to begin to work with them regardless. We will allow one transitional SRF covering 90 days, to allow you time to complete a CDA and Teaming Treatment Plan when a Member discharges to your care. Please use the following instructions to obtain this authorization:
1. Identify on the SRF in Section 6 Treatment History, # 2 Psychiatric Hospitalization History that, “This is a Transitional Request given this Member is discharging from a facility. We are in the process of scheduling a CDA/CDA Addendum, and treatment planning meeting. ” We would be interested in your listing when the Member’s impending treatment planning appointment date is on the form.
2. Complete Section 6 with the pertinent information from the discharging facility as you normally would.
3. You may use the discharge information from the facility to gather the Member’s “functional needs” and identify these functional needs in Section 8. You can by-pass the requirement to “Team” initially, and work to team going forward so that this has been completed for any subsequent requests.
4. Also in Section 8 of the SRF under “Goals” please state the goals developed that will address the listed functional needs. If you can, please identify the modality or intervention to be used. If you cannot, please include “Working with Member in Transition to the Community”.
5. A 90 day 154 unit authorization will be issued as a transitional authorization beginning with the date of submission of the SRF. (For any services provided prior to the date of the SRF submission date, you will need to submit the request for these dates using the retrospective review process described in the Optum Provider Manual.)
6. A transitional authorization will only be considered for cases in which the Member receives treatment directly from a hospital/facility discharge.
7. If more than 154 units is requested, the provider will need to provide sufficient clinical detail to demonstrate medical necessity for the additional requested units.
8. If a SRF for continued care is subsequently submitted, all of the requirements in the Level of Care Guideline will need to be followed. This includes teaming, listing assessed functional needs that are measurable, and identification of the modality and intervention that will be used to work on the functional need(s) identified.
The Development of the Clinician’s Treatment plan is separate from the Skills Building treatment plan. For Adult Members, skills building treatment planning should include the Member and their selected natural support, and also occur after the Clinician’s assessment and therapeutic treatment plan has been completed. (The Clinicians’ assessment and treatment plan will include the identified functional needs which will be the focus of any skills building treatment planning.) For providers not yet using the CANS with children, another functional assessment tool should still be used.
Optum is not mandating a specific functional assessment tool for adults at this time. However, some examples include the Adult Needs and Strengths Assessment (ANSA), Scales of Independent Behavior-Revised (SIB-R), ABAS-III, Adaptive Behavioral Scale-Residential & Community, WHODAS 2.0 or other assessments that would be appropriate for the Member’s specific case which identify functional deficit areas.
No; effective 7/1/19, the CANS will be the state-required functional assessment for all Medicaid Members under age 19, regardless of YES class membership. At that time, all Medicaid Members will need to have a current, updated CANS on file.
On the Service Request Form, all medical issues are now pulled together; the goals and objectives are now pulled together into one vs. two sections.
The same Supervisory Protocol applies and is not changing for Skills Building. Rostered clinicians and master's level clinicians operating under Supervisory Protocol can perform the CDA.
While Optum has adopted a new title for the service of CBRS to better reflect the intent of the service, CBRS as Skills Building continues to be is a service focused on Member’s functional deficits resulting from a behavioral health condition. No changes to provider qualifications have been made. Provider qualifications are defined in the Optum Supervisory Protocol: the CPRP and/or CFRP are required. Although Psychiatric Rehabilitation Association (PRA) may not require a bachelor’s degree, Optum does require it. Licensed staff (including LSW) do not need to obtain the CFRP per the Supervisory Protocol as always. In addition, more information will be coming soon from Optum regarding a paraprofessional roster.
The PRA credential has been required by Optum all along for providers doing CBRS. However, Optum and the PRA are exploring additional partnership and certification opportunities. In the meantime, please refer to the PRA website for additional information on costs and on obtaining the CPRP and/or CFRP credentials: https://www.psychrehabassociation.org/certification/why-get-certified
Yes, just like most other credentials in the field, recertification is required every 3 years.
The CPRC certificate is being retired by PRA, so all providers should begin transitioning to the CFRP credential. This is true for all providers in the PRA and is not unique to Idaho. We are still honoring the certificate, and are allowing individuals 30 months to transition to the CFRP.
All providers of Skills Building/CBRS must have certification, or be working toward certification within the 30 month allowance. The certification does require continuing education, and development of a practitioner knowledge base to apply Evidence Based Practice. The CEUs discussed are optional for you as one way you can meet the credentialing requirements. Optum is sponsoring some of these opportunities to support providers in meeting their certification requirements. In addition, in order to bill for Skills Building/CBRS, the teaming approach is required.
Yes, both providers may bill for Skills Building/CBRS service-specific treatment planning (H0032) on the same day working with the Member present. Similarly, Case Consultation (90882) is allowed for collateral contact between providers in different agencies. In order to bill for Skills Building/CBRS, the clinician and paraprofessional must develop the treatment plan together and both can bill for their time. Please refer to Optum’s YES Navigations Training for more information.
The CANS yields scores that reflect a child’s functional needs in specific domains. The provision of skills building (or behavioral health treatment of any kind) should directly address the functional needs identified from the CANS. (For children who do not have CANS score, or for adults: providers should always build treatment plans around the assessed functional needs of the Member.) The requirement to specifically use CANS is one of the outcomes of the settlement agreement. However, the CANS results are used in conjunction with family participation to address needs and requests for skills building and supports the treatment planning and goals processes. For more information on CANS administration, please refer to the Praed Foundation’s website (praedfoundation.org) as well as Optum’s YES Navigation Series training (optumidaho.com > For Network Providers > Provider Trainings).
The H0031 code expanded on the fee schedule effective July 1 for CANS and is available to be billed for all children receiving a CANS assessment from a CANS certified professional completed on the iCANS platform. Time spent on the CANS can be billed with the H0031 with a modifier HO (for master’s level) or U1 (for prescribers) in group agencies billing under Supervisory Protocol. The HN modifier will be used for paraprofessionals billing for functional assessments (not CANS) used for case management, peer support and family support.
That code is managed via review of outliers, which are statistical observations that are markedly different in value from the others of the sample. Optum manages outliers though the identification of practice patterns that fall outside typical patterns, including the measurement of improvement over time. Additional information about outlier management can be found in the Provider Manual, in the Clinical Outcomes Model: ALERT section.
There are no changes to this code other than increased rate. Prior authorization and medical necessity continues to be required.
For children accessing services via the Medicaid SED Program (via the 1915i waiver), the CDA will be completed or updated by the Independent Assessor- it’s used in the Person Centered Planning process. Just as is currently required, prior to the provision of therapeutic services, the clinician will need to meet the Member to establish services and develop a specific treatment plan for the therapeutic services they will provide. After this occurs, the clinician, and the paraprofessional practitioner providing Skills Building service will meet with the Member/family then “team” to complete the Skills Building Treatment Plan.
There are no changes to the auditing process at this time; however, outlier reports will be utilized to inform Optum of the need for outreach, assistance, and management of fraud, waste, and abuse. Any changes will have a 30 day notice.
Yes, Skills Building/Community Based Rehabilitation Services can continue to be requested through our current prior authorization process. If the Member is accessing services through the Independent Assessor, the service should be indicated on the Person Centered Plan.
No, the same system will be in place, which was introduced as a form submission tool vs a storage site. For technical and HIPAA reasons, forms cannot be stored longer than 30 days. However, if you make a change to a form, it will remain in the system for another 30 days.
Yes, the intent is to review current deficits vs all historical deficits. We review previous service requests so we don’t need that information provided again. The goal is to be clinically succinct. In addition, this information is summarized for you in the CANS results.
The Jeff D. settlement agreement has Skills Building throughout the document as a foundation. One reason we partnered with Psychiatric Rehabilitation Association (PRA) is to get back to the basics of this service. A Member’s need for Skills Building interventions are determined by assessed functional deficits being targeted. Functional needs that are addressed through skills building stem from the Member’s primary condition. The Member’s primary condition should be addressed using evidence-based clinical practices because Evidence Based Practices (or promising practices) are scientifically demonstrated to be most effective for the Member’s condition. Teaming together, the Member’s Clinician and Skills Building practitioner collaborate to achieve the best outcomes for the Member. Effective 7/1/18 we will have an Evidenced Based Practice library on the Optum Idaho website, and there will be some information on Attention Deficit Hyperactivity Disorder (ADHD).
Specific Service Questions
Starting January 2, 2018, Non-crisis Respite became available as a new service.
Current requirements for a non-crisis Respite Provider include an age minimum of 21 or older and a high school diploma or GED. Starting July 1, 2018, all Providers who
wish to provide non-crisis Respite services will need to complete an online certification course that will be offered free of charge by Optum to network Providers.
Yes. There is a training module on Relias designed specifically for supervisors of non-crisis Respite workers.
No. Non-crisis Respite does not require pre-authorization but must be included on the Person Centered Plan.
The Medicaid benefit limit for non-crisis Respite is a hard cap of 300 hours (group and individual combined) per calendar year for eligible Members.
The minimum CFT includes the therapist, the parent, and the child or youth. The CFT may include additional Providers, family Members and community supports or others, as determined by the youth/family.
No, the clinician and/or paraprofessional who provide services to the Member and have a relationship with the youth/family should be the one(s) to attend the meeting.
Yes, the DBH Care Plan Coordinator must attend the CFT meeting in order for it to be considered a formal, billable CFT Interdisciplinary Team Meeting.
Optum and Medicaid will be providing additional information on Wraparound to network Providers as it is developed.
Yes. Starting January 2, 2018, non-crisis Respite became available as a new service. Beginning July 1, 2018, the CANS, Child and Family Team (CFT) Interdisciplinary Team Meeting, and Case Consultation are available as new services. Additional services outlined in Appendix C of the Jeff D. Settlement Agreement will be announced by Optum to our network Providers as they are implemented.
Yes, clinicians and bachelor’s level paraprofessionals may bill for their time spent in formal CFT meetings.
No. Katie Beckett eligibility is a separate determination. A child or youth and their family will go through the YES Independent Assessment process using the CDA and CANS to determine Medicaid SED Program eligibility.
How to Find Information/ Next Steps
Additional information on the YES System of Care and the Jeff D. Settlement Agreement can be found online at www.yes.idaho.gov. Medicaid, DBH, and Optum are committed to timely communication and training for our Providers on the YES System of Care implementation to ensure you have what you need to be successful during this transformation of the system of care for children and youths and their families in the State of Idaho. Provider trainings will be communicated through our quarterly Provider Press newsletter as well as ongoing Provider Alerts. Questions on the YES System of Care implementation can be submitted at firstname.lastname@example.org.
Required services are listed in Appendix C of the settlement agreement and can be found online here. Optum Idaho will provide detailed service information to the Provider network throughout the implementation process and as required by Medicaid and the Agreement.