YOUTH EMPOWERMENT SERVICES (YES)

FREQUENTLY ASKED QUESTIONS

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 optum.idaho.yes@optum.com

General YES Questions  

Who is considered a Class Member?

·         Idaho Resident

·         Under 18 years of age

·         A qualifying DSM V Mental Health Diagnosis  

·         Has substantial functional impairment as determined by the Child and Adolescent Needs and Strengths (CANS)

What is a Person-Centered Plan?

A Person-Centered Plan is a single consolidated plan that represents all aspects of planning and care that will be provided to the youth and their family. Person-Centered Planning is consistent with YES Principles of Care and engages the youth and family in all aspects. Each provider will still do an individualized treatment plan, but the individualized treatment plans are NOT the Person-Centered Plan.

These plans are a requirement for all Medicaid eligible participants who seek services through the Independent Assessor which is explained in this document.

Who needs to go through the Person-Centered Planning process?

Beginning January 1, 2018 - Members and families that seek and obtain Medicaid eligibility through the Independent Assessor are required to have a Person-centered Plan.  These will include members/families that are seeking Medicaid reimbursed Respite care or Medicaid eligibility up to the 300% Federal Poverty Level.

How do we ensure collaboration on treatment goals and services within the Child and Family Team?

Beginning January 2, 2018, youth who are determined by the Independent Assessor to be Class Members and are Medicaid eligible will have a Person-Centered Plan. One of the key criteria for the Person-Centered Plan is that there is a formalized and agreed upon negotiation process for the team to determine appropriate services.  As the lead for the development of the Person-Centered Plan, the DBH Clinician will have a key responsibility to ensure that there is collaboration and agreement for the services that will be documented on the Person-Centered Plan. The team will also help develop conflict resolution guidelines to help the team work through disagreements that may arise during the treatment plan process.

Implementation of the Child and Family Team model for members outside of the Independent Assessment process is scheduled for July 1, 2018 and Optum will be providing more information to the provider network in the spring of 2018.

Is there going to be specific IDAPA related to YES services?

Medicaid has published proposed rules for the YES program that, when approved by the legislature, will become effective in 2018. Medicaid is constantly evaluating the need to make any other additional changes to IDAPA throughout the duration of the YES project implementation.

YES Service Accessibility

Will YES Services be available to Medicaid clients only?

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 and functional impairment, with the goal to utilize Medicaid reimbursement when the child is a Medicaid participant.   A child does not have to be a Medicaid participant to access the services and supports.  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. 

How can families seek services?

Beginning January 1, 2018 families that are seeking Class Membership or Respite care may be referred to the Independent Assessment provider.  Referrals may be made by a provider, family member, probation officer, attorney, or other 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 Assessment provider will conduct a Comprehensive Diagnostic Assessment (CDA) to assess whether the child or youth has a serious emotional disturbance and will also conduct a mental health functional assessment using the Child and Adolescent Needs and Strengths (CANS) to identify the functional impairments, strengths, and needs of the child or youth and family.

Once Class Membership has been established, individuals that do not have Medicaid eligibility will be referred to the Division of Welfare’s Self Reliance unit to complete the eligibility process. Children and youths who are determined to be non-Class Members, or those who choose to not accept YES services may be referred and connected to other community services.

How would these individuals be connected to an Idaho Behavioral Health Plan provider?

Once a child or youth has been determined to meet Class Membership criteria, is Medicaid eligible, and needs a referral to a provider, the Independent Assessor will give contact information to service providers in the Idaho Behavioral Health Plan network who reside within the child or youth’s community. If a child or youth is determined to be a non-Class Member, the Independent Assessment provider will identify community referrals.  The child or youth and their family always retain the right to choose their service provider.

YES Implementation Rollout

What is the 1915i state plan amendment?

The 1915i state plan amendment allows members to seek eligibility up to 300% Federal Poverty Level (FPL).  It also allows Medicaid the ability to reimburse providers for services that are not eligible to be provided under the Idaho Behavioral Health Plan. The 1915i state plan amendment is slated to go into effect on January 1, 2018 which will offer Respite as a Medicaid reimbursed service. As the YES implementation continues to roll out, additional services not eligible to be reimbursed under the Idaho Behavioral Health Plan are likely to be included in 1915i state plan amendment. Optum will be providing more information on the availability of YES services to our network providers as we move forward with the YES implementation.

What is being done to address workforce issues at all levels to deliver these YES services?

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. All providers in the State of Idaho are encouraged to participate and submit information for this survey when they receive a request to participate.  At this time, the plan is to launch the survey in late January.

Medicaid will continue to work with Optum regarding their role in assisting with workforce development.  Optum Idaho continues to work with the Optum Provider Advisory Committee (PAC) to develop a workforce development strategy and have a Children’s Advisory Committee in place to work specifically on the care approach for our child and adolescent Members.  

How were the programs and services for YES determined, and can additional ones be added?

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. 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.  The services are set forth in the Settlement Agreement and at this time the focus is to meet those requirements.  

What are the services included in the 1915i state plan amendment?

Starting January 1st, 2018, Respite will be the first new service available to Class Members.  Optum will provide information to our network providers on any additional services that may be funded through the 1915(i).

Independent Assessor

Who has been identified as the Independent Assessor?

Liberty HealthCare Corporation is the contracted Independent Assessor.

Is the Liberty Healthcare contract separate from the Optum contract?

Yes. The Liberty Healthcare and Optum contracts are two separate contracts. A provider who becomes an employee or a contractor with Liberty to administer Independent Assessments to determine YES Class Membership using the CANS cannot also provide Medicaid services in the community.

What date will the Independent Assessment process begin?

Liberty Healthcare will begin operations on January 2, 2018.

How would I refer a Member to the Independent Assessor?

 Beginning January 2, 2018, you may refer members to call 877-305-3469 to schedule an Independent Assessment.

Will the Independent Assessor process be similar to the DD program assessment process?

The Independent Assessment process for YES Class Membership has some similarities to the DD Independent Assessment process.  However, they are two different populations, contracts, and contract requirements. 

The CANS

Who will be conducting the CANS assessments?

Starting January 2, 2018, there will be two entities performing the CANS: the Independent Assessment provider through Liberty Healthcare and staff at the Division of Behavioral Health (DBH).

Implementation plans and training for the CANS assessment will be rolled out to the provider network in the spring of 2018.  Optum will be providing some in-person CANS training throughout the State of Idaho as well as on demand training to ready the network to begin conducting CANS assessments July 1, 2018.  The CANS assessment will be conducted by a Master’s level clinician or allowable individuals under Optum’s supervisory protocol.

Why was the CANS chosen over other assessment tools?

The CANS was identified in the Jeff D. Settlement agreement as the 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 measure outcomes.

Where can I find more information on the CANS?

Additional information on the CANS can be found on the Praed Foundation website at www.Praedfoundation.org

Will completing the CANS Assessment take a similar amount of time as current assessment tools?

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. Optum will provide more information on the CANS assessment process and the CANS training schedule for our network providers in early 2018.

What is the difference between the CANS and the CANS-50?

The CANS-50 is a sub-set of the full CANS assessment tool that determines functional impairment. The Independent Assessor will complete the CANS-50 to determine YES Class Membership. The full CANS contains additional questions that are critical to assist the provider and family in developing a comprehensive treatment plan and goals.

What is the cost to become CANS certified?

The cost for a provider to complete the CANS certification online is $12. 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. 

Is the CANS paper and pencil or is it online?

Online. The CANS assessment will be administered through an online platform that will be hosted by the Idaho Division of Behavioral Health (DBH).

Is CANS going to replace the CDA? Are both services reimbursable?

No, both the CDA and CANS are required. The CDA determines the diagnosis of a potential YES Class 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 will include methodology to reimburse for both a CDA and a CANS which will be communicated to the network prior to rollout of the service.

How often will it be necessary to update the 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.

What benefits will providers experience by becoming CANS certified?

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, lack of progress and will be updated as needed throughout the care of the Member.  The information provided in the CANS will allow the 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 is required for providers to utilize the CANS in the new system of care.  Providers will receive more information in the spring of 2018 about the CANS and the goals of the YES transformative project.

How do we access the CANS to use it with a Member?

Implementation, certification, and access to the iCANS online platform will be communicated in the near future.

What are the outcomes that will be measured, and will we have access to statewide data as well as our own outcomes?

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.

Specific Service Questions

When will Respite be available?

Starting January 2, 2018, Respite will be available as a new service.  At this time, Respite is the only service that will require an Independent Assessment.  

What are the credentials and qualifications for those providing Respite care?

Current requirements for a Respite provider include an age minimum of 21 or older, a high school diploma or GED, or a degree in a human services-related field. The reimbursement rate for Respite through June 30, 2018 will be the same for all levels of workforce providers. Starting July 1, 2018, all providers who wish to provide Respite services will need to complete an online certification course that will be offered free of charge by Optum to network providers and meet credentialing requirements.

Will Respite need to be pre-authorized?

No. Respite does not require pre-authorization but must be included on the Person-Centered Plan.

What is the benefit limit for Respite, and is there the possibility to request more?

The Medicaid benefit limit for Respite is a hard cap of 300 hours per calendar year for eligible Members.

Will CBRS still be available to Members who are Class Members?

Yes, CBRS services can continue to be requested through our current prior authorization process and must be indicated on a Person-Centered Plan for members accessing services through the Independent Assessor.

Who is on the Child and Family Team (CFT)?

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 CFT team as appropriate. A Master’s level clinician is a key member of the CFT and provides facilitation and direction throughout the treatment planning process.  More information about the CFT will be communicated in the spring of 2018 for implementation beginning in July 2018.

When will we learn more about Wraparound?

Optum will be providing additional information on Wraparound to our network providers as it is developed.  

Billing

Will there be any new YES services available next year to bill under Medicaid?

Yes. Starting January 2, 2018, Respite will be available as a new service. 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.

Will providers be reimbursed for participating on the Child and Family Team?

Optum will provide additional information on reimbursement methodology and requirements as they are developed.

Will the YES service program impact Katie Beckett eligibility?

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 YES Class Membership.

How to Find Information/ Next Steps

Where can we go for additional information on YES?

Additional information on the YES project 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 project 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 implementation can be submitted at optum.idaho.yes@optum.com.

 

 

 

 

 

 

 

 

Is there someplace that families or providers can see the list of services that will be rolled out?

YES 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.