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 developed a new children’s mental health system of care called YES – Youth Empowerment Services. YES provides a new way for families to find the mental health help they need for their children and youth. It is strengths-based and family-centered, and it incorporates a team approach that focuses on providing individualized care for children.
The video here presents the family’s perspective about the YES System of Care, experiences they have had and the impact YES Services have made on their family.
The section below is designed to help answer frequently asked questions about YES. Should you need additional information, please email us at firstname.lastname@example.org.
*Please see COVID-19 FAQs on this same webpage which, when applicable, supersede the YES FAQs until COVID-19 exceptions are lifted.
The Youth Empowerment Services Program refers to services and supports available under the Idaho Behavioral Health Plan, and/or accessed via the 1915(i) State Plan option. The Youth Empowerment Services Program provides children with serious emotional disturbance (SED) access to Medicaid services and supports.
Youth Empowerment Services 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. The Youth Empowerment Services Program is part of the YES System of Care.
The 1915(i) State Plan option is an amendment to the Medicaid State Plan used to set specific eligibility standards and services for a select population. It allows Medicaid to extend eligibility income levels and to reimburse providers for services that are not included in the state plan, such as Respite. The 1915(i) state plan amendment went into effect on January 1, 2018.
The YES System of Care refers to the entirety of the mental health supports and resources for children and adolescents in Idaho. The YES System of Care requires provider adherence to the YES Practice Model and the YES Principles of Care for all child and adolescent members they serve. All children and adolescent mental health services are part of the YES System of Care. The Youth Empowerment Services Program refers to a specific population within the YES System of Care. These are individuals who are eligible for Medicaid under the 1915(i) State Plan Option. In order to be eligible for Medicaid under the 1915(i) State Plan Option, individuals must undergo an independent assessment with Liberty Healthcare. Liberty Healthcare will determine if the child or adolescent has a serious emotional disturbance (SED). When Liberty Healthcare determines that the individual has an SED, those who did not previously qualify for Medicaid will then apply for Medicaid with higher income limits. If Medicaid eligibility is approved, these now members may receive Medicaid-funded services. A member who was already Medicaid eligible before the independent assessment are also considered to a part of the Youth Empowerment Services Program, can access services that are available only in the 1915(i) state plan option, which is currently respite.
Idaho residents under the age of 18 who meet the financial eligibility requirements and are determined to have an SED via an independent assessment from Liberty Healthcare are eligible for the Youth Empowerment Services Program.
A member who is part of the Youth Empowerment Services Program will have a rate code 44 or a YES condition code to indicate their participation in the YES Program. For more information, please refer to the Identifying Member YES Eligibility section in the TCC Toolkit, which is located at: optumidaho.com > For Network Providers > Targeted Care Coordination > Targeted Care Coordination Toolkit.
Rules for the YES Program can be found in IDAPA 16.03.10.635-638.
No specific registration is required. All YES services are billable by qualified providers in Optum’s Network, assuming they have met all requirements for the respective services as described in the Level of Care Guidelines and Optum Idaho Provider Manual. If you have further questions about your ability to provide specific services, please contact your Provider Relations Advocate at optumidaho.com > Contact Us > Regional Representation Flyer. For more information regarding training opportunities, please see OptumIdaho.com > For Network Providers > Provider Meetings and Trainings. Please also see Provider Alerts for announcements regarding specific services at optumidaho.com > For Network Providers > Alerts & Announcements.
The Department of Health and Welfare will ensure that services and supports are made available to all children who are determined to have serious emotional disturbance (SED), with the goal to utilize Medicaid reimbursement when the child is a Medicaid member. Children and youth who qualify for Medicaid can receive YES services based on their eligibility and benefit plan. Children and youth who are not Medicaid members, and are over 300% federal poverty guideline, can access resources available through their local Children’s Mental Health (CMH) offices. These resources may be available to the child or youth even if they have private insurance. Please Click Here for additional contact information.
To receive services in the YES Program, a person must complete the following steps:
1) Schedule an assessment with Liberty Healthcare Corporation at 1-877-305-3469.
2) Complete the assessment. The assessment can determine that a child has a serious emotional disturbance (SED). After the assessment, Liberty Healthcare Corporation will contact the family with the results. If the family disagrees with the decision they will need to contact Liberty Healthcare Corporation at 1-877-305-3469.
3) After the child is determined to have SED, the family will apply for Medicaid. If the family applies online, and they are over traditional income limits, they will receive a denial. However, the YES Program allows families to be approved for income up to 300% of the Federal Poverty Guidelines (FPG). Click Here for additional FPG information. Self Reliance will complete this manual process and send a formal notice to the family via mail.
4) Contact a Targeted Care Coordinator. Once the child has been approved for Medicaid coverage, the family will contact a Targeted Care Coordinator of their choice to create a person-centered service plan (PCSP). To find a Targeted Care Coordinator, the family can call the Optum Idaho member line, 1-855-202-0973, or refer to the list of TCCs on the website at optum.idaho.com > For Network Providers > Targeted Care Coordination. The youth/family have the right to choose their own TCC.
5) Find a provider. Contact the Optum Idaho Member Access & Crisis Line at 1-855-202-0973 TD/TTY: 711 or visit optumidaho.com to find a provider of behavioral health services in your area. Children and youth who do not qualify for Medicaid, or those who choose to not accept YES services, may be referred and connected to other community services like the following:
Liberty Healthcare: 1-877-305-3469
Self Reliance: 1-877-456-1233
CMH Office: Click Here
211 Idaho Care Line: 211
Optum continues to work with Medicaid regarding their role in assisting with workforce development, and Medicaid 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. This committee is now open to all providers to call and listen in and to provide feedback. If you have an interest in being on this committee, please contact your Provider Relations Advocate.
Beyond these efforts, Optum has worked to develop many free training events online and throughout all regions in the state, educating providers and other community stakeholders about the YES Principles of Care and Practice Model, YES services, Youth Support, Targeted Care Coordination, Skills Building, and Respite, for example. Optum has also partnered with nationally recognized institutions such as the REACH Institute, the Crisis Prevention Institute, and the Praed Foundation to offer free certification events and in-depth training to Optum providers. Please continue to check our website, as trainings are added on an ongoing basis.
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 Comprehensive Diagnostic Assessment (CDA) and CANS to determine Youth Empowerment Services Program eligibility.
Additional information on the YES System of Care and the Jeff D. Settlement Agreement can be found online at yes.idaho.gov. Medicaid, DBH, and Optum are committed to timely communication on any upcoming changes and/or training for our providers on the YES System of Care within 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 can be submitted at email@example.com.
Members who moved from traditional Medicaid to the YES Program for Respite services may move back to traditional Medicaid if Respite is no longer needed or wanted. In this situation, the member does not need to complete a reevaluation through an independent assessment, obtain a Targeted Care Coordinator, or complete a person-centered service plan (PCSP). These members will receive notification from the Idaho Department of Health and Welfare’s Self-Reliance Program when it’s time for Medicaid eligibility renewal. Please follow their instructions to complete renewal of eligibility.
Content in the above section was last updated on April 6, 2020.
Targeted Care Coordination (TCC) / Child and Family Teams (CFT) / Person-Centered Service Planning (PCSP)*
Providers wanting more information about being a TCC in the Optum Idaho Network may speak with their Provider Relations Advocate and/or review the TCC page of the website to determine if this service is of interest. Please refer to optumidaho.com > For Network Providers > Targeted Care Coordination. For additional information on requirements and/or to enroll as a TCC, please visit optumidaho.com > For Network Providers > Provider Meetings & Trainings > New Trainings > Targeted Care Coordination. The Optum Idaho Education Team will then assign the training plan to the provider in their Relias account. The assigned modules must be completed before starting TCC services or using Optum Supports and Services Manager (OSSM) to submit PCSPs to Optum. Once training is completed, Optum will add the TCC’s agency name to the approved list for member referrals. This list is updated on the Optum Idaho website on a regular basis and is also provided to members who contact Optum looking for a TCC. This process ensures that providers have completed the required training before they begin providing TCC to members and accessing their information in OSSM.
To find a TCC in their community, a family may either contact Optum's Member Line at 1-855-202-0983, option 1, or go to the website at optumidaho.com > For Members > Resources & Tools > Targeted Care Coordination Agencies. It is the member's and family's right and choice to select their own TCC, but Optum is here to assist them if necessary.
Children and adolescents that go through an independent assessment for income up to 300% Federal Poverty Guidelines (FPG), or members that qualify for Medicaid in traditional income limits that are seeking respite services, will need to have a person-centered service plan. A person-centered service plan, of which can be referred to as a coordinated care plan, is created in a Child and Family Team. Child and Family Teams are facilitated by Targeted Care Coordinators. Members that do not go through the independent assessment process do not need a Targeted Care Coordinator, though they are welcome to have one if they want Targeted Care Coordination.
All children members in the YES program are required to have a PCSP developed in a Child and Family Team, which is facilitated in the Idaho Behavioral Health Plan by a TCC. Per the Federal requirements for programs authorized under the 1915(i) State Plan Option, every child must have a PCSP that meets the requirements in 42 CFR 441.725. However, services may begin while the PCSP is being developed. If the child’s needs are being met through counseling or counseling and medication management, then those services would be included in the PCSP as identified through the Child and Family Team. Please also refer to the question below to see which members should continue to work with their IDHW Case Manager instead of an Optum TCC. However, please see the next Q&A below.
No. Families who are working with a case manager with the Children's Developmental Disabilities Program or Children’s Mental Health (CMH) for Wraparound or 20-511A may not need a PCSP from a TCC. If a family has already developed a PCSP or Plan of Service and is actively working with a department Case Manager, they will not need an additional plan developed, and are not required to work with a TCC as it is considered a duplication of services. If you are unsure if a family is working with a Department Case Manager, you can contact Medicaid for more information at 1-866-681-7062.
Newly eligible YES members will have gone through the independent assessment process and therefore should have a CANS and CDA from Liberty Healthcare. There should be no need to complete another CDA or CANS right away, unless the provider does not fully agree with the results. If the Liberty CDA does not meet the requirements of the provider, they need to have an intake conversation (billing either 90791 or 90834) and fill in the gaps with an addendum. The auditors will consider both the initial CDA and the addendum in their review of the treatment records. As a reminder, the CANS does need to be updated every 90 days by a CANS certified provider using the ICANS platform.
The CANS should be administered with child and family engagement and the members of the CFT should collaborate to identify who would be the best CANS certified provider to administer the CANS. Optum network providers that are CANS certified master’s level clinicians and/or CANS certified bachelor’s level paraprofessionals in a human services field who are involved in the member’s care can complete and bill for the initial/annual CANS and CANS updates. For additional information, please see the Optum Idaho Provider Manual> Child and Adolescent Needs and Strengths (CANS) section.
No. As we build the network, we realize there may be some delays in the child receiving an updated CANS as quickly as needed. Services will not be denied, and claims will not be recouped because a child doesn't have an updated CANS.
The CFT Interdisciplinary Team Meeting is scheduled by the TCC and is a face-to-face meeting with the child and their family present. The CFT meeting must also include an independently licensed clinician (or a master’s level clinician under the Supervisory Protocol) who participates face-to-face or telephonically. Other than the TCC, network providers must participate face-to-face or telephonically, when appropriate. Additionally, a CFT will include individuals selected by the child and family who are to be involved in coordinating their care or who will provide support throughout care such as a soccer coach or neighbor. The TCC may have a conversation with a treating provider if they are unable to attend the CFT to make sure there is alignment with content in the person-centered service plan.
Yes, the Targeted Care Coordinator must schedule, attend, and facilitate the CFT meeting in order for it to be considered a formal, billable CFT Interdisciplinary Team Meeting.
Speak with the family about participating in their Child and Family Team, but it is ultimately up to the child or youth and their family who attends. You may also contact the TCC, who can document this request in the person-centered service plan (PCSP). Even if unable to attend the CFT meeting, treatment goals should still align with the PCSP developed by the CFT.
No. The clinician(s) and/or paraprofessional(s) who provide services to the member and has a relationship with the child/family should be the one(s) to attend the meeting.
Yes. TCC providers can be reimbursed for mileage when completing TCC services in the family's home. Best practice is to only bill one time if providing TCC services to different family members during one trip. Code T2002 is used for transportation and mileage reimbursement.
At least one parent or legal guardian must be present for the CFT meeting, and it’s highly recommended that the child attend as well, to ensure he/she is in agreement with the PCSP. However, we understand there may be circumstances, such as illness or hospitalization, which may not allow the child to be present. If this is the case, the reason for the child’s absence must be documented in the PCSP.
Until further notice, a TCC's supervising clinician (established by Supervisory Protocol) can deliver direct services to a child (if there are no other options available to the child) and may still supervise the TCC. As a reminder, it is best practice to separate direct supervision of another professional who is also providing services to the same child as the supervising clinician. Optum continues to work with the Division of Medicaid to develop a strategy to meet conflict-free requirements per CFR 441.301.c.vi by July 1, 2021. However, the requirement that TCCs are not to provide other services to the child remains in effect.
Not at this time, but Optum is continuing to evaluate this service with Medicaid.
A PCSP is a type of a coordinated care plan where the person is supported to use their own power to choose what they will do and who will help them to achieve a life meaningful to them. The PCSP incorporates the results of the Comprehensive Diagnostic Assessment (CDA) and CANS functional assessment and is a result of Child and Family Team (CFT) Interdisciplinary Team Meetings. In the Medicaid YES Program, this process is directed by the child/family, is ongoing, and focuses on the strengths, interests, and needs of the whole person. PCSPs include the child's overall treatment goals and objectives, strengths, needs, crisis/safety plan, and a transition plan.
The PCSP is a collaborative effort by all members of the Child and Family Team (CFT). An Optum Targeted Care Coordinator (TCC) enrolled in the Optum network facilitates the formal CFT meetings and creates and finalizes the plan with input from the team. If the child has gone through the Independent Assessment and is not completing a plan with a Department Case Manager, Optum must review the finalized PCSP to ensure adherence to the Code of Federal Regulations. However, if the child is a part of the Developmental Disability program, 20-511A, or Wraparound program, the coordinated care plan will be developed as a part of those meetings and are acceptable to meet the requirements for the YES Program.
PCSPs must be updated at least annually or more frequently if the child/family requests it or whenever clinically indicated, such as by changes in the CANS.
Medicaid will be enforcing the TCC/PCSP requirement in 2021, so we urge you to help connect your YES members with TCCs in your agency or community to develop a PCSP. Children accessing services through the 1915(i) State Plan Option (expanded income or traditional Medicaid needing Respite) are required to have their PCSP updated at least annually.
As soon as a child is approved for the YES Program and becomes approved for Medicaid, all Medicaid billable services can be accessed. The child may receive medically necessary services while the PCSP is in development, but these services should be documented on the PCSP along with the names of the providers who are participating. We urge you to help connect your YES members with TCCs in your agency or community to develop a PCSP which includes recommended services. Medicaid will soon be enforcing the TCC/PCSP requirement.
As a reminder, children accessing services through the 1915(i) State Plan Option (expanded income or traditional Medicaid needing Respite) are required to have their PCSP updated at least annually.
One of the key parts of the PCSP is a formalized and agreed upon consensus building process for the CFT to identify the goals of the child and family. Through that process, the child and family will lead the team as the team collaborates to determine appropriate services and treatment for the child/family. The TCC will have the responsibility to ensure that there is collaboration and agreement for the services that will be documented on the PCSP through their facilitation and support of the child and family. The CFT also develops conflict resolution guidelines, which are also included in the PCSP, to help the teamwork through disagreements that may arise during the planning process.
All CFT members need to sign the PCSP, including the parent(s) or legal guardian(s), the child (if the family thinks the child is age-appropriate to sign), and the TCC. This also includes all providers from behavioral health, mental health, developmental disabilities, and substance use who are treating the child, as well as informal supports or anyone else in attendance. If the provider is listed on the PCSP, even if they did not attend the CFT meeting, they must sign the PCSP (or provide an email to the TCC stating they are in agreement with the plan). For clarification, if a child is receiving direct services from any of these providers, they must be listed on the PCSP and agree/sign. The TCC’s signature attests that the TCC has these appropriate signatures on file.
For providers that are not within the Optum Network, or if the provider refuses to participate, their service will not be included in the plan. The PCSP can still be approved through Optum, and the TCC should work with the family to get the providers to engage. All efforts should be made to obtain agreement and signature, though this lack of participation should not create a barrier to care for the child. Any/all attempts made to retrieve agreement/signature should be documented. An example of this type of provider would be any medical provider or, if an Optum Network provider refuses to participate in the CFT, they wouldn’t be providing direct services to the child.
The TCC is responsible for obtaining agreement for the PCSP from the participating providers and other CFT members. The TCC’s electronic signature on the PCSP means that the TCC has either emails and/or signatures on file from CFT members, subject to audit. Only those providers who are in agreement with the content of the PCSP should sign it and be involved in the member's care.
Please refer to optumidaho.com > For Network Providers > Targeted Care Coordination. The blank PCSP form is located on the website in both English and Spanish. Please save it to your desktop before using and make sure you are using Adobe Acrobat Reader DC, which can be downloaded for free from Adobe's website.
This webpage is also where you can log in to Optum Supports and Services Manager (OSSM), under the TCC section, in order to submit the completed PCSP to Optum for review of compliance under the Code of Federal Regulations (CFR). Please refer to the OSSM Instruction Manual located on the same page.
After you have completed the TCC training, you should receive an email from OSSM Provisioning. Be sure to follow the email instructions when logging in for the first time. If you are still having difficulties, please email us at firstname.lastname@example.org or call us at 1-855-202-0983, option 1. Please provide your first and last name, email, phone number, and Optum ID (if you have one).
For YES 1915(i) State Plan Option children, progress notes may be documented in OSSM if you like, but you should primarily store progress notes in whichever platform your agency chooses to use to meet record auditing requirements. However, the attendance log must be completed in OSSM to indicate who attended the CFT meeting.
No. The PCSP should still be developed. However, it does not need to be submitted to Optum for CFR review. If the child is accessing services and is working with a Department Case Manager through other Medicaid programs (such as 20-511A, Wraparound, or Developmental Disabilities), you will not use OSSM to store any records.
Optum will respond to a PCSP submitted in OSSM within 5 business days. Please refer to the OSSM Instruction Manual located at optumidaho.com > For Network Providers > Targeted Care Coordination. You may also click on the plan in OSSM, and then click “Assessments” to review the CFR Review Sheet with any comments from Optum.
For resubmission of PCSPs not meeting CFR, please refer to the OSSM Instruction Manual located on the website at optumidaho.com > For Network Providers > Targeted Care Coordination. When changes are made to the PCSP to ensure it meets CFR, please document those conversations in the PCSP, and be sure the TCC signs it with the revised date.
No. TCCs cannot provide other direct services to the child.
Yes. Optum Idaho Network Providers may bill for attending a CFT meeting using G9007, regardless of whether it's facilitated by the Optum TCC or IDHW case manager, as it is important for the providers to engage in all of the care for the child or youth.
Content in the above section was last updated on July 16, 2020.
1915(i) Independent Assessment
The independent assessment process is an annual Federal requirement related to the 1915(i) State Plan Option. Currently, the only service that is available on this waiver is Respite, as Respite is not in the State Plan with the other Medicaid services. CMS has the ability to impose and require certain criteria in order to receive Respite since it is on the waiver. However, this waiver also allows families with a household income of 186% to 300% Federal Poverty Guideline (FPG) to obtain Medicaid coverage for their child with serious emotional disturbance (SED).
Children and youth’s participation in the independent assessment is optional. There are two reasons they would go through an independent assessment: 1) The child/youth is not Medicaid eligible under traditional income limits and is seeking eligibility through the higher limits provided by the 1915(i) State Plan Option, and/or; 2) The child/youth needs access to Respite.
If the Member is Medicaid eligible under traditional income limits and does not require Respite, they do not need to go through the independent assessment, even if they have SED.
Children and youth will need to complete the independent assessment on a yearly basis. Liberty Healthcare will contact the family about 60 days before their assessment is due. If the child/youth gained Medicaid eligibility at a higher income (of 186%-300% FPG), they may also need to complete their redetermination through Self Reliance around the same time.
Liberty Healthcare conducts the independent assessments for both the YES Program and Developmental Disabilities (DD) 1915(i) support services. There are some similarities between the two processes; however, separate assessments are required for each program and families will apply for each separately. For more information, please contact Liberty Healthcare at 1-877-305-3469.
You can use a CDA from any provider, including Liberty Healthcare, if it was completed within the last 6 months. The clinician is still required to do an independent clinical assessment/interview to verify that the information provided hasn’t changed.
If the Liberty CDA does not meet the requirements of the provider, they need to have an intake conversation (billing either 90791 or 90834) and fill in the gaps with an addendum. The auditors will consider both the initial CDA and the addendum in their review of the treatment records.
Yes, Liberty Healthcare can accept a CANS that has been completed within the last 100 days. Liberty can use a CDA that was completed in the last 6 months. The assessor is still required to do an independent clinical assessment/interview to verify the information provided hasn’t changed. The assessor will then complete a CANS update in ICANS to document any changes.
Content in the above section was last updated on May 6, 2020.
Child and Adolescent Needs and Strengths (CANS)*
Optum network providers who are independently licensed clinicians (or master’s level clinicians working under supervisory protocol) who are certified in the CANS can bill for the initial/annual CANS (if one has not yet been completed) and CANS updates. A CANS certified bachelor’s level paraprofessional in a human services field can complete CANS assessments (initial/annual and updates), if they are involved in the member’s care. In some cases, a bachelor’s level paraprofessional may need to refer some more difficult applications to a CANS certified master’s level clinician. If a CANS is completed by a bachelor’s level provider, an Independent Assessor or the treating clinician will need to conduct the CDA.
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 an ongoing method for measuring clinical outcomes.
Additional information on the CANS can be found on the Praed Foundation website at Praedfoundation.org
The time to complete a CANS assessment will vary depending on factors such as the child's/youth's and family's presentation, current risk factors, and complexity of the strengths and needs of the child's/youth's and family, and the provider’s experience in administering the CANS.
The cost to complete the CANS certification online is $12.00 annually. Additional information on the CANS can be found on the Praed Foundation website at Praedfoundation.org. Individuals should allow approximately 8 hours of uninterrupted time to complete the certification.
For questions about upcoming CANS training, please contact the Division of Behavioral Health at email@example.com. There is also a CANS overview module available on Relias. Providers must complete the CANS certification through the Praed Foundation. For more information, please go to OptumIdaho.com > For Network Providers > Provider Trainings > Available On-Demand Trainings.
Please email Praed at firstname.lastname@example.org with your agency name to have your agency added to the drop down listing of Idaho providers. For more information about the Praed foundation and their website, please reach out to email@example.com.
Yes. As of July 1, 2019, the CANS is the state-required functional assessment tool for all children and adolescents who receive services through the Idaho Behavioral Health Plan. Services that do not require a CANS are: Neuro/Psych Testing, Medication Management, and Crisis Services.
The CANS assessment is administered through an online platform called ICANS that is hosted by the Division of Behavioral Health (DBH). For more information about ICANS, please reach out to DBH at firstname.lastname@example.org visit their website at icans.dhw.idaho.gov.
To get set up on the ICANS platform, providers are required to sign and submit an Agency Agreement, Authorized User Agreement for each staff, and attend ICANS System training. For more information, please navigate to icans.dhw.idaho.gov for the Calendar of trainings and Resources and User Guide tabs for all system requirements, electronic system manual, and additional information. For help with this process, contact the Automation Help Desk, at the Division of Behavioral Health, at (208) 332-7316 or submit a ticket via email at email@example.com.
No. Both the CDA and CANS are required for children and adolescents receiving services under Medicaid.
Yes. The CDA is used to form a mental health diagnosis, and the CANS determines functional impairment and is used in treatment planning. Both can be done on the same day. The CANS must be completed within the ICANS platform for a provider to bill and be reimbursed for the CANS. The initial or annual updated CANS can be completed in conjunction with an initial or updated Comprehensive Diagnostic Assessment (CDA), by the Independent Assessor or the treating clinician. If the CANS is completed by a bachelor’s level provider, an Independent Assessor or the treating clinician will need to conduct the CDA.
The CANS will need to be updated at a minimum of every 90 days, 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 may be updated by the Targeted Care Coordinator who is working with the member, by a master’s level clinician, or by a CANS certified bachelor’s level paraprofessional in a human services field if they are involved in the member’s care.
We encourage all network providers to become CANS certified and set up on the ICANS platform. Effective July 1, 2019, the CANS is the state-required functional assessment tool for all children and adolescents.
Yes. If the child or youth 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 can be used to monitor outcomes. This can be accomplished in two ways. First, items that are initially rated a ‘2’ or ‘3’ are monitored over time to determine the percent of youth who move to a rating of ‘0’ or ‘1’ (resolved need, built strength). Secondly, dimension scores can also be generated by summing items within each of the dimensions (Problems, Risk Behaviors, Functioning, etc). These scores can be compared over the course of treatment. CANS dimension scores have been shown to be valid outcome measures in behavioral health treatment.
To ensure providers have the most appropriate data measurements possible, the ICANS system provides each agency access to their own Transformational Collaborative Outcomes Management (TCOM) data via the reports section on the home dashboard. The Department of Health and Welfare gathers statewide CANS data to perform comparisons and measure trends. This information is used to assist with workforce development and ensure members access to care.
The CANS is the state-required functional assessment for all Medicaid members under the age of 19. However, Optum does not mandate what additional assessments are appropriate for use. Rather, it’s based on clinical discretion, as long as the CANS is used initially and updated every 90 days.
The H0031 code can be billed for all children and adolescents receiving a CANS assessment from a CANS certified professional, completed on the ICANS platform. The CANS can be billed with H0031 with a modifier HN (for bachelor's level), HO (for master’s level), or U1 (for prescribers) in group agencies billing under the Supervisory Protocol.
In order to access 1915(i) State Plan Option services (e.g. Respite), the initial and annual assessment must be done by the Independent Assessor, Liberty Healthcare. This is a federal requirement of the state plan option. To schedule an independent assessment, please call Liberty Healthcare at 1-877-305-3469.
Both CANS certified master’s level clinicians and CANS certified bachelor’s level paraprofessionals can be reimbursed for mileage when completing the CANS assessment whether initial, update or annual, in the child or adolescent's home. Best practice is to only claim the mileage code one time if providing multiple CANS assessments to different family members during one trip. The transportation and mileage reimbursement code is T2002.
Content in the above section was last updated on July 17, 2020.
Treatment planning for the provision of Skills Building should be completed with the member’s clinician, the Skills Building paraprofessional, the member & their family or other natural support present. The telemental health policy does apply to this billing code for master’s level clinicians. For more information about the telemental health policy, please refer to the Provider Manual.
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 manner. Please refer to the Skills Building/CBRS Quick Reference Guide for additional information.
Yes, both providers may bill for Skills Building/CBRS service-specific treatment planning (H0032) on the same day working with the member present. In order to bill for Skills Building/CBRS, the clinician and paraprofessional must develop the treatment plan using the teaming approach and both can bill for their time. Please refer to the Provider Manual and the Level of Care Guidelines for more information.
Providers are required to utilize the CANS to identify the member specific functional strengths and needs to be addressed with Skills Building/CBRS. Providers will use the CANS results/measurements to develop the Skills Building treatment plan in order to demonstrate treatment progress or to substantiate the need to modify treatment plans.
Skills Building/CBRS treatment plans should include attainable, measurable objectives aimed at assisting the member in achieving his/her goals related to the specific functional need. Goals for Skills Building/CBRS focus on resolution of functional impairments which will be reflected as CANS scores improve. When CANS scores do not improve, the interventions should be assessed and changes to treatment considered. For more information, consult the Provider Manual.
Prior authorizations for Skills Building/CBRS cover a six (6) month timeframe.
The paraprofessional roster is an online database that allows providers to register the basic information of their non-licensed workforce with Optum. As a recommendation, any clinical staff (LSWs, CADCs, Skills Building paraprofessionals) working with Medicaid members under Optum’s Supervisory Protocol should be recorded on this registry. The registry is located at providerexpress.com > Our Network > State-Specific Provider Information > Idaho >Paraprofessional Registry.
The PRA Child and Family Resilience Practitioner (CFRP) is the required certification for paraprofessionals providing Skills Building/CBRS primarily to children and the Certified Psychiatric Rehabilitation Practitioner (CPRP) is the required certification for paraprofessionals providing Skills Building/CBRS primarily to adults.
Skills Building/Community Based Rehabilitation Services (CBRS) providers must earn a psychiatric rehabilitation certificate based upon the primary population with whom they work in accordance with the requirements set by the PRA.
• Child and Family Resilience Practitioner (CFRP) for those working with children
• Certified Psychiatric Rehabilitation Practitioner (CPRP) for those working with adults
Note – those individuals who have earned the children’s psychiatric rehabilitation certificate previously issued by PRA and continue to work primarily with children / adolescents are not required to also earn the CFRP.
Yes, those paraprofessionals that received the children’s certificate are grandfathered in to provide services.
No, the paraprofessional can be certified in one or the other depending on the majority of their clients that they serve. However, individuals who work primarily with children, but who also work with members age 18 and older, must have training or have evidence of classroom hours addressing adult issues in psychiatric rehabilitation. The worker's supervisor must determine the scope and amount of training the worker needs in order to competently work with adults assigned to the worker's caseload. If the paraprofessional primarily treats adults, they must have training or have evidence of classroom hours addressing child issues in psychiatric rehabilitation. The worker’s supervisor must determine the scope and amount of training the worker needs in order to competently work with children assigned to the worker's caseload.
No, an LSW does not need the certification to provide these services. For a complete list of providers who can provide CBRS/Skills Building services, please refer to IDAPA 16.03.09.855.
Individuals who began working as a Skills Building/CBRS specialist between July 1, 2018 and April 2019, and have not yet begun working toward a certification must immediately begin to show documentation that they are working toward this certification. Please contact your Regional Provider Relations Advocate if you are having problems getting certified by the PRA.
Content in the above section was last updated on May 5, 2020.
Respite is in-person, short-term or temporary care for children and youth with serious emotional disturbance (SED) provided in the least restrictive environment that provides relief for the usual caretaker and that is aimed at de-escalation of stressful situations. Individual respite is provided by a credentialed agency in the member’s home, another family’s home, foster family home, a community-based setting and/or at the agency facility. Group respite may only be provided at the credentialed agency facility, a community-based setting, or in the home for families with multiple children who have been determined to have SED. Respite services are provided in a manner that is strengths-based, culturally competent and responsive to each member’s individual psychosocial, developmental, and treatment care needs. The duration of individual respite care varies and may include an overnight stay in the member’s home, as identified by the Child and Family Team (CFT) but will not exceed a single episode of 72 hours.
No, respite does not require prior authorization, but must be included on the person-centered service plan (PCSP). The total annual limit for respite (group and individual combined) for a member is 300 hours per calendar year.
Group respite may be provided at the credentialed agency facility, in the community setting or in the home for families with multiple Medicaid eligible SED children. Group respite services shall be provided at a staff-to-participant maximum ratio of 1:4. Group respite does not allow for an overnight stay. As the number and severity of the participants with functional impairments or behavioral issues increases, the staff-to-participant ratio must be adjusted accordingly. As a reminder, respite services are provided in a manner that is strengths-based, culturally competent and responsive to each member’s individual psychosocial, developmental, and treatment care needs.
If a member is eligible for respite through both waivers, they may receive respite through an Optum network provider and through a DD provider. Respite delivered through each program will have to follow and comply with each program's requirements. For example, YES members will need to have a PCSP that includes respite as a service, have a hard limit of 300 hours per calendar year, etc.
Children and youth who go through the Liberty Healthcare independent assessment process, and have been determined to have SED, may access respite services immediately. However, once a child/youth has an approved person-centered service plan, respite must be included on it.
Content in the above section was last updated on May 13, 2020.
The number of units indicated for some of the YES services are a guideline for providers. Providers should make a clinical decision and be guided by medical necessity while being aware of the utilization guideline. The provider is not responsible for units used outside of their agency. Except for Respite, which has a hard cap of 300 hours per year, there is not a hard cap in place to automatically deny claims that exceed the guideline(s) at this time. Optum monitors utilization by reviewing outliers and requesting records on cases that exceed the hourly guidelines to understand the needs of the member.
Yes. If a provider is following an evidence-based practice for Family Psychoeducation that recommends the parents and children/youth are separated for a group. It is recommended that providers use SAMHSA’s Family Psychoeducation Evidence-Based Practices (EBP) Kit. As noted in the Provider Manual, Multifamily Group Psychoeducation (2-5 families) warrants two providers, at least one being an independently licensed clinician or an individual with a master’s degree who is able to provide psychotherapy in a group agency under Optum’s Supervisory Protocol. The second may be a minimum of a bachelor’s level paraprofessional operating in a group agency under Optum’s Supervisory Protocol. More than one provider can be present at each group, although no more than two providers may bill for facilitating a Multiple Family Group Psychoeducation session.
Content in the above section was last updated on July 17, 2020.