Who Is Eligible for the YES Waiver?
To participate in the YES
Waiver, a child must:
- Have a serious emotional disturbance (SED);
- Meet the criteria to be in a psychiatric hospital;
- Be between the ages of 3–18 years; and
- Live in a home setting with a legal guardian, or on their own if legally
Who do I call if I may need YES Waiver Services?
you are caring for a child with a serious emotional disturbance and need help,
please Find Your
Local Mental Health Authority and call the YES Waiver Inquiry line to add
your child to the YES Waiver Inquiry List.
How do I submit the Inquiry List to DSHS?
The Inquiry List is
emailed to YESWaiver@dshs.state.tx.us
on the last business day of each month.
How long does it take to get approval for a Clinical Eligibility
DSHS has five business days from the date the CED
was placed in “Ready for Review” in CMBHS to make the determination.
How do I submit YES Waiver Service claims for payment?
Waiver service claims –called service notes—are entered into CMBHS for payment.
Can TCOOMMI funded youth be enrolled in the YES Waiver?
individual participating in TCOOMMI can also be enrolled in the YES Waiver.
Can I bill for Intensive Case Management before the first wraparound team
Yes, Intensive Case Management services are reimbursable
before the first wraparound team meeting. For more information, see the “Using
Wraparound to Provided Intensive Case Management” presentation available at https://www.dshs.state.tx.us/mhsa/yes/.
Do I continue to bill regular services (i.e. skills training, therapy,
psychiatry, and intensive case management) through the Medicaid
Yes, billing for traditional state plan services is not affected by
the YES Waiver.
How are critical incidents reported to DSHS?
A YES Waiver
Critical Incident Report is located in the Forms Library on
the YES website. Completed Critical Incident Reports should be sent to YESWaiver@dshs.state.tx.us
and in accordance with the current YES Policy Manual posted on the YES
Is there a deadline for submitting critical incident reports?
must submit a Critical Incident Report to DSHS within 72 hours of finding
out about the critical incident. LMHAs should also submit a Critical Incident
Report when there is updated information regarding the critical incident (i.e.
when a participant is released from the hospital or returns home).
Do I have to update the 90-day TRR Uniform Assessment (UA) for individuals
enrolled in YES?
Yes, the LOC-R generated by the 90-day update UA should
be deviated to an LOC-A of “LOC-YES” while the child/youth is enrolled in YES.
This authorizes TRR services—including Intensive Case Management—which function
independently of YES Waiver services.
Is there a specific form or format required for transition plans?
Currently, DSHS does not have a form or template for transition
What program documentation is reviewed during DSHS on-site
DSHS reviews include the following:
- LMHA maintenance of the Inquiry List
(including attempts to contact LAR,
complete demographic eligibility, and attempts to schedule intake assessment)
- Progress notes for Intensive Case Management Services
- Wraparound Plan
- Progress notes for waiver services
(for more information, see the
Service Documentation section of the YES Policy Manual.
Do I need to submit outreach and marketing materials to DSHS for
Yes, outreach and marketing information must be reviewed
and approved by DSHS. Please email them to YESWaiver@dshs.state.tx.us
with the subject line “approval requested: outreach and marketing information.”
Most approvals are made within five business days.
Do individuals authorized for LOC-YES count toward overall service
targets and performance measures in the LMHA Performance
Individuals enrolled in LOC-YES are counted toward service
targets in the LMHA Performance Contract. However, LOC-YES is not considered a
full level of care (FLOC) and is excluded from many of the measures in the LMHA
Performance Contract. For questions regarding the LMHA Performance Contract,
please contact the DSHS Contract Management Unit.
How do I know when DSHS has approved something that was submitted in
Approved documents are placed in the ‘Closed Complete’ status in
CMBHS. If the document requires changes for approval, it will be put back into
‘Draft’ status by DSHS. It is the responsibility of the LMHA to track the status
of approvals in CMBHS.
Do I submit Enrollment Packets through CMBHS?
The Enrollment Packet
is not submitted to DSHS; however, it must be kept in the participant case
What is a pre-engagement service, and when is it used?
request reimbursement for the time spent enrolling individuals in Medicaid
through the special income group through the waiver who are ultimately denied
(Please note that because participants must already be enrolled in Medicaid
to qualify for GR-funded Programs, pre-engagement services are not available to
What impact does enrolling in YES Waiver Services (LOC-YES) have on the
individual’s TRR services?
Individuals enrolled in YES waiver are
entitled to all TRR services for which they have a clinical need. LOC-YES
authorizes TRR services, which function independently of YES Waiver services.
The services and supports that are needed are determined during the Wraparound
process, and are often a mix of state plan (TRR) services and YES waiver
If an individual receives an LOC-R other than LOC-4 LOC-R, how do I
complete the Service Request/Authorization (SRF) section which asks “Please
indicate the recommended level of care generated from the CMBHS system.”?
LOC-YES is not currently represented on the SRF. Providers should
include LOC-4 as the LOC-R generated from the CMBHS system and provider
requested level of care for YES participants.
What do I do if a MCO does not approve the LOC-4 for a YES Waiver
MCOs should approve LOC-4 for YES Waiver participants.
Refer the MCO to their health plan manager (HPM) at HHSC for policy
clarification. All complaints/inquiries should be routed to the HPM Complaints
box for tracking and trending. Please include any known names of MCO staff
members that have been contacted to avoid duplication of efforts.
In the DSHS process for Fair Hearings, an LMHA does not change the
LOC from a higher to lower LOC for 10-14 days after the determination that a
different LOC is appropriate. This is to allow for the Medicaid Fair Hearing
letter to be sent and the member time to respond. Will the MCOs allow the
current LOC to remain for 14 days before starting the new authorization at the
lower level of care?
Based on contract requirements, MCOs must continue
services for at least 10 days after the notice has been sent. However,
providers should reach out to the MCO to discuss the process, and any specific
requirements by the MCO. All complaints/inquiries should be routed to the
health plan manager Complaints box for tracking and trending.