1. CMBHS: Entering Clinical Eligibility Assessments
YES Waiver
CMBHS: Entering Clinical Eligibility Assessments
Identify Waiver Provider for the LMHA
June 23, 2016
Texas Department of State Health Services (DSHS)

2. Clinical Eligibility Types
CE—Pending: Created when a client who does not have Medicaid or the YES Waiver approved Medicaid type but has been assessed to determine Clinical Eligibility for YES Waiver
CE—Initial: Created when a client has active Medicaid (approved for YES Waiver) and has been assessed to determine Clinical Eligibility for the first time
CE—Annual: Created when a client is a current YES Waiver recipient and is being assessed to be approved for an additional year
CE—Termination: Created when a client terminated from YES Waiver
CE—LMHA Transfer Out: Created to close out services from the LMHA where the client will no longer live
CE—LMHA Transfer In: Created to open a current YES Waiver client who moved from another county
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

3. Clinical Eligibility Criteria
Criteria A: Score within specified range on CANS for developmental domain
Criteria B: Score within specified range on CANS for specified child risk, caregiver strengths and needs, and life domain functioning
Criteria C: Must have attempted outpatient therapy or partial hospitalization or have documentation by a psychiatrist as to why inpatient care is required
Criteria D: Must be reasonably expected to qualify for inpatient care under the Texas Medicaid inpatient psychiatric admissions guidelines
Criteria E: Have a valid Axis I diagnosis as the principle admitting diagnosis
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

4. Prior to Entering a “CE”
Ensure client data exists in CMBHS
Enter/batch diagnosis
Enter/batch most recent CANS assessment
Run Medicaid Eligibility Verification (MEV) and review
Ensure LAR information is entered in Client Profile
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

5. Find Client Select “Find/Add Client” on left hand side
Enter search criteria
Select “Search”
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

6. Review Client Workspace
Look for Diagnosis and Child and Adolescent Uniform Assessment (CANS) under Document Type
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

7. Create CE
From the client workspace, select the following from the left-hand column: Special Services Documentation YES Waiver Services YES Waiver Clinical Eligibility
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

8. Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

9. Eligibility Type: Select appropriate CE types
Performed On date:
It will default to the date that the assessment was created and opened
Select the date from calendar or enter date of the day that the Clinical Eligibility assessment took place
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

10. Notes on Eligibility Type: Enter any pertinent notes Start Date:
Defaults to the date that the document was created
Cannot be changed by LMHA
Will be changed by DSHS to the day that the CE is approved
End Date
Calculates 364 days out from start date (unless the client will reach his/her 19th birthday prior to the 364th day)
Can only be changed on a CE-Termination
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

11. Has Individual lived in a facility during the last 12 months: Mark yes or no
If yes, please provide Facility details: Describe where, length of stay, etc.
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

12. Auto-populated information:
Axis I, Diagnosis, Axis II Diagnosis
CANS Assessment Criteria A and Criteria B (make sure CANS Assessment Date is the day of the most recent CANS which is to be done on during the Clinical Eligibility Assessment)
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

13. Criteria C—Outpatient therapy or partial hospitalization has been attempted and failed OR a psychiatrist has documented reasons why an inpatient level of care is required.: Mark YES or NO
Criteria D—Check the Medicaid psychiatric inpatient hospitalization criteria below that the client meets.: Mark any that apply.
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

14. Criteria E—The Medicaid eligible youth must have a valid Axis I diagnosis as the principle admitting diagnosis.: Mark YES or NO.
Notes on Clinical Eligibility: Enter any pertinent information that should be considered when determining eligibility.
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

15. System Clinical Eligibility Determination: Once all information has been auto-populated and entered, this area will show which criteria has been met/not met.
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

16. Signatures: Enter names or select from drop down boxes
Dates: Select or enter the date of when the signatures were obtained which should generally match the “performed on” date.
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

17. Saving Documents Draft Ready for Review Closed Complete
Only the LMHA can see the document
Saved but is not being reviewed for approval
Put back in “draft” when a correction or clarification is needed by DSHS
Can be edited
Ready for Review
Shows up on DSHS queue to approve
Both the LMHA and DSHS can see the document
Can still be edited by LMHA in this status
DSHS has 5 business days to approve once saved in “Ready for Review”
Closed Complete
Cannot be edited
Only DSHS can save to “Closed Complete”
Document is final after “Closed Complete”
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)

18. Reviewing Status from DSHS
Return to Client Workspace to review document status
Once “Closed Complete,” Open document and review approval status
Demographic eligibility criteria;
Clinical eligibility criteria;
Financial eligibility criteria;
Service array descriptions;
The LMHA informs the individual/LAR that if enrolled in the YES Waiver, he/she will not be eligible to participate in another Medicaid 1915(c) home and community-based waiver concurrently.
The LMHA informs the individual/LAR that the YES Waiver utilizes the wraparound model.
Texas Department of State Health Services (DSHS)