Children and Youth Evaluation Service (C-YES):

the State–designated Independent Entity (IE) for Children´s HCBS

Part I: An overview of the role of C–YES during the February 1, 2019 – March 31, 2019 transition period

January 31, 2019

Purpose of this webinar

  • This webinar covers the role of the Independent Entity between February 1, 2019 and March 31, 2019
  • A separate webinar will be held to overview the role of the Independent Entity beginning April 1, 2019

Basis for an Independent Entity*

  • Today, children are transitioning from the care coordination provided through a 1915c waiver, to Health Home care management
    • This transition began on January 10 and will be completed by March 31
  • Health Home care management is an optional benefit, but HCBS requires a Plan of Care (POC) and care coordination
  • To permit a current 1915c waiver child to opt out of Health Home care management, but still receive aligned children´s HCBS, the State designated an Independent Entity to develop and manage HCBS plans of care

Who is the Independent Entity?

  • Maximus is the State–designated Independent Entity.
  • This program is being branded and marketed as "Children and Youth Evaluation Service (C–YES)"
  • C–YES can be contacted at 1–833–333–CYES (1–833–333–2937); TTY: 1–888–329–1541
  • Web site: nymedicaidchoice.com/information–care–management–agencies
  • C–YES staff are regionally located; call for the location in your region

Children and Youth Evaluation Service
Your Connection to Home and Community–Based Services


Role of C–YES

  • For children receiving HCBS who opt out of Health Home care management, C–YES will manage an HCBS plan of care. This may include:
    • Meet with the child/family and acquire signature to the POC
    • Adding new HCBS to the plan of care
    • Making referrals to HCBS providers
    • Updating the plan of care and communicating the plan of care to MMCPs (MMCP will monitor access to care indicated in the plan of care, for children enrolled in a plan)
  • C–YES will conduct future HCBS eligibility assessments
  • C–YES will only manage HCBS; families with other service needs, including CFTSS, may work with their providers or independently to obtain those services

Children who may access C–YES

  • Children who are referred to C–YES during the transition period (February 1, 2019 – March 31, 2019) must already be enrolled in a HCBS waiver for children and must have opted out of Health Home care management
  • C–YES is accepting referrals from HCBS waiver care coordinators through a defined referral process
  • Transitioning children must have a current Level of Care

Level of Care determinations

  • CHANGE: Transitioning Children need a current Level of Care (LOC) Determination
    • If a child´s LOC recertification is due during the transition period, then the current waiver LOC process will continue to be completed
  • If a child´s LOC recertification is due on or after April 1, 2019, then the new HCBS/LOC eligibility Determination will be completed during the month the recertification is due

Transitioning children´s waivers

  • Children enrolled in the following1915(c) HCBS waivers are transitioning to Health Home or C–YES:
    • OMH Serious Emotional Disturbance (SED) waiver #NY.0296
    • DOH Care at Home (CAH) I/II waiver #NY.4125
    • OPWDD Care at Home waiver #40176
    • OCFS Bridges to Health (B2H) SED waiver #NY.0469
    • OCFS Bridges to Health B2H Developmental Disability (DD) waiver #NY.0470
    • OCFS Bridges to Health B2H Medically Fragile waiver #NY.0471

Making a referral to C–YES

  • Only a care management agency can make a referral to C–YES (during the January through March transition period)
  • It is the responsibility of the CMAs to send a complete referral package using their secure email protocol to CYESreferral@maximus.com
  • The CMA should organize the documents into one package and send the package as one PDF attachment to C–YES
  • A completed C–YES referral packet MUST be Sent and Accepted by the C–YES
  • If the CMA has to make referrals for multiple children within the same family, the CMA must send 1 email per person (for example, if a CMA has 4 children to refer to C–YES, the CMA would send 4 separate, secured emails for each child)

C–YES referral packet elements

  • A complete referral packet includes all of the following:
    • C–YES Referral form
    • Health Home Opt–Out form (DOH–5059)
    • Agency consent form to share information with C–YES
    • Current plan of care, with service names cross walked to new service names, and listing all services and providers
    • Historic clinical, treatment, and service information
    • Previous HCBS or Level of Care assessments, which indicate the due date for waiver eligibility re–assessment

Complete referral packets

  • CMAs are expected to send complete documents that include the child´s demographic information and appropriate signatures. The following data elements should be double checked before sending in a referral:
    • First name, Last name
    • DOB
    • Social Security Number (SSN)
    • Medicaid Client Identification Number (CIN)
    • Gender
    • Address

Making a referral to C–YES

  • The Referral to C–YES form is posted on the C–YES website: nymedicaidchoice.com/information–care–management–agencies
  • C–YES will communicate back to the CMA either "referral accepted" or "referral declined," via secure email
  • If the referral is declined, the notification will detail the reason (such as missing information)
  • The CMA is responsible for the child and their plan of care until C–YES notifies the CMA that the referral has been accepted
  • Once the referral has been accepted by C–YES, C–YES is responsible for the child and their plan of care
  • Transitioning providers should notify their DOH Liaison whenever a child opts out of Health Home (DOH Liaisons are tracking all transitioning children)

How children may access C–YES

  • C–YES will meet the child in their home or a community setting to perform Plan of Care updates
  • C–YES has a statewide presence and secured space in community settings in most counties
  • Call 1–833–333–CYES (1–833–333–2937); TTY: 1–888–329–1541 to reach C–YES

Provider interaction with C–YES

  • C–YES is directly contracted with NYS DOH
  • Providers do not need to take any action to establish a formal/contractual relationship with C–YES
  • All referrals must be made via secure email
  • C–YES cannot accept incomplete referrals; if an incomplete referral is submitted to C–YES, it will be rejected and returned to the referent (with an explanation)
    • All referrals must include a signed consent form; without a signed consent form, no information about the specific child can be sent to C–YES, under any circumstance
  • C–YES may contact the referring CMA with questions

MMCP interaction with C–YES

  • C–YES is directly contracted with NYS DOH
  • There is no need for MMCP to contract with C–YES
  • MMCP must accept Plans of Care from C–YES
  • C–YES will be collecting consents from children and families to share information with an MMCP Expanding the role of C–YES on April 1, 2019

Expanding the role of C-YES on April 1, 2019

  • Though March 31, 2019 – children are referred through the normal pathways to the existing HCBS waivers (including those using family of one budgeting methodology)
  • Beginning April 1, 2019, C–YES will accept referrals to assess children who are not Medicaid–enrolled to determine eligibility for the consolidated children´s HCBS waiver
    • C–YES will assist children who are determined HCBS–eligible and meet other specific criteria in applying for Medicaid with the LDSS (including those who use family of one budgeting methodology);
  • C–YES will continue to be available to develop and manage plans of care for children who opt out of Health Home care management and are not enrolled in a Medicaid Managed Care Plan (MMCP)
  • MCTAC will host another webinar detailing this process on March 18, 2019

Contact Information

Questions/Comments:
BH.Transition@health.ny.gov