Youth Empowerment Services

YES Overview

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 new YES system of care will offer a comprehensive array of services to address the needs of children and youth with serious emotional disturbance (SED). Through a coordinated and collaborative effort, multiple child-serving agencies (e.g. Family medical providers, schools, Health and Welfare, Juvenile Justice) will work with the family to build a treatment plan around the unique needs and strengths of each child.

SED Defined

Serious emotional disturbance (SED) is a legal term that is defined in Idaho Code, 16-2403(13) and refers to people who have a mental, behavioral or emotional issue that limits their ability to participate in family, school, or community activities.

From the code:

“Serious emotional disturbance” means an emotional or behavioral disorder, or a neuropsychiatric condition which results in a serious disability, and which requires sustained treatment interventions, and causes the child’s functioning to be impaired in thought, perception, affect or behavior. A disorder shall be considered to
“result in a serious disability” if it causes substantial impairment of functioning in family, school or community…”

A person is identified as having SED if they have both a DSM diagnosis and a
functional impairment as identified by the Child and Adolescent Needs and Strengths (CANS) tool.

YES Service Accessibility

The Department of Health & Welfare will ensure that services and supports are made available to all children who are determined to have an SED 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.

Beginning January 1, 2018 families that are seeking Class Membership (see below) 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 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.

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.

Class Members

To be identified as a “Class Member,” individuals must meet the following criteria:

  • Be an 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)

 

YES Implementation Rollout

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. 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. 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.

Independent Assessor

Liberty HealthCare Corporation is the contracted Independent Assessor. Liberty Healthcare will begin operations on January 2, 2018.  Beginning January 2, 2018, you may refer members to call 877-305-3469 to schedule an Independent Assessment.