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Care at home for children with serious emotional disorders​​

Care at Home
for Children
​with Serious
Emotional Disorders


What is the Children with Serious Emotional Disorders Waiver (CSEDW)?

​The CSEDW program provides additional Medicaid support to children from ages three to 21 with serious mental, behavioral, or emotional health needs. The program helps keep children with their families at home or in the community instead of going to a care facility or a group home. While they are at home or in the community, they receive services to improve their condition.


CSEDW is a West Virginia Medicaid Home and Community Based Services (HCBS) waiver program that allows children with serious emotional disorders receive additional services based on the National Wraparound Initiative model. This model uses the strengths of families and each person to start growing and changing. This model also helps the child and their family get the skills they need to deal with challenges and helps keep the child stable at home. 


The model also focuses on the child's needs and their family. A child who has challenging behaviors is the center of the process. They are involved in the plan to help develop the skills that are required to get stable and improve their ability to deal with the situation. The goal is to give the child the ability to reach their personal goals. 

    

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The CSEDW ​is for members who:

  • Are between the ages of three and 21
  • Are a resident of West Virginia, even if they are now living out of state in a psychiatric residential treatment facility (PRTF). Proof of West Virginia residency is required with the waiver application.
  • Meet the program eligibility.
  • Choose home and community-based treatment services instead of services in a medical facility or group home.
  • Choose to sign up with the identified managed care organization (MCO).
  • Currently or at any time during the past 12 months, have been diagnosed with a mental, behavioral or emotional disorder for a period of time that is satisfactory to meet standards that are in the most current edition of the Diagnostic and Statistical Manual (DSM).
  • Have a Child and Adolescent Functional Assessment Scale (CAFAS) or Preschool and Early Childhood Functional Assessment Scale (PECFAS) score of "severe" (score of 90 or above is considered severe).

The CSEDW program provides services that include:

  • Training needed to perform activities for daily living that make someone more independent.
  • Finding and creating opportunities for work.
  • Help getting competitive employment in the community and support to make sure they are successful where they work.
  • Specific therapy or treatment for severe problems or when all other treatments have already been tried.
  • Support for people between the ages 18 to 21 as they move from living in a facility to living in a house or an apartment with others.
  • In-home family therapy and support.
  • Guidance and support for family, parents, and caregivers.
  • Short-term relief for primary caregivers through respite.

Services must be:

  • Appropriate and medically necessary for the symptoms, diagnosis, or treatment of an illness.
  • Provided for the diagnosis or direct care of an illness.
  • Within the standards of good practice.
  • The proper level of care that can be safely provided.

​Services must not be primarily for the convenience of the member or provider.

The member will receive a Plan of Care (POC) that is just for them. The plan will identify each step necessary to acquire a specific skill in a reasonable time frame that was stated in the goal. 

 

For more plan information, see Chap​ter 502, Children with Serious Emotional Disorder Waiver of the BMS Policy Manual. ​

​The CSEDW application process begins by calling the WV Crisis and Referral line at 844-Help4WV​. ​


A family member can contact this line for assistance with an​y crisis situation.

You may submit your completed CSEDW application form via mail, fax, or email:

 

Mail: Ascentra Health (formerly Kepro)​ – 1007 Bullitt St. Suite 200 Charleston, WV 25301 

Fax: (866) 473-2354 

Email: wvcsedw@kepro.com 

 

If you have not heard back from Kepro​​​ within five business days, please call (304) 343-9663​ ext. 4483 or 4418.

 

Enrollment into the CSEDW program depends on the availability of a funded space. If a space is not available, the applicant is placed on a Managed Enrollment List (MEL) using the date they were determined eligible. When a space becomes available, the member is informed and starts the enrollment process for the CSEDW program. 

​For more information or to get help with th​e application, contact:

 

Acentra Health

1007 Bullitt Street, Second Floor

Charleston, WV 25301

Phone: (866) 385-8920 | (304) 380-0617​

Fax: (866) 521-6882

Email: wvcsedw@kepro.com

  1. ​​​​​​​​Does my child have to be in a care facility or getting treatment outside of West Virginia?
    No. However, eligible children/youth with serious emotional disorders (SED) will be given preference who are:
    ​a. ​In psychiatric residential treatment facilities (PRTFs) or other residential treatment providers either out-of-state or in-state; and
    b. Eligible for Medicaid and are at risk of being placed in a medical care facility.

  2. Can I apply for CSEDW services while on another waiver waitlist?
    Yes. However, you cannot be on multiple waivers at the same time. Although youth with diagnoses for both conditions are eligible, the CSEDW services must benefit them.

  3. I just had a psychological report done. Can I use that report to apply?
    No. The health care provider must be an approved evaluator by the MECA (Medical Eligibility Contracted Agent), and the CSEDW requires specific tools or tests. It will be helpful if you provide the independent evaluator with a copy of the recent report and other important medical records. 

  4. Can I keep the same therapist if I get the CSEDW?
    For children who have a therapist before they become eligible for CSEDW and their therapist is not enrolled as a CSEDW provider, the Bureau for Medical Services (BMS) and Aetna Better Health of West Virginia have developed a process for them to receive therapy through the Medicaid State Plan. When it is determined that a relationship has been made, the child's team will work with Aetna's care manager and fill out a Coordination of Care Agreement. The agency chosen to provide all the other CSEDW services will be on the form. The form will also state that the primary caregiver wants this option and that in-home family therapy will not be billed for that child under the CSEDW program. Assistance with the Wellness Recovery Action Plan (WRAP) must be kept separate and follow standard policies and procedures for choosing a provider.

  5. How long does the CSEDW last?
    Medical and financial eligibility must be re-established annually. However, this waiver is not for long-term services. The individual child's needs determine the length of the stay, with an expected average of six to nine months. 

  6. Is there an exact list of diagnoses eligible for the CSEDW?
    No, the CSEDW does not have a list of exact SED diagnoses. 

  7. How long does it take to go through the referral process?
    The goal is less than 45 days from referral to getting the decision.

  8. How do I appeal a decision on eligibility?
    The member or parent/legal representative will receive a Notice of Decision in writing if a member is not medically eligible. The decision includes a Request for a Second Medical Examination, a form to Request a Hearing with free places to get legal help, and the reassessment results. The case manager and Aetna Better Health of West Virginia also receive the notice. A member may appeal the denial through the Medicaid Fair Hearing process if they submit the Request for Hearing Form to the Board of Review within 90 calendar days of receiving the Notice of Decision. The member or parent/legal representative can request a second medical evaluation within 14 days from the date on the Denial Letter.

  9. What can I use to prove I live in West Virginia? 
    You can use a valid driver's license, utility bill, Medicaid card, vehicle registration, valid passport (or anything else you have to use your driver's license to get), Social Security card, or birth certificate. If you just moved, you need to get permission from the program director. These decisions are made on a case-by-case basis.

    The West Virginia Department of Human Services (DOHS​) case workers are NOT required to provide proof of residency for people in the State's care.

  10. How can I get my child evaluated within 14 days if there are no providers on the list in my area or available?
    ​Please contact Psychological Consultation & Assessment (PC&A) to assist you in finding a provider in their network at (304) 776-7230​.​

  11. Are there any services I can use while I am on a waitlist for the CSEDW?
    Yes. West Virginia Medicaid members and their families have access to the 24/7 HELP4WV Children's Crisis and Referral Line for links to additional services. These services are dependent on the member's needs. CSEDW members on the waitlist can also contact their Aetna case manager for questions and referrals.​​

  12. ​​Are there any services I can use while I am on a waitlist for the CSEDW?

    Yes. West Virginia Medicaid members and their families have access to the 24/7 HELP4WV Children’s Crisis and Referral Line​ for links to additional services. These services are dependent on the member’s needs. CSEDW members on the waitlist can also contact their Aetna case manager for questions and referrals​

CSEDW
Application

Click here for the CSEDW application form. 

Find a
Provider

Click here to find a CSEDW provider near you. 

Info for
Members

Click here for additional waiver information and benefits for home and community-based services members.

Info for
Providers

Click here for home and community-based services provider resources. 

Fact
Sheet

Click​ h​ere for the CSEDW Fact Sheet. 

Non-Emergency Medical Transportation Information

​​​Individuals who have a West Virginia Medical Card may be eligible for transportation to and from your routine medical appointments. For more information, call 1-844-549-8353, Monday - Friday between 7:00 am to 6:00 pm

To learn more please click here.​ ​