Ref doc - NJ Children`s System of Care

Instructional Guide for the
Annex A Addendum in CYBER
07/30/2015
Instructions for Use
Table of Contents
I. Introduction ........................................................................................................................................................................ 2
II. Accessing CYBER ................................................................................................................................................................ 3
III. Accessing the Annex A Addendum ................................................................................................................................... 4
IV. Creating a New Annex A Addendum ................................................................................................................................ 7
V. Completing a New Annex A Addendum – Section by Section .......................................................................................... 9
VI. Renewing an Existing Annex A Addendum .................................................................................................................... 23
VII. Creating a Modification to an Existing Annex A Addendum ......................................................................................... 23
VIII. Submitting a Change to Contact Information .............................................................................................................. 25
IX. Creating an Admin Change Annex A Addendum ............................................................................................................ 25
X. Using the Copy Annex A Addendum Functionality ......................................................................................................... 27
XI. Submitting the Annex A Addendum (& Validation Errors) ............................................................................................. 29
XII. Printing the Annex A Addendum ................................................................................................................................... 30
Appendix A: Required Fields............................................................................................................................................... 32
Appendix B: Changes to the Annex A Addendum ............................................................................................................... 35
Appendix C: Updated Specifiers ......................................................................................................................................... 36
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I. Introduction
The Annex A Addendum in CYBER is the electronic version of the Addendum to the Annex A contract that residential
providers have with the NJ Children’s System of Care (CSOC). This document will review the Anne A Addendum
functionality that was updated in the CYBER 1.28 and 1.31 releases (the functionality was initially released in 2011 and
this guide replaces all prior Annex A training materials). The Annex A Addendum feeds a program’s Provider Information
File (PIF) in CYBER, which supplies the specifiers that are used to match a youth’s needs to the appropriate Out of Home
program in YouthLink. (All validations previously attached to the Annex A Addendum are still in place with this release
and are discussed in this guide.)
Users within an agency that will have access to the Annex A Addendums for their agency include those with the Contract
Role or Annex A Administrator level of security (agencies can have more than one user with this role), and those with
the Read-Only level of security. The Read-Only security level allows users to view and print the Annex A Addendums
that are in CYBER for the programs they are associate with. These users will not be able to add, edit or submit
Addendums.
New CYBER users who are not familiar with the way security is set-up in the system, or who are new Security
Administrators and need further information about establishing security for their users, should review the training
materials posted on the PerformCare website entitled “CYBER Release 1.16 System/Security Administrator Role Based
Security” (#102). If users have any difficulty or questions about security or the Annex A Addendum functionality, they
should contact either their System Administrator or the CYBER Service Desk at [email protected] or 1-877736-9176.
Existing CYBER and Annex A Addendum users are encouraged to review the Appendix for Changes/Additions to the
Addendum, as well as the Appendix that lists all of the required fields in the Addendum.
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II. Accessing CYBER
Users must first log-into CYBER with their UserID and Password. The log-in screen can be found via the PerformCare
website – www.performcarenj.org.
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III. Accessing the Annex A Addendum
Once the user is logged into CYBER, they will click on the Provider Details button on the left side of the Welcome Page.
Clicking here will bring the user to the Provider Details screen, where they will need to click on the Annex A Addendum
button on the left-side of the screen.
The Annex A Addendum button will bring the user to the Annex A Addendum screen for the programs they are opened
to in CYBER. (Each user is attached to programs via their User Profile; in order to change the programs a user is opened
to, they would need to contact their Systems Administrator or the Service Desk; also, if a user does not have access to
the Annex A Addendum button here and should, they would need to contact their Systems Administrator to adjust their
security settings.)
This screen will list all of the Pending Addendums in the top grid for every program; these Addendums are either saved
and not submitted for CSOC review, or have been returned to the program(s) for changes. This screen will also house a
list of all approved or denied Addendums for all programs the user is opened to.
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The user will find a drop-down menu at the bottom of the screen that will list all of the programs they are opened to.
Navigating to a program using this menu will show the user only the Addendums associated with that program and will
allow the user to create new documents. (Users can open documents from this screen and make changes to any that
are in a Saved or Returned for Changes status.)
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The information that a user will find in the Pending grid includes;


All of the Addendums for the program(s) that have been saved, submitted or returned for changes by CSOC.
o Please note that any user within the agency with the appropriate security level can edit, submit or
delete an Addendum that has not yet been submitted to CSOC; Addendums that have been returned for
changes can be edited by any user with the appropriate security level.
Columns include the following information;
o EffDate – Effective Date – the Effective Date entered by the author of the Addendum that has been
submitted; can be edited by CSOC
o Contract Number – as entered by the author on the Addendum; can be edited by CSOC after submittal
o Contract Begin Date – the start date as entered on the Addendum; can be edited by CSOC after
submittal
o Contract End Date – the end date as entered on the Addendum; can be edited by CSOC after submittal
o Medicaid ID – the Medicaid ID number of the program
o Status – the status of the Addendum – Saved, Submitted or Returned for Changes
o Submission Type – the type of Addendum that was created/saved/submitted/returned for changes –
New, Renewal, Modification, Admin Changes
o ModNo – if the Addendum is a Modification that has been Returned for Changes, the number will
appear here as it was entered by CSOC
o Agency Name – the agency, or program name that the Addendum was created for
o Program Type – DAP, TH, GH, RTC, SPEC, PCH, IRTS, EDR, ORT, SSH-IDD, SA-IDD, GH 1-DD, GH 2-DD, GH
3-DD, RTC-IDD, SPEC-IDD, PCH-IDD, IPCH-IDD, ORT-IDD, SA-RTC-ST, SA-RTC-LT; can be edited by CSOC
after submittal
o Submitted By – the CYBER ID of the user that submitted the Addendum
o Submitted Date – the date the Addendum was submitted to CSOC for review/approval
If there is an Addendum in this grid, another Addendum of the same type cannot be created. For example, if there is a
Renewal already created and saved for a program, and a user attempts to create another Renewal for the same
program, they will get an error message stating that a document already exists and must be deleted before another of
the same type can be created.
The information that a user will find in the Approved/Denied grid at the bottom of the screen includes;


All of the Addendums for the program(s) that have been approved or denied; denied Addendums will remain on
the grid for 60 days after being denied. Denied Addendums can be viewed but cannot be printed or copied
from.
Columns include the following information;
o EffDate – Effective Date – the effective date of the contract; may be different than the Begin Date if a
Modification has been submitted and approved
o Contract Number – as entered on the Addendum (CSOC has the ability to alter the number before
approval)
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o
o
o
o
o
o
o
o
o
o
Contract Begin Date – the start date as entered on the Addendum (CSOC has the ability to alter the date
before approval)
Contract End Date – the end date as entered on the Addendum (CSOC has the ability to alter the date
before approval)
Medicaid ID – the Medicaid ID number of the program
Status – users will see either Approved or Denied
Submission Type – New, Renewal, Modification, Admin Change
ModNo – Modification Number – if the Addendum has been Modified and the Modification has been
approved and is active, the number will appear here (as entered by CSOC)
Agency Name – the agency or program name the Addendum was approved or denied for
Program Type – DAP, TH, GH, RTC, SPEC, PCH, IRTS, EDR, ORT, SSH-IDD, SA-IDD, GH 1-DD, GH 2-DD, GH
3-DD, RTC-IDD, SPEC-IDD, PCH-IDD, IPCH-IDD, ORT-IDD, SA-RTC-ST, SA-RTC-LT (CSOC has the ability to
alter the program type before approval)
Submitted By – the CYBER ID of the user that submitted the Addendum
Submitted Date – the date the Addendum was submitted to CSOC for review/approval
IV. Creating a New Annex A Addendum
Whenever a user is creating an Annex A Addendum, whether it be a new Addendum, a Renewal, etc., they must first
chose a program from the drop-down menu at the bottom of the Annex A Addendum screen. To create a new
Addendum, they will then select the “New/Renew Annex A Addendum” button. *Please note – if the user’s programs
are all new to the system and no other Annex A Addendums exist in CYBER, the Addendum is considered to be “New”;
the program may have had previous Addendums on paper or outside of the CYBER system but because this is the first
version in the system it is considered a New Addendum.
(If a user is creating an Addendum for a new program, but has other Addendums in CYBER for other existing programs,
they have the option of copying an existing Addendum for the new program. See page 27 for more information on the
copy functionality.)
Also to note – the Renew functionality will become available for any Addendums that have been approved and will be
renewing 90 days from the current date. The other functions – Modifications, Update to Contact Information and
Administrative Change – will be available once the Addendum has been approved and is active (the effective date of the
contract has passed).
Once the “New/Renew Annex A Addendum” button has been selected, a new Addendum will open on the screen.
*Please note – only one pending Annex A Addendum can be in the system at one time. If there is another Addendum in
CYBER for the program that has been saved, or submitted to CSOC but not yet approved, denied or returned for
changes, the user will be blocked from creating another Addendum for the program.
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The “New” radio button at the top of the document will be pre-selected by the system as the document type. The
Addendum is set up as an accordion, so the user can open just the areas they are working in without having to navigate
through the entire document.
*Please note – it is highly recommended that the user utilize the “Save” button at the bottom of the Addendum on a
frequent basis – at least every 10-15 minutes. That way, if there are any issues with the user’s Internet connectivity or
with CYBER, the user will not lose a great amount of information should the system go down. Clicking “Save” will not
run validations on the document; any validations will run when the user clicks the “Submit” button. (If the user chooses
to print the Addendum at any point, the system will automatically save the document at that time, as well.)
There is a “Delete” button at the bottom of the document that can be utilized if the Addendum was created in error; the
button cannot be used once the Addendum has been submitted, returned for changes, approved or denied. The Delete
button may be used if the user accidentally creates an Addendum; the system automatically saves the document once it
is created so the user will need to delete it if it was created in error.
Some fields in the Addendum will pre-populate with the information from the Provider Information File (PIF). It is
recommended that the user double-check this information and, if necessary and available for edit, make any changes.
(The Medicaid ID and Program Type cannot be edited by the user.)
Most text boxes within the Addendum are required, unless otherwise noted. If a user has nothing to add to a required
text box, it is recommended that they enter “N/A” so that, once submitted to Contracting, it is clear that this area does
not apply to the program.
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V. Completing a New Annex A Addendum – Section by Section
Once the user creates the new Addendum, they can begin working in any accordion. It is recommended that users begin
at the top and proceed through the accordions in order; this is specifically useful when completing the Populations
Served and then the Site Details accordions because information in the latter depends upon what was entered into the
former.
The first accordion that the user will see is the Agency Information accordion.
The Agency Information accordion sample above includes information from this program’s PIF – Medicaid Provider ID#,
Agency Name and Program Type. (Users will see a new field – Provider Type – appear above Program Type; this was
done to aid CSOC in completing any edits they may need to do to the type of program that is attached to this Addendum
submission.)
The user must complete the Contract Number, Contract Begin and Contract End Dates (the Contract Begin Date should
be the day after the current contract expires). If the user makes any errors, CSOC may make changes to any of these
fields.
The Effective Date has been added and is optional; if the effective date of the contract is different than the begin date,
the user may enter it here.
Users will also see a “Conditionally Approved” checkbox under the Effective Date. This will be utilized by CSOC when,
based upon current information, a contract is approved. The program will need to submit a Modification (see page 23)
to make changes.
Please note: the Website Address for the program, if it is available, has been moved to the Agency Contact Info
accordion.
The next accordion is Agency Contact Info.
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All of the fields in this accordion are required except the Website Address; attempting to submit the Addendum without
completing the required fields in this accordion will cause the user to receive a validation error and they will not be able
to submit until all required fields are completed.
The user can copy and paste in the fields in this accordion, which may save time if all of the individuals are at the same
location. Selecting the text in one field, hitting the “ctrl” and “c” button on the keyboard will copy the information. After
selecting the destination field, hitting the “ctrl” and “v” buttons on the keyboard will paste the information into the next
field.
Users will also see that the City and State boxes are not available for use; these will populate once the user enters a zip
code. If a zip code is entered that covers multiple towns, the user will get a selection menu to chose the appropriate
town.
*Please note that the Admissions Contact information is not a part of the Annex A Addendum; that information can be
found in the PIF. The PIF is accessed via the Provider Details screen and the Update PIF button on the left-side of the
screen (see page 4 for an example). The Admissions Contact information is the only field that can be updated there; all
other changes must come through an Annex A Addendum.
*Please note: the Contract Person’s information was overriding the Admissions Contact information in the PIF in prior
releases, but this was changed in CYBER Release 1.28. The Contract Person’s information will no longer feed into those
fields on the PIF.
The next accordion is Populations Served
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The accordion will open to the Gender and Ages Served areas (which document the population that is served for the
entire program, across all sites); both of these are required fields and at least one selection must be made in each area.
There is a Navigation menu at the top of the accordion that allows users to choose what area of the accordion they want
to go to, making navigating through the large accordion an easy task.
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By checking off a specifier (population served) in this accordion, the user is indicating that the program serves individuals
with these needs. By leaving a specifier blank, the user is indicating that this is a need that the program does not serve;
any specifiers left blank will print with an indication of “no”.
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As shown in the above example, a new option has been added to some specifiers in this accordion. Some specifiers will
have No, Yes and Required as selection options.



Selecting No indicates that the program does not serve youth that have this need; youth with this need will not
be automatically matched with the program in YouthLink.
Selecting Yes indicates that the program does serve youth with this need and they will be automatically matched
with the program in YouthLink.
Selecting Required indicates that the program only serves youth with this need; unless this need is indicated on
the referral, the youth will not be automatically matched with the program in YouthLink. If a youth has all other
specifiers indicated on their referral, but does not possess the one that is required by the program, they will not
be matched to the program in YouthLink.
*A selection must be made of Yes, No or Required in order to pass validation. If an item under the specifier is
selected (in the above example, if Adjudicated was chosen), Yes would automatically be selected by the system
for Non-Predator (Victim is known to offender), the main specifier.
*A sub-specifier must be selected in order to pass validation. For example, if the main specifier of Substance
Abuse is selected as Yes or Required, the user must select at least one sub-specifier (such as History of
Addiction) in order to pass validations and submit the document.
The additions/changes and all required fields in the Populations Served accordion are detailed in the Appendices; please
review prior to completing the document to ensure all required fields are completed appropriately.
Site Details is the next accordion.
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The example above shows a program that has sites already set-up in the PIF. In order to make changes to the record
in the grid, the user would double-click on it in the grid to open the Site Details window. To add or create a new site,
the user will utilize the button at the bottom of the grid. The New Site window will then open.


All of the fields here are required; at least one selection must be made within Ages Served and Gender Served.
*Please note – the Ages Served, Gender Served, and total Capacity across all sites MUST fall within the
parameters selected or entered into the corresponding areas in the Populations Served accordion. For example,
if the user were to enter 10 in the Capacity field, and another site had 15 entered (for a total of 25) and the total
number of Contracted Beds in the Populations Served accordion was 10, the user would get a validation error
upon attempting to Submit. (See page 32 for information on Population Served required fields.)
If the above screen example had been an existing site already entered into the accordion, the “Inactivate”
button at the bottom of this window would be active. This allows the user to keep site information in the
Addendum without having to delete it; Inactivating the site removes it from YouthLink.
o The delete option is available on the Site Details grid and allows a user to delete a site from the Annex A
Addendum; users can only delete a site if it does not have a PIF in CYBER already. If there is a PIF for a
site, then it must be Inactivated (any sites that are Inactivated will not appear in future Addendums).
(The “Activate” button becomes active only for sites that have been deemed Inactive.)
Physical Environment is the next accordion.
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All areas of this accordion are required; at least one selection must be made in each area and the Mass Transit Access
Description text box is required.
Under Bedroom Type, the corresponding text box for the selection made must be completed with the appropriate
number.
The next accordion is Services Provided.
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Under Part A, Clinical Service, the user should check off either Agency, Community or both options for any of the listed
Clinical Services that are provided through the contracted per diem rate.
Please note: there is a new Type menu available for use if the user selects Agency or Community for Independent Living
Curriculum/Life Skills Training.
Under Part A, Allied Services, the text box labeled “Other” is a required field; if the user has nothing additional to add,
entering “N/A” will fulfill the field requirement.
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In Part B – Other Services, Educational Services – at least one item must be selected; Agency, Community or both
options can be selected. Also required is the text box, “Describe how educational program is supported by agency”.
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Under Medical Services, all three of the text boxes are required.
Under Community Based Opportunities, the only required field is the text box; all others are not required but can be
completed with either one option or both.
The next accordion is Clinical Model.
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Users will find a grid when the accordion opens; in order to add information, users will click on the Add button at the
bottom of the accordion. Doing so will open the Create New window.
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For each Model entered, all fields are required; at least one Model must be entered in order to submit the Addendum
successfully.
The Intensity menu includes Family, Group, Individual and Other; if Other is chosen, the text box immediately below
becomes a required field.
The Frequency menu includes Weekly, Biweekly, Monthly and Annually. The Duration of Occurrence menu currently
only has Hours as an option.
Users can add as many Clinical Models that are necessary to document their model for clinical services; in the previous
version, users could only enter seven.
The next accordion is Team Members to Child Ratios.
Although no one row is required, if a user completes a field within a row (including Credentials), the entire row becomes
required.
Users will notice that, as they complete the fields within a row that the # Children Served box will automatically
populate with the number of Contracted Beds entered into the Populations Served accordion. (If the user changes the
number of Contracted Beds, this field will automatically update.)
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New positions have been added to this accordion. They are as follows;



NJ Licensed Physician
Addictions Counselor
Behavior Analyst
Performance Based Outcomes is the next accordion.
Every field in this accordion is required; each can accept a whole number with two numbers after a decimal point (if
necessary).
Miscellaneous Stipulations is the final piece of the Addendum that is part of the contract.
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The user must make one selection in the first two areas under Referral and Admission Process.
Users do not have the ability to upload their schedules to attach to the Addendum; they also do not have the ability to
enter an electronic signature. Therefore, users must print two copies of this page to submit (with original signature),
along with the weekly schedules. These documents must be received by Contracting in order for the Annex A
Addendum to be reviewed; Contracting will use the receipt of these documents as a flag to them that your Addendum
has been successfully submitted, is complete and ready for review. (For more information on printing the Addendum,
see page 30.)
The final accordion, Comments, will be enabled once the user submits the Addendum to CSOC. This area will be used for
Contracting to document reasons regarding the return of an Addendum for changes or regarding a denial. Once the
document has been returned and the user has made changes or updates, they may utilize this area to communicate
back to Contracting regarding the changes made. The Comments accordion is not part of the contract, so it will not print
with the rest of the document.
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VI. Renewing an Existing Annex A Addendum
Users will have the ability to create a Renewal 90 days prior to the end date of the contract; prior to that, the Renew
functionality will not be available.
In order to create a Renewal document, as with New Addendums, users must first select the appropriate program from
the drop-down menu at the bottom of the Annex A Addendum screen. Once the program is selected, the user will find
the currently active and approved Addendum in the bottom grid of the window – Approved/Denied Annex A Addendum
Details. Clicking on the New/Renew button at the bottom of the window will generate a Renewal Addendum.
The Renewal will be pre-populated with all of the information from the approved Addendum; as of release 1.28, the
General Comments text box in the Populations Served accordion also pre-populates from the approved Addendum and
should be reviewed prior to submitting the Renewal.
VII. Creating a Modification to an Existing Annex A Addendum
Users have the ability to create and submit a Modification once the program’s Annex A Addendum has been approved
and is active (the start or effective date of the contract has passed by one day); this includes any previous Modifications
that may have been submitted. A Modification should be submitted when there are changes to the program, such as a
change to the number of contracted beds or a change in the population that the program serves. (If there are changes
only to the Agency Contact Information accordion, the user should create and submit an Update to the Contact
Information; please see page 25 for information.)
In order to create a Modification, the user will select the Modify Annex A Addendum button at the bottom of the
program window.
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Once the Modify button has been selected, the user will receive confirmation that the Modification has been created
and the document will open.
The document that opens is the active and approved current Addendum; by choosing a Modification, the system allows
the user to make any necessary changes to the entire document. The user must go into the Agency Information
accordion and enter an effective date for the Modification.
This date can be modified by CSOC, if necessary, after submittal. This date must be equal to, or after, the start date or
effective date of the currently active Addendum, and will display as the Effective Date in the Approved/Denied grid.
(Please note that the Mod # field is not available for the use of the program; the number is for tracking purposes and will
be entered by CSOC.)
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If an Approved Addendum has been modified (the Modification was approved), the “EffDate” column may have a
different date than the “ContractBeginDate” column; the Addendum will also have a number in the “ModNo” column in
this grid.
VIII. Submitting a Change to Contact Information
If the only change that needs to be made is to the Agency Contact Information accordion of the Addendum, the user
should utilize the “Update Contact Information” button at the bottom of the program window.
Clicking here will bring up the currently active and approved Addendum; the user will only have access to the Agency
Contact accordion. Once the user has updated the information, they will save the document and the changes will
immediate be in effect; there is no CSOC review for this change.
IX. Creating an Admin Change Annex A Addendum
The Administrative Change Annex A Addendum allows a user to only change information in the program’s Site Details;
changes can include moving the number of beds at a site to another site, activating/deactivating a site, adding a new
site, changing the gender and/or ages served at a site. *Please note that these selections still need to fit into the
parameters chosen within Populations Served, even though that accordion is not available for use in the Admin Change
Addendum; if users need to make changes to that accordion, they should complete a Modification.
When the “Admin Changes” button is selected, the system will open the most recently approved Annex A Addendum for
the program.
*Please note: if there is a pending Addendum in the system for the program of any type (Modification, Renewal, etc),
the user will be unable to create an Administrative Changes Addendum until the pending Addendum is approved and
the effective date has passed (meaning, it is active), unless the effective date of the new Administrative Changes
Addendum is after the effective date of the approved an Annex A Addendum that is not yet active.
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Three sections of the Addendum will be available for use – Agency Information, Site Details and Comments.
The Admin Changes Effective Date must be completed; it is the date on which the changes the user makes to Site Details
go into effect and this field can be edited by CSOC/Contract Administration, if necessary. When the Addendum is
approved, the PIF will update immediately if the Effective Date is in the past or is equal to the date of approval. If the
Effect Date is in the future, the PIF will update on the Effective Date.
Users can utilize the Comments area of the Addendum to document why the changes were made, or to give further
information about the changes made to Site Details. (Because this accordion is not part of the contract, this accordion
will not appear in the printed version of the document.)
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X. Using the Copy Annex A Addendum Functionality
Users can copy existing, approved Annex A Addendums from one program to a new program only; if the program has a
pending Addendum in the system (saved, submitted, returned for changes), or has an approved Addendum, the user will
not be able to use the Copy functionality.
In order to use the Copy function, the user must first navigate to the new program (or to a program that does not have
an Addendum in the system). Upon selecting the program, the Copy Annex A Addendum button will be active and
available for use.
Clicking on the Copy button will open up a list of the available Addendums for copying; only active and approved
Addendums will appear in the list.
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Selecting an Addendum from the grid and then clicking on the Copy button will create the new Addendum for the
program; all sections of the Addendum will copy into the new document except Agency Information, Site Details and
Comments. Within the Populations Served accordion, the Number of Contracted Beds, Genders and Ages Served, and
Licensing will also not copy into the new Addendum. All fields that copied over will be available for edit and should be
reviewed by the user. The copied Addendum will have the same validations placed on it when the user attempts to
submit to CSOC.
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XI. Submitting the Annex A Addendum (& Validation Errors)
In order to submit the document to Contracting for review and approval, the user will click on the Submit button at the
bottom of the Annex A Addendum window.
Clicking the Submit button runs a series of validations on the document that check that all required fields are complete,
the Begin and End Dates for the contract do not overlap inappropriately, etc. If there are any issues with the document,
the user will receive a Validation Error message, detailing the missing information.
The Validations will list with the title of the accordion and the field name that is either missing or has been completed
incorrectly. On the Addendum, the missing or incorrect fields will be highlighted, making them easier to locate.
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XII. Printing the Annex A Addendum
At any time, the user can print the program’s Annex A Addendum. Any Addendum that is not approved will print with a
“Draft” watermark on every page.
Clicking on the “Print” button at the bottom of the Addendum window will prompt the system to generate the report.
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It is recommended that users export the report to another version, a PDF file, in order to print the document; printing
directly from CYBER may be a lengthy process. To export the report, users will select utilize the Export button on the top
of the reporting window (highlighted in above example; appears as a disk with a green arrow in the corner).
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Appendix A: Required Fields
All of the required fields in the Annex A Addendum are documented here, separated by accordion. If these items are
not completed, the user will receive a validation upon attempting to submit the document. The validation error will give
the user a list of items that are either missing or need correction; these items will be highlighted within the document,
making them easy to locate. (See page 29 for an example of the validation error message.)
Agency Information




Contract Begin Date (must be the day after the current contract ends)
Contract End Date (must be after the Begin Date)
Contract Number
Modification/Admin Change Effective Date (required only for those Submission types)
o Modification Effective Date must be after the effective date of the current contract
o Admin Changes Effective Date can be in the past; if passed, the PIF will be updated as soon as the
Addendum is approved
Agency Contact Information

All fields in this accordion are required
Populations Served
The following fields are required in the Populations Served accordion;
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Gender Served – one option must be selected
Ages Served – at least one option must be selected
o *Please note – both of these are for the genders and ages served by the whole agency at all sites; in Site
Details, the information must align with what is entered here
Languages Spoken by Staff – at least one option must be selected; if Other is chosen, the associated text box is
required
o The text box – “Describe how program will access language/translation services for youth who do not
speak English” is required
IQ – at least one option must be selected; for those options that have the Yes/No/Required associated, one
option must be selected
Genetic/Congenital Disorders – the “Other” text box is required
Notes to Medical Section text box
Special Expertise text box – “Please submit additional information on any special programs….”
Licensed Capacity – this is the total licensed capacity across the entire program
Date of Last Licensing Inspection
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Total # of Contracted Beds – this is the total number of contracted beds across the entire program; the total
capacity across all sites entered in Site Details cannot exceed the number entered here. The number entered
here cannot exceed the number entered in the Licensed Capacity field.
Accreditations – at least one accreditation is required; a user may select “None” to fulfill the requirement
o If an Accreditation is selected, the Last Inspection Date and Date of Expiration for that Accreditation are
required
General Comments text box
*Any specifier with a “Yes”, “No”, “Required” option must have at least one selected. Those specifiers are as
follows;
o IQ – 65 to 69; 60 to 64; 50 to 59; 40 to 49; 30 and below
o Sexual Behavior
o Substance Abuse
o Pervasive Development Disorder
o Cerebral Palsy
o Intellectual/Developmental Disability
o Pregnancy
o Diabetes
o Visually Impaired
o Hearing Impaired
 Please note – if there are lower-level specifiers associated with a specifier that has Y/N/R
attached to it, a lower-level specifier must be selected in order to pass validation if Yes or
Required is selected. For example, if the user selects “Yes” for Substance Abuse, and also
chooses History of Addiction, the document will pass validation. If no specifier associated with
Substance Abuse is chosen, the document will fail validation and the user will be unable to
submit.
Site Details
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All fields in the Site Details window are required.
Ages and Gender Served must match the selection made in Populations Served.
The total Capacity across all sites entered must match or be less than the Total Number of Contracted Beds as
entered in Populations Served.
Physical Environment
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At least one selection must be made in each area of this accordion.
If “Other” is selected for Therapeutic Holds Used, the associated text box becomes required.
Under Bedroom Type, the text box associated with the option selected is required.
The Mass Transit Access Description text box is required; there is a limit of 1000 characters
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Services Provided


Part A – users may select Agency, Community or both for any service.
o Allied Services – “Other” text box is required.
Part B
o Educational Services – at least one selection must be made; Agency, Community or both can be
selected.
 The text box for Describe how educational program is supported by the agency is required;
there is a limit of 1000 characters.
o Medical Services
 Each of the three text fields under Medical Services are required; there is a limit of 1000
characters for each field.
o Community Based Opportunities – no selections are required; Agency, Community or both can be
selected.
 The text box for Describe any other provisions for community opportunities is required; there is
a limit of 1000 characters.
Clinical Model
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At least one row of information must be entered.
All fields are required if one field is entered.
Treatment Team Members to Child Ratios

If a user enters information into a row, all fields in that row become required.
Performance Based Outcomes

All fields are required.
Miscellaneous Stipulations


Selections must be made for the two statements under the Referral and Admissions Process.
The user must print this page and submit two copies of the original, hard copy, to Contracting; the user must
also submit the activities and staffing schedule.
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Appendix B: Changes to the Annex A Addendum
The 1.32 release of CYBER made changes to the matching of certain specifiers on the Addendum and the PIF.
Populations Served
The Psychiatric Condition specifier in the PIF will match with:
 Primary Psychiatric Diagnosis:
o Schizoaffective Disorder and Other Psychotic Disorders
 Actively Psychotic (all subcategories)
 Non-compliant with medications
 Mood Disorders
o Actively psychotic (all subcategories)
o Not psychotic
o Non-compliant with medications
 Anxiety Disorders
 Dissociative Disorders
 Impulse-Control Disorder
 Adjustment Disorders
 Personality Disorder Traits
 Mental Disorders Due to a General Medical Condition
 Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence
o Developmental Disabilities
o Tic Disorder (Tourette’s, etc.)
Medical Conditions
The Medical Conditions specifier in the PIF will match with:
 Enuresis
o Non-compliant with treatment
 Encopresis
o Non-compliant with treatment
 Seizure Disorders
o Controlled (all subcategories)
o Non-compliant with treatment
 Physical Disability
o Non-ambulatory
 Spinal Condition (all subcategories)
 Immuno-suppressed
 Cardiac Problem (all subcategories)
 Respiratory Disorder (all subcategories)
 Bleeding Disorder (all subcategories)
 Hepatitis (all subcategories)
 Kidney Dialysis
o Non-compliant with treatment
 Any medical condition requiring 24-hour nursing
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Appendix C: Updated Specifiers
This refers to the full list of specifiers shown in the Update PIF screen and the corresponding item(s) on the
Annex A that triggers each specifier (from Release 1.23; updated with release 1.31).
Specifier (* = new/changed)
Age
Corresponding Annex A item
Anything marked “yes” in “Ages Served” section
Gender
Gender Served
IOS
Program Type
Pregnancy
Medical Conditions - Pregnancy
*IQ 50-69
IQ – 65 to 69
IQ – 60 to 64
IQ – 50 to 59
*IQ 49 and under
IQ – 40 to 49
IQ – 39 and below
Assault
*Cerebral Palsy
Destructive Behavior
*Diabetes
Anything marked “yes” in “Assault” section
Genetic/Congenital Disorders – Cerebral Palsy
Anything marked “yes” in “Destructive Behavior” section
Medical Conditions – Diabetes
*I/DD
Self-Help/Developmental Skills – Intellectual/Developmental
Disability
*Disruptive Disorder
Psychiatric Hospitalization – Primary Psychiatric Diagnosis –
Disorders Usually First Diagnosed in Infancy, Childhood, or
Adolescence – Disruptive Disorders
Eating Disorder
Educationally Classified
Fire Setting
Anything marked “yes” in “Eating Disorder” section
Anything marked “yes” in “Education” section except “Not Classified”
Anything marked “yes” in “Fire Setting” section
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*Hearing Impaired
Medical Conditions – Physical Disability – Hearing Impaired
Medical Condition
*See page 35 for full list*
*PDD
Psychiatric Condition
Primary Psychiatric Diagnosis – Disorders Usually First Diagnosed in
Infancy, Childhood, or Adolescence – Pervasive Developmental
Disorders
*See page 35 for full list*
Runaway
Anything marked “yes” in “Runaways” section
Sexuality
Anything marked “yes” in “Sexuality” section
*Sexual Behavior
Suicide Risk
Substance Abuse
*Trauma
*Visually Impaired
Sexual Behavior
Anything marked “yes” in “Suicide” section
Substance Abuse
Anything marked “yes” in “Trauma History” section
Medical Conditions – Physical Disability – Visually Impaired
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