A
Overview
for County Officials
January 25, 2013
10:00 a.m. – 12:00 noon
THE BASICS: What is
Meghan Mohs, Ramsey County
Pam Erkel, DHS
2
Purpose of the Webinar?

Share information on MnCHOICES from DHS
and county perspectives

Inform county officials on status of MnCHOICES
project

•
What’s known; what’s been decided
•
What remains unknown; still to be decided
Outline next steps for MnCHOICES
implementation
•
•
For DHS
For county boards
3
Minnesota’s Vision for
Long-Term Services and Supports
Minnesota’s system for long-term services and
supports will:

Support people in having a meaningful life at
all stages of life

Keep Minnesotans in their community; prevent
more costly institutionalization

Be flexible, responsive and accessible

Ensure the system’s sustainability in order to be
available to those who need it in the future
4
Context for Change

Changing demographics and economic
pressures put Minnesota’s current system
for long-term services and supports at risk
of not being sustainable

Opportunities to support innovation and
reform

Compliance with federal requirements

Strong county-state partnership
5
Objective
Transition Minnesota’s long-term
services and supports system from
“What programs do
you
qualify for?”
“What do you need to
meet
your goals?”
6
What Won’t Change:
Mission and Values of the DHS’s
Continuing Care Administration
 Mission
• Improve the dignity, health & independence of the
people we serve
 Values
• Equity across individuals, lead agencies, providers
• Quality services that can be measured and
maximized
• Transparency, efficiency, consistency
• Leverage all viable resources to reduce
dependence on public funds
• Continuously improve service administration
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What Will Change:
Three Major Reforms
Provider Standards
Rate System
A system that
standardizes
provider
qualifications &
drives continuous
quality
improvement
A rate-setting
platform that
ensures consistent
& transparent
statewide pricing of
disability waiver
services
A single comprehensive
assessment that focuses
on strengths, needs and
preferences; drives
efficiency and supports
choice
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What is
?
 Supports longstanding core county
function – conducting assessments
 Combines assessment with service
planning process
• Determines eligibility for programs and
services
• Used for all ages and disability types
• Completed by a certified assessor using
web-based application
• Functions offline -- without an internet
connection
9
What is
?
 Replaces four assessments:
1.
2.
3.
4.
Developmental Disability Screening (DD)
Long-Term Care Consultation (LTCC)
Personal Care Assistance (PCA)
Private Duty Nursing (PDN) - Future
 Uses person-centered approach to
tailor services to individual’s strengths,
goals, preferences and assessed needs
 Changes who conducts assessments
• Only certified assessors
• County of location responsible for conducting
all assessments
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Supports a Partnership Between
the State and Counties
Counties
The State
Provide administrative
framework that
supports personcentered services
• Establish a framework for
setting clear & consistent
expectations
• Provide a functional
assessment application
• Assure fair and timely
MnCHOICES payment to
counties
• Provide innovative and
meaningful training
• Collect and analyze data for
quality improvement
Minnesotans
Provide and direct
service in local
communities
•Act as state’s
administrative arm
•Ensure staffing and
technology resources to
support MnCHOICES
•Generate and use data
to promote shared policy
goals
•Advance continuous
quality improvement
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Next Steps…
For DHS…

Continue building the MnCHOICES application for
implementation

Implement payment structure

Provide assessor training and certification to county staff

Provide communication state-wide
For County Boards…

Be ready to make decisions for local implementation of
MnCHOICES

Budget, staffing and technology
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THE DETAILS:
How will
be Implemented?
13
Presenters
• Pamela Erkel, DHS
• Nancy Jurgensen, DHS
• DiAnn Robinson, DHS
• Tom Henderson, Brown County
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DHS’ Next Steps…
Continue building the MnCHOICES
application for implementation
 In-the-field testing of the Beta application by First
Implementers
• Beta 1 – Summer 2012
• Beta 2 testing – Fall 2012
• Beta 3 testing – First quarter of 2013
 Initial Release –Summer 2013
 Second Release – to be determined
 Future Releases – to be determined
15
DHS’ Next Steps…
Change Payment Structure – Why?
 Assessments are administrative, gatekeeping activities that
determine eligibility for programs and services for the proper
administration of Minnesota’s Medicaid Program
 DHS delegates some Medicaid administrative functions to
counties
 Currently, counties are reimbursed for assessments through 5
different funding methodologies; some as a service and others
administrative
 Reimbursing these types of assessments as a service contradicts
Centers for Medicare and Medicaid Services’ (CMS) intent to
delineate administrative gatekeeper functions from services
such as case management
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DHS’ Next Steps…
Implement Payment Structure – How?

MnCHOICES activities are eligibility assessments and will
be reimbursed through random moment time surveys

Time studies draw down Federal Financial Participation
(FFP) through Medicaid Administrative Claiming MA

There are two options for FFP reimbursement
1. Administrative FFP - Used for activity defined by CMS to be
part of administering MA
2. Service FFP - Used for activity defined by CMS to be services
rendered to individuals (medical treatment, PCA, Targeted
Case Management, etc.)

Random moment time studies (RMTS) are Minnesota’s
approved methodology to pay for administrative
activities
17
DHS’ Next Steps…
Implement Payment Structure – How?, cont.

Three types of time studies for MnCHOICES
reimbursement:
1. SSTS (Social Services Time Study)
2. LCTS (Local Collaborative Time Study) – Public Health
3. MATTS (Medicaid Administrative Tribal Time Study)

Random moment surveys are sent to staff to identify activities
being completed at the time of the survey

New time study activity codes and definitions to identify
MnCHOICES activities in the survey
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DHS’ Next Steps…
Implement Payment Structure – How?, cont.

Reimbursement for MnCHOICES activity will consist
of 50% federal funds and 50% state funds

It will cover 100% of the MnCHOICES eligible costs
as determined by the time study cost and activity
report

MnCHOICES payments will be a separate line item
from other time study payments
Implement Payment Structure – When?

It is anticipated that this payment structure will
begin July 1, 2013
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DHS’ Next Steps…
Implement Payment Structure – When?
What if my county is using MnCHOICES before the Time Study
payment starts?
What if my county isn’t using MnCHOICES when the Time
Study payment starts?
Claiming through
Fee-For-Service
Conducting Paper Assessments
Time Study
Conducting MnCHOICES
assessments
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Expectations/Assurances of Counties
1. Perform administrative functions and activities
• Assessment and support plan development
 Level of care determination
 Program and service eligibility
• Service authorization for providers to get
paid
• Quality management
2. Provide access to assessment process
• Assessments to all regardless of incomes or
assets, referral source or county financial
responsibility
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Expectations/Assurances of Counties
3. Assure an adequate number of certified assessors
• Only a certified assessor can complete an
assessment/reassessment & develop a support
plan
• Must meet qualifications and experience:
 A minimum of a bachelor’s degree in social
work, nursing with a public health certificate,
or other closely-related field and at least one
year of home- and community-based
experience, or
 A two-year registered nursing degree with at
least two years of home- and communitybased experience
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Expectations/Assurances of Counties
Continued…
3. Assure an adequate number of certified
assessors
• Reassign county case managers and/or
hire new social workers and/or public
health nurses to meet the staffing need
• Will hand-off to case manager if on a
waiver or Alternative Care;
communication is important
• Must complete certification and training
called MnCHOICES Certified Assessor
Training (MnCAT)
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MnCAT (MnCHOICES Certification and
Training)
Recertification
Professional Step 4
Development
Certification
Certified
Assessor
Step 3
Step 2
Step 1
Qualifications +
Experience
Step
3
Step
2
Step
1
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Expectations/Assurances of Counties
Support qualified staff to receive MnCHOICES
Certified Assessor Training (MnCAT)
Step #1 – Foundation:

Overview of MnCHOICES
Pass a test on topics including: waivers/Alternative Care, formal
and informal supports, funding, data practices, etc.

Estimated time: 2.5 – 6 hours

Step #2 – MnCHOICES Principles:


Pass course tests of an eLearning program that teaches skills to
perform MnCHOICES assessments and support planning functions
such as person-centered thinking, communication and interviewing
Estimated time: 7 – 15 hours
Step #3 – Application:

Online training to become familiar with the MnCHOICES app
Face-to-face training to enrich and improve professional practice

Estimated time: 7 hours

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Expectations/Assurances of Counties
4. Develop certified assessor multidisciplinary
team
• Team of social workers, public health
nurses and other professionals
• Experience and expertise with all
populations – all ages and disabilities
• Support in understanding programs and
developing support plans
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Expectations/Assurances of Counties
5. Provide resources for technology
 Laptop for certified assessors
• Meets minimum technology requirements
• See 9/21/2012 SSIS Update handout
• iPad or tablet does not work with
MnCHOICES at this time
 Internet access
 Computer proficiency
 Technical support for staff
27
Expectations/Assurances of Counties
6. Conduct quality assurance and monitoring
activities
• Collect client satisfaction data about
services and providers
• Use MnCHOICES data and reports for
program management
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Key Partnership
•
A transformational change requires a dedicated team effort
•
DHS and counties have come together on the MnCHOICES
project
•
Counties have played a critical role in providing input into
training, policy, content of MnCHOICES and testing the
software
•
A core group of counties called First Implementers tested the
training and the software application

•
Identified changes to improve MnCHOICES before statewide
launch
It will be important that our partnership continues
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Information from Pilot
Test Counties about
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Presenters
Kay Dickison, Dakota County
Tom Henderson, Brown County
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Pilot Agencies
Anoka
Becker
Blue Earth
Dakota
Hennepin
Ramsey
Scott
St. Louis
Swift
Yellow Medicine
Blue Plus
Leech Lake Band of
Ojibwe
Medica
PrimeWest
Ucare
White Earth
Dakota County Experience
• Training – Important to Broaden
“Specialist” Staff
• Tool—Navigation “Friendly” but
New/Time
• Yielded Additional/Helpful Information
• Eligibility Rules Effective
Implementation Considerations
• “Right” staffing plan?
• One Intake
• Workflow /transitions if pending MA, wait list,
seniors going to Plans
• Staff Interested!
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Implementation Considerations
 More Staffing Considerations
• Training and start up time
• Teams of nurses and social workers
• Pros and cons of having a team separate
from other staff
• Staff cross training, mixed caseloads vs.
assessment only caseloads
• Contracting case management? Home
care?
 Role of lead agencies vs. contracted
agencies
Moving Forward
Key Role Now & Forward to
Assess/Plan Long Term Services &
Supports
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Thank you!
If you want to learn
more about
MnCHOICES web site:
www.dhs.state.mn.us/mnchoices
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