Notes
1.
Welcome, Introductions, Review Agenda – Glenda Eoyang welcomed Panel members, reviewed the agenda, and asked participants to introduce themselves.
2.
CCA Approach to Transformation – Alex Bartolic, Director, Disability Services
Division; and Jean Wood, Director, Aging and Adult Services Division
This presentation was postponed to allow more time for the MnCHOICES discussion.
3.
Demonstration of MnCHOICES – Kristi Grunewald, Projects Coordinator; Pam Erkel,
Reform Projects Manager
Pam explained MnCHOICES programmatic intent to match clients’ individual needs and strengths with best services through a single assessment process (regardless of waiver program) and decision making. The assessment is done in person, using a web-based assessment tool. The rules-based application aligns regulations to prevent unnecessary overlap and redundancies.
The program has been designed to be easily accessible and responsive to user needs. It covers all programs and services provided by Continuing Care Administration. At the same time, if an individual chooses not to answer a question for personal reasons, that is an option, too. Health Plans will be required to use the MnCHOICES Program, as it is applicable for preventive and health risk planning. The application targets the questions based on the age of the consumer so the questions are age-appropriate. There are also questions that allow a person to elect to self-direct their services.
Information will be generated by MnCHOICES for the client, certified assessors and case managers. It will also track the assessments to be able to connect/compare with previous assessments. There was a recommendation that, once it is operational, the
MnCHOICES database be used for policy and resource decisions.
Certified assessors from lead agencies will work with the client to perform the assessment. MnCHOICES is also designing the training program for that certification.
Full implementation has been delayed due to platform and development challenges, and the decision to integrate the tool with SSIS as lead agencies are already using that for case management. The change in technology will not require additional hardware for local use. All that will be needed to access MnCHOICES is a laptop. An internet connection is required to transmit the data, but people in areas without reliable internet access can download the questions, complete the assessment on the computer and then once they are able to be connected again, upload the information at that time.
The following topics were put onto a parking lot for the Partner Panel to discuss with
Pam and Kristi in a future session.

 Maintain separation between case worker and assessor to avoid any appearance of conflict of interest
 Use of the database to compare current to past needs to assess progress
 Ability to reconcile with MDS and OASIS
 Assurance of consistency and reliability
 Access to the data
 Training requirements
 Time requirements for the assessment
 Availability/use of data for research, policy discussions, longitudinal planning, etc.
 Ability for cross-program information for individual planning and budgeting
 Triggers for reminders of reassessments, notices, etc.
 Preparation of individuals to know what to bring, what to expect, what to take away for self and family
 Ability to review summary before final
 Access for public and private payments
 Impact of more detailed information on eligibility decisions
 Comparison or inclusion of required information for Health Plans
4.
Money Follows the Person Update Q&A – Cathy Jacobson, Acting Planning Director,
Money Follows the Person, and Todd Wilson, CMS Project Officer
Cathy shared an update of the progress they are making to move toward implementation to 1) support clients in transition from institutions to more independent living in the community and 2) establish infrastructure to support people in the community and end overdependence on institutional care. The department will use this as an opportunity to align the services that currently exist and to focus on the match between client and services. The plan ultimately calls for a thorough evaluation of the infrastructures they develop in this effort.
The grant requires work across administrations to combine and coordinate services based on client needs. Partnerships across administrations, and agencies, will create more comprehensive support systems that can address needs across disability type (i.e. including mental health) and across client needs, such as housing and transportation.
The project is intended to address the issue of more timely placements and transitions, including children in Level 5 mental health facilities. Any client who does not meet the criteria to be referred to as a “qualified individual”, one who is not moving to an approved residence, and anyone who doesn’t qualify for specific services will not be eligible. There is a need for flexibility and adaptability in the system to support clients as they seek mid-level care. At this point there will be people who won’t qualify as a demonstration participant. However as the state uses this grant to build its system, the system improvements should help everyone within the system, regardless of eligibility for this grant. The department intends to build structures to help more people, to strengthen programs, and to increase options for clients to find places where they can get their needs meet.
Cathy told the group that the planning team is looking at ways to integrate more people into the decision-making. She also explained that costs for this demonstration will
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remain inside current budget constraints, and use the grant’s extended match of 125% to establish and strengthen the infrastructure.
Cathy introduced Todd Wilson to give him a chance to receive questions from the Panel.
He complimented the group on the work that has already been done in Minnesota to place individuals in the community, and acknowledged that Minnesota’s past progress in this area means many of our challenges and questions are different from those faced by other states.
He pointed out that the money in this state will not flow directly to the client, unless the client signs up for that program specifically. He also recommended a number of ways the funds from the enhanced federal match can be used to extend, expand and enhance services. He pointed out that different states are focusing their work in different ways under this grant. Examples include looking at service gaps, restructuring to use technology for assessment, and to create more waiver capacity. Those various approaches are included on the national Money Follows the Person website at http://www.cms.gov/CommunityServices/20_MFP.asp#TopOfPage.
The following issues were presented as issues to be considered as the planning continues.
 How does this integrate with current processes at the counties?
 What happens when someone needs transitional location between hospital and home?
 How does this support those at the extremes of the bell curve?
 How can this have an impact on how the systems change to meet the particularly complex needs of some clients?
 Do we or are we asking people if they want to live in community?
5.
Accountable Care Organizations – Jeff Schiff, MD, Medical Director, Health Care
Administration; John Selstad
In 2008 Minnesota passed health care legislation to improve affordability, expand coverage and improve the overall health of Minnesotans. In addition, the 2010
Legislature mandated the Minnesota Department of Human Services (DHS) to develop and implement a demonstration testing alternative and innovative health care delivery systems, including accountable care organizations.
DHS will contract with delivery systems as voluntary demonstration sites that will be paid under alternative arrangements. Demonstration sites should include MHCP fee-forservice recipients and managed care enrollees and support a robust primary care model and improve care coordination (e.g. health care homes) for recipients. The goal is to have demonstration contracts with the selected providers in place by January 2010.
The presenters shared a handout that has been put onto the website at www.dhs.state.mn.us/provider/HCDeliveryDemo . Dr. Shiff outlined the current work that is being done to improve outcomes, improve patient experiences and reduce costs.
About one-sixth of the facilities in the state are in this pilot program.
When the demonstration created in the summer of 2010 attempts to re-design the system to move to coordinated care at facilities that meet quality care and experience measures. The demonstration includes the following elements: a.
Requirements of participating delivery systems b.
Payment model options
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c.
Role of quality measures d.
DHS program populations included e.
Attribution/enrollment of patients f.
Role of managed care organizations (MCO’s) g.
DHS data feedback to practices
There are two models. The presenters talked about coordination as conceived under the federal Accessible Care Act as embedded in the health care home. Minnesota’s approach under the ACO model is to engage all settings to address even the non-medical contributors to health.
One panel member asked the presenter to share a “picture” of what the shared/coordinated services might look like. Care providers will access other parts of the system to provide a continuum of services for patients, and then bill for the additional care. There are concerns about transition services and how they can be coordinated for individuals in continuing and long-term care, and how they can preventive treatment rather than acute care.
The group plans to return to this topic when they can dig deeply into these questions and really explore the implications.
6.
Round Robin on Mental Health Concerns – Glenda Eoyang, Facilitating
The purpose was to collect the questions and issues the partners have about mental health concerns. a.
Mental health, physical health and long-term care of disabilities are not unrelated concerns. Mental health impacts physical health, and people with physical and/or intellectual disabilities and the aged also have mental health issues. There seems to be too little thought for this given when designing systems for serving our care systems. b.
Need to remember that in assessment data there is not enough recognition that mental illness impairs a person’s ability to function. There is no recognition that mental illness is chronic and has remissions and relapses. c.
System is bifurcated and has been for way too long. d.
Focus the energy and resources on continuing to integrate mental health care with physical health care. e.
We need to get out of the medical and begin to address the whole person’s needs. f.
A question about the timing of the implementation of the expansion of services under the CADI waiver. g.
Are the waiver programs looking for and trying to address issues for people with mental illness? h.
What kind of technology can help people and what is available that might keep them functioning? How can we fund that? i.
How do we provide support to people so that we can avoid what happens when they look stable and then they lose their supports?
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j.
Co-occurrence and rise of autism with mental illness. How to develop resources and partnerships that help us support people just in time when they need support? k.
How can we align and coordinate services between children and adults? l.
There is a lack of professional mental health services for elder patients. m.
The support systems for people at the end stages of life aren’t adequately prepared/aware to know how to support people with mental illness and their families through the dying process. n.
What are the rights of people with mental illness as a disease. o.
What are the supports/adaptations people with mental illness need to stay employed?
7.
Round Robin on Legislative Issues – Glenda Eoyang, Facilitating
This portion was postponed until the next meeting.
8.
Closure – Glenda thanked the members for attending and adjourned the meeting at
12:10 p.m.
Remaining Meeting Dates and Locations for 2011
(Second Friday of even-numbered months)
August 12 – DHS (note location!) December 9 - DHS
October 14 - MSRS
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Organizational
Affiliation
NAMI Minnesota
MN Legislature, Chair House Health/Human Services Finance
MnDACA
Alzheimer's Association
Sue
First
Name
Last
Name
Abderholden
Jim Abler
John Wayne Barker
Mary Birchard
Minnesota Association of Mental Health Centers
Association of Minnesota Counties/CBP
Care Providers of Minnesota
Minnesota Association of Centers for Independent Living
Local Public Health Association (LPHA)
Minnesota Legal Services Coalition
Minnesota STAR Program
Ron
Patricia
Patti
Victoria
Kay
Ron
Jo
Medica - representing MN Council of Health Plans
MN Network of Hospice and Pallliative Care
ElderCare Rights Alliance
Julie
Michele
Janet
MN Legislature, Chair House Health/Human Services Reform Comm Steve
Minnesota Board on Aging Joseph
Courage Center (rep for TBI Advisory Group) Jodi
MN Legislature, Chair Senate Health/Human Services Committee
Minnesota Disability Law Center
AARP
LTC Ombudsman
Minnesota Home Care Association
Minnesota Area Geriatric Education Center
PACER
Advocating Change Together (ACT)
Brain Injury Association of Minnesota
Minnesota Consortium of Citizens with Disabilities
Governors Workforce Development Council
Association of Residential Resources of Minnesota
MNAPSE-The Network for Employment
Minnesota Habilitation Coalition
Ombudsman for MR/MI
MACSSA - Anoka County
Minnesota Adult Day Services Association
Minnesota Council of Child-Caring Agencies
Minnesota Association of Area Agencies on Aging
Minnesota Association for Children's Mental Health
David
Anne
Heidi
Deb
Neil
Robert
Kim
Mary Kay
Pete
Steve
Bryan
Bruce
Bob
Lynn
Roberta
Jerry
Laura
Mary
Catherine
Debora
White Earth Home Health Agency
Minnesota HIV Services Planning Council
Courage Center
Minnesota Leadership Council on Aging
Governor's Council on Developmental Disabilities
Minnesota State Council on Disability
Jen
Tim
John
Mike
Colleen
Joan
Stevens
Sullivan
Tschida
Weber
Wieck
Willshire
Aging Services of Minnesota Mary Youle
Staff Present: Spenser Drover, Jake Priester, Lori Lippert, Janice Hones, Wendy, Cathy
Jacobson, Alex Bartolic, Pam Erkel, Krista Grunehold, Dave Schultz, Kari Benson
Guests Present: Mindy Morrell, Tanisse Joyce and Todd Wilson, CMS; Phil Manse, MN Care
Providers; Glenda Eoyang and Royce Holladay from Human Systems Dynamics Institute; Janice
Jones, Health Department x x x x
Brand
Coldwell
Cullen
Dalle Molle
Dickison
Elwood
Erbes
Faulhaber
Fedderly
Golden
Gottwalt
Grant
Greenstein
Hann
Henry
Holste
Holtz
Johnson
Kane
Kang
Kennedy
Klinkhammer
Larson
Lindsley
Nelson
Niemiec
Noren
Opheim
Pederson
Philbrook
Regan
Sampson
Saxhaug
6.10.11 x x x x x x x x x x x
Sub x
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