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Overviewfor County Officials

January 25, 201310:00 a.m. – 12:00

noon

THE BASICS: What is

Meghan Mohs, Ramsey CountyPam Erkel, DHS

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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 boards3

Minnesota’s Vision for Long-Term Services and SupportsMinnesota’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

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Objective

“What do you need to meet

your goals?”

“What programs do you

qualify for?”

Transition Minnesota’s long-term services and supports system from

to

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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 administration7

What Will Change:

Three Major Reforms

A single comprehensive

assessment that focuses on strengths,

needs and preferences; drives

efficiency and supports choice

Provider Standards

A system that standardizes

provider qualifications &

drives continuous quality

improvement

Rate System

A rate-setting platform that

ensures consistent & transparent

statewide pricing of disability waiver

services

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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

connection9

What is ? Replaces four assessments:

1. Developmental Disability Screening (DD)2. Long-Term Care Consultation (LTCC)3. Personal Care Assistance (PCA)4. 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 assessments10

Supports a Partnership Between the State and Counties

The State

Provide administrative framework that supports person-centered 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

Counties

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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Minnesotans

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 12

THE DETAILS:How will

be Implemented?

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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

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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

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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 Health3. 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?

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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 Time Study

Conducting Paper Assessments Conducting MnCHOICES assessments

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

Expectations/Assurances of Counties

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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 community-based experience

Expectations/Assurances of Counties

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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)

Expectations/Assurances of Counties

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MnCAT (MnCHOICES Certification and Training)

Step 4Professional Development

Step 3

Application

Step 2

Principles

Step 1

Foundation

CertifiedAssessor

Recertification

Certification

Step 3

Step 2

Step 1

Qualifications + Experience

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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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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

Expectations/Assurances of Counties

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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

Expectations/Assurances of Counties

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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 continues29

Information from Pilot Test Counties

about

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PresentersKay Dickison, Dakota County

Tom Henderson, Brown County

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Pilot AgenciesAnokaBeckerBlue EarthDakotaHennepinRamseyScottSt. LouisSwiftYellow Medicine

Blue PlusLeech Lake Band of

OjibweMedicaPrimeWestUcareWhite 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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