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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. Purpose of the Webinar?. Share information on MnCHOICES from DHS and county perspectives

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A overview for county officials

A Overviewfor County Officials

January 25, 2013

10:00 a.m. – 12:00 noon

The basics what is meghan mohs ramsey county pam erkel dhs
THE BASICS: What isMeghan Mohs, Ramsey CountyPam Erkel, DHS

Purpose of the webinar
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

Minnesota s vision for long term services and supports
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

Context for change
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


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

“What programs do you qualify for?”


“What do you need to meet your goals?”

What won t change mission and values of the dhs s continuing care administration
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

    • Qualityservices that can be measured and maximized

    • Transparency, efficiency, consistency

    • Leverage all viable resources to reduce dependence on public funds

    • Continuously improve service administration

What Will Change:Three Major Reforms

Provider Standards

A system that standardizes provider qualifications & drives continuous quality improvement

A single comprehensive assessment that focuses on strengths, needs and preferences; drives efficiency and supports choice

Rate System

A rate-setting platform that ensures consistent & transparent statewide pricing of disability waiver services

What is
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

What is1
What is ?

  • Replaces four assessments:

  • 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

Supports a partnership between the state and counties
Supports a Partnership Between the State and Counties

  • 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

  • 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


Next steps
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, staffingand technology

The details how will be implemented
THE DETAILS:How willbe Implemented?


Pamela Erkel, DHS

Nancy Jurgensen, DHS

DiAnn Robinson, DHS

Tom Henderson, Brown County

Dhs next steps
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

Dhs next steps1
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

Dhs next steps2
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

  • Administrative FFP - Used for activity defined by CMS to be part of administering MA

  • 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

  • Dhs next steps3
    DHS’ Next Steps…

    Implement Payment Structure – How?, cont.

    • Three types of time studies for MnCHOICES reimbursement:

      • SSTS (Social Services Time Study)

      • LCTS (Local Collaborative Time Study) – Public Health

      • 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

    Dhs next steps4
    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

    Dhs next steps5
    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?

    Expectations/Assurances of Counties

    • 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

    • Provide access to assessment process

    • Assessments to all regardless of incomes or assets, referral source or county financial responsibility

    Expectations assurances of counties
    Expectations/Assurances of Counties

    • 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


    • 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)

    Mncat mnchoices certification and training
    MnCAT (MnCHOICES Certification and Training)


    Step 4




    Step 3

    Step 2

    Step 1

    Qualifications + Experience






    Step 2





    Expectations assurances of counties1
    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

    Expectations/Assurances of Counties

    • 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

    • 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 counties2
    Expectations/Assurances of Counties

    • Conduct quality assurance and monitoring activities

    • Collect client satisfaction data about services and providers

    • Use MnCHOICES data and reports for program management

    Key partnership
    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

  • Presenters1

    • Kay Dickison, Dakota County

    • Tom Henderson, Brown County

    Pilot agencies
    Pilot Agencies



    Blue Earth





    St. Louis


    Yellow Medicine

    Blue Plus

    Leech Lake Band of Ojibwe




    White Earth

    Dakota county experience
    Dakota County Experience

    Training – Important to Broaden “Specialist” Staff

    Tool—Navigation “Friendly” but New/Time

    Yielded Additional/Helpful Information

    Eligibility Rules Effective

    Implementation considerations
    Implementation Considerations

    “Right” staffing plan?

    One Intake

    Workflow /transitions if pending MA, wait list, seniors going to Plans

    Staff Interested!

    Implementation considerations1
    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
    Moving Forward

    Key Role Now & Forward to Assess/Plan Long Term Services & Supports

    Thank you if you want to learn more about mnchoices web site www dhs state mn us mnchoices
    Thank you!If you want to learn more aboutMnCHOICES web site:www.dhs.state.mn.us/mnchoices