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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

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

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
  • 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