A Overview for County Officials

1. A Overviewfor County Officials January 25, 2013 10:00 a.m. – 12:00 noon

2. THE BASICS: What isMeghan Mohs, Ramsey CountyPam Erkel, DHS

3. 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

4. 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

5. 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

6. Objective Transition Minnesota’s long-term services and supports system from “What programs do you qualify for?” to “What do you need to meet your goals?”

7. 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

8. 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

9. 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

10. 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

11. 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 Minnesotans

12. 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

13. THE DETAILS:How willbe Implemented?

14. Presenters Pamela Erkel, DHS Nancy Jurgensen, DHS DiAnn Robinson, DHS Tom Henderson, Brown County

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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?

21. 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

22. 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

23. Expectations/Assurances of Counties Continued… • 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)

24. MnCAT (MnCHOICES Certification and Training) Recertification Step 4 Professional Development Certification Step 3 Step 2 Step 1 Qualifications + Experience Certified Assessor Step 3 Application Step 2 Principles Step 1 Foundation

25. 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

26. 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

27. 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

28. 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

29. 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

30. Information from Pilot Test Counties about

31. Presenters • Kay Dickison, Dakota County • Tom Henderson, Brown County

32. 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

33. Dakota County Experience Training – Important to Broaden “Specialist” Staff Tool—Navigation “Friendly” but New/Time Yielded Additional/Helpful Information Eligibility Rules Effective

34. Implementation Considerations “Right” staffing plan? One Intake Workflow /transitions if pending MA, wait list, seniors going to Plans Staff Interested!

35. 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

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

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