a overview for county officials january 25, 2013 10:00 a.m. – 12:00 noon
TRANSCRIPT
A
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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