LTSS Update - August 2017

Key Highlights This Month:  

CSG/CDCS  – Financial Management Services (FMS)

• Currently there are three models, going forward there will only be one employment model: Payroll Model.  This will be the case for CSG and CDCS once federal approval is granted.
• There will be a “network of providers” to provide Financial Management Services (FMS)
• During transition, people receiving services will need to be educated and supported regarding what the change means, what it means to be their own employer.
• Transition Plan and Communication Plan needs to be developed and implemented.  This change will likely be during 2018.

CFSS Status Update

• Design work is complete.  Moving forward with plans for transition from PCA to CFSS – timeframe is still undetermined.  DHS is completing work needed; some of the work is dependent on what happens at the Federal level.  Federal approval has not been provided and DHS is not engaged in conversation at this time.  Plans along the way were and continue to be changed due to Federal actions and internal DHS resources including system modernization, which is needed for this as well.
• There is not a defined timeframe with CMS.  Legislative language is implementation within 90 days of Federal approval.
• CFSS has a Federal match – an enhanced 6% so the Federal match is 56%
• When CFSS is implemented, CSG will no longer be available.
• CSG goes away; County 5% admin will no longer be available.  Consultation Service Provider is a service added – and required.  The Consultation Service Provider would explain the program, provide options, and approve the plan.  At reassessment time, the Consultation Service Provider would again review options and approve the plan.

New Employment Service – Disability Waivers

Update on the three new employment services

• Employment Exploration Services – community based services that introduce and explore employment – assists people in making an informed choice about working in competitive, integrated employment.
• Employment Development Services – individualized services that help people find competitive, integrated employment or attain self-employment.
• Employment Support Services – Individualized services and supports that assist people with maintaining community employment in an individual OR group arrangement.

Waiver Amendment – will include a transition plan

Plan will include that within 180 days of CMS approval or January 1, 2018 (whichever is earlier).  Services will be authorized (switched over to new services) at the person’s annual review – with a 6 month window in 2018.  By June 30, 2019 everyone will have transitioned to one of the new services.

In DTH – only service that will remain is center based non-community employment activities. Other activities will move to one of the new services.  There will be an option to have both DTH and one of the three new services.

Requested Actions Needed From MACSSA:  

New Trends in This Area:  

Issues/Concerns Regarding This Topic:  

MnCHOICES County Share

LTSS Statewide Earnings:

• 113 million in SFY 2016 payments to Counties/Lead Agencies
• 134 million projected for SFY 2017 (not yet finalized)

Legislation is effective July 1, 2017 (SFY 2018).  First payment with language applied is the current quarter, July1 – Sept 30, 2017. Typically paid 6 weeks later (November).

DHS is working with programmers to make the needed reimbursement calculations within the systems.

Activity codes, time study work at the county level are unchanged.

What to expect:

• DHS will remit to counties only the approved percentage of the non-federal share of the LTSS.
• The federal share will be unaffected and remitted in full
• DHS will NOT pay the entire amount and invoice counties at a later date.

Formula:  LTSS Eligible Expenses – Federal Share = Non-Federal Share X 84.3% = Discounted State Share. 

Discounted State Share + Federal Share = Payment to County/Lead Agency

Example: 5,000 Eligible Expenses – 2,500 Federal Share = 2,500 Non-Federal Share X 84.3% = 2,108

2,108 + 2,500 = 4,608 Payment to County/Lead Agency.

Secondary example/option to apply the share:

5,000 Eligible LTSS Expenses

Payment              Share                    Percentage

2,500                     Federal                 50%

2,108                     State                     42%

392                         County                 8%

Follow up to the MnCHOICES Forums at the July MACSSA meeting – The Home and Community Based Services County State Work Group (HCBS CSWG) reviewed the information generated during the forum at MACSSA during the workgroup’s meeting on 7/28/2017.  Many of the items listed have historic conversation.  There is a need to make sure we reference the reasons for why decisions were made as well as the Federal requirements:  Need to review the values that were determined originally. 

The following is a brief summary of next steps and potential workgroups

• Create a document that has the areas identified – includes the citation/policy/rule/etc. (Wendy and small work group) including a group to get together with DHS to review.  *This was completed by Deb Sjostrom and sent to Wendy for DHS to review and provide information.
• Determination of when can administrative updates be completed – changes/updates without face to face
• Extending time limits including telephone update options – DHS to determine what can be done under policy and then what needs legislative change.
• Intent vs. practice – what are the assessors doing
• MnCHOICES “lite”
• Longer term administrative simplification and modernization
• DD alignment
• Communication

Focus on the “high value” activities that best serve people. 

Legislative Impacts:  

Supporting Materials:  

Contacts(s):