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Behavioral Health Update - April 2019

Key Highlights This Month:  

SUD Reform: 

Invitation for a webinar on Withdrawal Management. (attached) This is the second one; the first gave a historical perspective. 

The State/County workgroup met last month and are working through many of the issues.  DHS has proposed that current Rule 25 Assessors could be grandfathered in provided they meet certain requirements including 30+ hours of training.  If counties were able to provide comprehensive assessments with such credentialing the rate that would be paid by MA most likely would be lower and we agreed to that.  We are hopeful to have a legislative change yet this session on the insurance requirement (decrease to 1.5 million vs 2 million).  The State/County Workgroup meets at the end of the month and we hope to discuss further the supervision of care coordination.  Direct access has been delayed due to technology issues with the billing and is not expected to be ready until sometime next year. 

Local Mental Health Authority Discussion:

There will be a presentation at MACSSA to begin the conversation on the role of the county as the local mental health authority.  This will include a brief review of current statutes/requirements as well as some table talk discussion about what the role should be; Counties perspectives; Are there pieces we could let go and how What absolutely needs to stay with the county; Can we (MACSSA) speak with one voice representing counties; Can we be more Proactive not just Reactive.   This seems to come up in different ways each legislative season.  Discussion in this group about need to stay responsive to local needs and that the state currently does not seem to respond to local needs well.

Competency Restoration Program/Rule 20:

Current proposed legislation establishes a task force to study this issue (outpatient CRP).  County Attorney bill attached to Rosen bill.  Several counties being impacted on a case by case basis and trying to come up with solutions without “owning” cost and process!  Judges ordering Case Managers and others to provide Competency Restoration evaluation. Several counties using IRTS facilities.  Hennepin reports many clients they work with being impacted by the state no longer facilitating process.  Questions about what response (if any) was received on the request to pull back the change until all the partners could talk and work something out.  No clear path forward beyond Task force legislation.

DCT Appeals

Angie Youngerberg updated the group on the most recent discussion regarding legislative language and the Appeals process for billing issues with State Operated Facilities.  Language is in both house and senate side.  An agreement has been reached and the appeals will be handled by the Commissioner, not an administrative law judge.  Payment responsibility will go to the state, not the client.

Requested Actions Needed From MACSSA:  

New Trends in This Area:  

Issues/Concerns Regarding This Topic:  

LMHA Direction and MACSSA Position

CRP and no path forward to resolve beyond potential Task force legislation

Delay of Direct access for SUD Reform

Legislative Impacts:  

MACSSA has numerous support and promote positions around Behavioral Health.  

Supporting Materials:  

Webinar on Withdrawal Management
State Advisory Council on Mental Health (SACMH) Report o the Governor & Legislature
SACMH Summary Recommendations
Mental Health Legislative Network recommendations

Contact(s):  

Julie Ellis, Jerry Pederson

Case Management Update - April 2019

Key Highlights This Month:  
We are entering a key period of the case management redesign as it relates to finance so having member input and awareness is critical. We will have a forum at the April MACSSA meeting to discuss finance issues and challenges with moving forward with a new finance scheme for case management. At the March MACSSA meeting, DHS presented on potential 2020 legislation focusing on the concerns of CMS related to county set rates for contracted providers. DHS will be working with MACSSA on how best to move forward with planning on this topic.

In relation to the policy aspect of case management redesign, DHS received an overwhelming amount of feedback to the proposed policy changes and has pushed back a meeting of the policy design group to mid-summer to give them time to go through the feedback and categorize it. 

Requested Actions Needed From MACSSA:  

New Trends in This Area:  

As noted above, we are entering a key phase of case management redesign in relation to the financing aspect. We will focus on at the April MACSSA meeting.

Issues/Concerns Regarding This Topic:  

Financing will be discussed at our April meeting!

Legislative Impacts:  

None for the 2019 session

Supporting Materials:  

Contact(s):  

Child Wellbeing Update - April 2019

Key Highlights This Month:  

  • MACSSA/DHS CP Fiscal workgroup met on 4/4/19.  See minutes from the meeting attached. 
  • MACSSA/DHS Legislative workgroup did not meet this month.    
  •  MACSSA/DHS CWB Team Call took place on 4/10/19.  Minutes attached.

 African American Family Preservation Act-Eric and some others attended a meeting with Representative Moran on this bill. The bill as is, is likely not going to move forward in its current state. There is a hope to move forward on a couple of key components which are the CW Training Academy, timeline for petitioning parental rights to be reinstated, and removing some foster care licensing barriers for relatives.

 Family First Prevention Services Act-  Attached is a comparison of Federal Requirements for Qualified Residential Treatment Programs (QRTP) & Psychiatric Residential Treatment Facilities (PRTF)  Building Bridges Initiative, with support from Annie E. Casey Foundation, produced a comparison document to help with addressing questions on the differences, similarities, and connections between new Family First defined Quality Residential Treatment Programs (QRTP) & Psychiatric Residential Treatment Facilities (PRTF).  Also attached is the Program Instruction 19-02 that was released to provide guidance to states around CAPTA, Chafee and ETV Programs, and Title IV-B.

Requested Actions Needed From MACSSA:  

New Trends in This Area:  

Issues/Concerns Regarding This Topic:  

Legislative Impacts:  

We are also still tracking the school transportation/foster care item. $1M (a repeat of the first pilot project) made it into the Senate Education bill, but didn’t get into the House bill.  We hope to get this to the conference committee and perhaps see if we can get the appropriation raised to $2M.

Supporting Materials:  
CP Fiscal Meeting Minutes
Minnesota Time Studies with IV-E
Program Instruction 19-02
April CWB Minutes

Contact(s):  Jodi Heurung/Amy Shillabeer

Healthcare Update - April 2019

Key Highlights This Month:  
The METS 19.1.1 release was deployed April 6-7, 2019.  Some highlights are below, see attached for more details:

  • METS will systematically deny pending MA program eligibility when applicants do not provided requested verifications
  • Two new notices generated – pending MA denial notice and ROP extension notice
  • Ability for workers to remove and add participants back into a household using Application Details evidence – this eliminates the need for workers to close and re-enter a case each time a previous member returns to the household
  • Ability for workers to have the ability to change an applicant to a non-applicant
  • Address Change wizard to help streamline the change in circumstances (CiC) process for address changes
  • When an MA eligibility determination is made on a CiC, the system will create or update Financially Responsibility Agency (FRA) evidence, eliminating the need for the worker to do so
  • In-Edit Evidence wizard allows workers to discard or update multiple pieces of in-edit evidences at the same time
  • Interface improvements
  • Corrections to the Standard Eligibility Notice (SEN)
  • Update to latest version of Verify Lawful Presence (VLP)

 The Social Security Act has a work incentive provision for people whose earnings reduce or eliminate their SSI cash benefit.  People who are eligible for SSI under this section (1619) are eligible for Medical Assistance without regard to their income or assets.  Instructions have been created in ONEsource on how to determine if members meet this status or if they no longer qualify.

 The Health Insurance Recovery Unit presented a Third Party Liability (TPL) Refresher PowerPoint on March 13th to the PIX meeting.  It includes an outline of trends on TPL policies entered in MMIS, resulting issues and problems, and impacts on the unit.  Presentation is attached.

 Requested Actions Needed From MACSSA:  

New Trends in This Area:  

Issues/Concerns Regarding This Topic:  

DHS is working with lead agencies and waiver service providers in preparation and response for areas of MN that are at a higher risk of flooding.  Information on eligible reimbursements for relocating people who receive waiver (DD, CAC, CADI, BI and EW) and Alternative Care program services, see here:  DHS announces community emergency and disaster assistance protocols for people who receive waiver services

 Legislative Impacts:  

Supporting Materials:  
19.1 Release Notes
Third Party Liability

Contact(s):  Kari Ouimette

Long Term Services & Supports Update - April 2019

Key Highlights This Month:  

The LTSS topic is in the process of connecting with DHS in order to develop a listing of subtopics and contact persons/groups/committees currently in place working on these identified sub topics. 

Contact(s): Paul Bukovich  

Modernization Update - April 2019

Key Highlights This Month:  

Modernization update – meeting 4/10/19

Along with MACSSA members who sit on the various committees of the governance structure, we also had guests for a couple of topics.

Modernization Strategic Plan briefing

Guests: Sarah Small, DHS, part of the program and performance area & Crystal Fairchild –DHS, part of Health care administration

They came to provide a review of the status of the Modernization Strategic Plan at our meeting and seek input on the plan from counties.  She clarified that it is meant as a guiding document. Not going to wordsmith it much longer, but she welcomes any further comments by April 17th. The EAB is planning a retreat to look at how to use it.

Highlights of the presentation:

-          Purpose of the plan - How transform the system

-          ISBM and roadmap fall underneath this

-          Measurement framework still needs to be developed – how do we know we are successful

-          Essential functions we need to do in modernization

-          Strategies have been reworked down from 56 to 13. The plan is to have action plans around each strategy.

-          Some technology ideas were identified in the ISBM, but clear that we need to do Business Readiness first

-          Feedback so far has been mostly positive, people want to move from planning to action

-          Getting a glossary of terms to help with level-setting

-          EAB has oversight. Next step is for EAB to approve the plan

-          Ideas being developed on and implementation framework

Discussion –

-          Big tensions between the practical development and prioritization of projects that move integration and advance the modernization planning.

-          Would like to see some room for innovation carved out.

METS Position

 Jane recapped the presentation on current status, and reviewed the feedback from the March monthly meeting. The group discussed some different options, but we’re not ready to put forward as a position statement. She will work with Janet Goligowski and Eric.

 Conversation with DHS and MNIT

Guests: Greg Poehling, Debra Hauerwas, Wendy Weisner, Roberta Downing, & Jeff Jorgenson (Chuck Johnson wanted to be there but had a last minute conflict).

We invited leaders from MNIT and DHS to talk about the governance structure and discuss whether or not it is the right model and/or if the model could be modified to better allow county members to participate and give meaningful input. We kicked off the conversation by stating why we appreciate being at the table at the various levels of governance and why we care about the modernization work. Our talking points included:

  1. Appreciate the engagement; strong desire to engage. We want to engage on the things that are commonly important.
  2. Different systems, there will be tension. We’re ok with that, hope you will be too.
  3. Our involvement in the structure is not the end of their need to communicate to counties and MACSSA. How can DHS and counties bring messages both ways.
  4. Adopt agile, human-centered design methodologies.

 Highlights of the conversation included:

  • From Greg’s perspective, MNIT does feel that the county input at the PMT level has been a huge benefit.
  • There is common ground in that DHS staff who have fulltime jobs have similar challenges with the time to participate, and to get grounded in the context in order to do it well. Adding it to a job description and carving out time makes it work.
  • The Modernization Strategic plan, when agreed on and embraced, could be a guiding document
  • The current governance structure with the new PMTs has only been going since January, so may need more time to mature.
  • Willingness to consider trying something different in the future.
  • Agreement to work together in the spirit of co-creation regarding the structure, and the end product. Including the people we serve.

 Some critical questions to further the discussion were raised.

-          What involvement do counties want?

-          How do we engage?

-          Co-create a solution together for modifying county participation?

-          Do we all agree what modernization is?

-          Are there different expertise at the different levels – can we restructure to be more effective?

We thoroughly discussed the challenges of the governance structure and the specific issues county reps experience. The state staff agreed and some said they had similar concerns about the ability for state staff to participate. All felt the discussion was valuable and worth more discussion with the possible outcome of modifying how counties (and maybe others) provide input.

Next step, a couple MACSSA reps will meet with Jeff Jorgenson and Debra Hauerwas to plan an additional meeting.

Requested Actions needed from MACSSA in the next month:

We continue to discuss what our METS position should be. If anyone has insights, suggestions or questions about this item, please reach out Marti Fischbach or Brad Vold and we will get you connected with the right person and/or take your input.

 New Trends in this area:

The state is making progress on the strategic plan.

Issues/Concerns regarding this topic this month:

Going through some growing pains with regards to know that we are being included in so much of the governance structure, how do we find the capacity to fill all of the roles.

Legislative Impacts:

There are some financial limitations that may inform future legislative needs

 Supporting materials :

Contacts:

Marti Fischbach – Modernization Co-Lead; IHSM ESC Co-chair

Brad Vold – Modernization Co – Lead; BADT member

Jane Hardwick, Stephanie Radtke, Chris Lancrete - EAB

Self-Sufficiency Update - April 2019

Key Highlights This Month:  

Child Care

  • The Office of Legislative Auditor released the Minnesota Child Care Assistance Program Assessment of Fraud Allegations report on March 13th and a second report regarding Minnesota Child Care Assistance Program Assessment of Internal Control on April 10th. These are available on the OLA website.
  • DHS plans to revise MN Rules, Chapter 3400, Child Care Fund. For more information, visit https://mn.gov/dhs/partners-and-providers/news-initiatives-reports-workgroups/child-care-and-early-education/ccap-rule-rev.jsp. If you have questions or comments regarding rule revision, email dhs.CCAPrule@state.mn.us.
  • DHS will move forward with first quarter reallocation in 2019. There is a CCAP Policy Manual Chapter with information about the process. See CCAP Manual 16.33 BSF First Quarter Reallocation.
  • DHS CCAP is working with MFIP staff to implement a change in counting the income for new spouses that passed in the 2017 legislative session. This change was effective Dec. 1, 2018.
    • A joint bulletin was published Nov. 20. See Bulletin #18-69-02 New Spouse Income Policy for Cash and Child Care Assistance Programs.
    • MEC² Temporary System Guidance was posted to SIR on Dec. 3.
    • DHS CCAP is working on Policy Manual changes to be published in April.
    • Substantial changes to the CCAP program have been included in the Governor’s budget proposal including changes to:
      • Implement 12-month continuous eligibility for all families, including those who move to counties with BSF waiting lists, who are not currently eligible for TY after MFIP closes but are in a county with a BSF waiting list, and children who age out during their 12 month-eligibility period.
      • Increase child care reimbursement rates to at least the 25th percentile and tie on-going rate increases to the most recent market rate survey.
      • Create an expedited application pathway for families that are homeless that reduces verification and activity requirements for the first three months of care.
      • Establishes due process for child care providers
      • Clarifies and simplifies program integrity requirements and policies

Many of these changes are required for Minnesota to comply with federal law.

  • In addition, there have been numerous proposals introduced in the 2019 legislative session that would impact CCAP. The department is monitoring and analyzing proposals as they are introduced.

Child Support

The Child Support Division (CSD) has completed Minnesota’s Federal Fiscal Year (FFY) 2018 Self-Assessment Report.  The report can be found on the DHS-SIR>PRISM>Documentation>Self-Assessment. Federal Regulations require states to monitor compliance with federal child support timeframes, and report results annually in a Self-Assessment Report.  In order to complete the requirement a random statewide sample of cases was reviewed from November through February by CSD. Once again as a state we met or exceeded compliance in all eight self-assessment review categories. 

The Work Number(TWN)

DHS sent notification in a March 21st memo regarding the future status of TWN number.  Child Support will continue with Standard Service access while Income Maintenance programs will have access through TWN’s Express Service.  There is a fee for the use of the Express Service.  DHS will be picking up the entire cost of this contract for 2019. However, counties were advised to budget for a portion of this cost in 2020.  A MACSSA forum to discuss next steps will occur on April 24th.

 EGA Allocation

DHS confirmed via an email from Shawn Tobias on April 12th that DHS has revised the current state year allocations for EGA.  This is an attempt to spend out the state allocation as there has been approximately $1,000,000 left unspent for the past five years. A MACSSA forum on this topic will be held on April 24th to discuss this decision and best practices from counties who have been able to spend down their allocation.

 Requested Actions Needed From MACSSA:  

New Trends in This Area:  

Issues/Concerns Regarding This Topic:  

Legislative Impacts:  

Supporting Materials:  

 Contact(s):  Barb Dahl, Brad Thiel

ISBM Update - April 2019

Key Highlights This Month:  

Counties Continue to Implement ISBM in 2019 thank you to Region 5 for extending an invitation to me. I look forward to attending your regional meeting June 3. Please remember to reach out to me as you are looking to learn more, refresh yourself or have projects to share with me around the Business Model.

 Why is this work important to counties?

 This is an opportunity to provide on-the-ground experience to inform the MN integrated services business model, refine it, experiment with it, and finally turn it into a real solution.

Christina.Klaphake@co.wright.mn.us

 5x5 Design Branding Project Update

5x5 Design, the branding firm working on the messaging framework for ISBM. This work has been briefed with Commissioner Lourey and will begin again. More to come on this restart.

 Business Readiness and Program Simplifications

I have had the pleasure this last month of learning more information about the work that continues to develop in these areas (both of which will involve county-level engagement and feedback). Business Readiness is the pre-project, business-side work that should be done prior to beginning to identify IT solutions or business process changes. It ensures we know exactly what we’re trying to achieve and why prior to embarking on a project. It’s critical to ISBM implementation, and the initial phases are getting underway at DHS, as a dedicated team is coming together.  

 Program simplification is another key piece of the journey to ISBM. The program simplification core team is currently identifying resources and looking forward to starting workgroups and eventually subgroups to review the current state of business. The core team, which includes county representatives and members from across DHS, has completed chartering documentation, outlined deliverables, and is actively resourcing one of their first tasks, completing a Program Eligibility Inventory. The project is launching this month and is projected to run for 8 weeks. It will provide baseline information to form the group’s simplification/alignment roadmap for the year.

 Reflections

I was able to take time this month to review all 14 worksheets that were received from the February meeting. One thing I want to share is that there is a common theme around hopes and dreams. The membership shared with me that we, as counties, are looking forward to having a system that helps us provide prevention services, put clients first, and looks to provide an opportunity to improve communication not just within human services but at a broader level. The one thing I kept thinking was “Yes, this is what I’m hearing from DHS as well.”  It is so pleasant to read and then realize that at the foundational level, our goals are in close alignment.  I continue to be hopeful that as traction is gained around this work that we will all keep in mind that our goals are the same.

Contact(s):  Tina Klaphake

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