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Case Management Update - December 2018

Key Highlights in this topic/WORKGROUP for the PREVIOUS month:

The first draft of the case management initial design team recommendations have been shared and DHS is currently working to get feedback from a variety of stakeholders. Lisa Cariveau and Jennifer Blanchard presented at the MACSSA forum in December related to the report and the progress of the reform effort (see attached presentation and draft report).

 

The Finance Team of the redesign is reviewing the draft report of Navigant of their initial analysis of local/county level of what financing looks like. The group has questions related to the work and what it is saying, and more time will need to be spent on how we would recommend that work move forward. The finance team is considering several questions including:

  • Does the cost survey tool provide us with enough information to begin to understand current costs at the county level in order to assess potential impact of changes?  
  • To what extent would it be beneficial to expand the tool to other counties and providers?
  • If we were to use the tool with more counties and providers, what would need to be changed or better clarified to get the information we need?

That draft report is not available to share yet at this point as they work on feedback, but we will share it as sonn as possible.

 

 Requested Actions needed from MACSSA in the next month:

None at this time. We will work on have a session at an upcoming MACSSA meeting to inform the group on design work.

 

APPARENT TRENDS IN THIS TOPIC AREA:

The design work has wrapped up, but finance work will continue.

 

Issues/Concerns regarding this topic this month:

As noted previously, we should be paying attention to the fiscal workgroup and potential implications for rate changes for counties.  The work of the design team seems to be in line with what we have previously agreed to. 

 

Legislative Impacts:

NA for 2019

 

Bulletins, Publications, or supporting materials to be included with this update: (Please attach to the email sent with this report.)

CM Draft Service Design_Oct 2018
CaseManagementRedesignPresentation

CONTACTS (For Topic Groups):

Stacy Hennen and Mike Herzing

Child Wellbeing Update - December 2018

Key Highlights This Month:  

  • Title IV-E Foster Care Maintenance Payments for Children Placed with a Parent in Substance Use Disorder Treatment:  DHS participated in a forum at the December meetings to provide further details about this new service option.  Please see attached document for further details.
  • MACSSA/DHS CP Fiscal workgroup met 12/7/18.  Reviewed new program instructions released by Children’s Bureau.  For additional details please refer to the notes from this workgroup at the end of this document. 
  • System of Care:  A system of care conference was held 11/28/18.  Presentations included cultural and linguistic competence, youth guided and family driven care, high fidelity wrap around, Intensive Bridging model, etc.  Contracts are being executed with counties, tribes and regions for pilot services.  For additional details please see the attached notes.
  • AspireMN will be reviewing the Children’s Intensive MH Report with several MACSSA representatives on 12/21/18.  A forum is being coordinated for January to review the report with MACSSA membership.
  • Monthly consult with DHS.  The following topics were discussed:  System of Care Grant, CMH, Intensive MH Needs, Study, FFPSA, Educational Stability/School Transportation, Safety Framework workgroup update, CQI workgroup update.  See attached notes for detailed information. 
  • FFPSA forum scheduled for Jan. 2019 to review and discuss recent guidance released by Children’s Bureau and to provide input on provider surveys being sent out.

Requested Actions Needed From MACSSA:  

New Trends in This Area:  

Issues/Concerns Regarding This Topic:  

Legislative Impacts:  

Supporting Materials:  

Contact(s):  Suzanne Arntson/Brenda Mahoney (Jodi Heurung, Amy Shillabeer beginning January 2019)

Healthcare Update - December 2018

Key Highlights in this topic/WORKGROUP for the PREVIOUS month:

Marie Zimmerman, Medicaid Director, has left her position at DHS to join Hennepin Healthcare as the VP of Public Funding and Medicaid Transformation.

 

Effective 2/1/19, the Asset Verification System (AVS) will be required to be used to verify assets for all MA-Aged, Blind, Disabled (ABD) applicants and enrollees.  If a client provides verification of their assets or reports no assets, a worker still has to send a query to verify assets using AVS.  AVS cannot be used for MA- Family, Children, Adults (FCA) cases with a spenddown where an asset test is applied and only staff who determine eligibility for MA-ABD should have access to the system.  There will be a bulletin issued towards the end of the year.

 

Effective 2/1/19, the MA spenddown standard for aged, blind, disabled individuals will increase from 80% FPG to 81% FPG.

 

Changes to the Spousal Impoverishment Rules effective 1/1/19 for community waiver.   Bulletin #18-21-08 announces that Minnesota is returning to deeming waiver rules to determine eligibility for waivers for people with disabilities. The waivers include BI, CAC, CADI, and DD.  EW & AC waivers not impacted and will continue to use spousal impoverishment protection rules.  The ACA put into place a temporary provision that required spousal impoverishment protection rules to be applied to all waivers, including the disability waivers.  The temporary ACA provision sunsets on December 31, 2018.  At the beginning of 2019, workers should start to use deeming waiver rules again for married applicants applying for BI, CAC, CADI, and DD waivers.

 

Effective Jan. 1, 2019, DHS will no longer be a third-party administrator (TPA) for South Country Health Alliance (SCHA) health plan. Providers who have current Elderly Waiver service agreements with SCHA will have those agreements closed by a lead agency or case manager no later than Dec. 31, 2018. Elderly Waiver providers may continue to follow the fee-for-service billing process for dates of services through Dec. 31, 2018.  For dates of service on or after Jan. 1, 2019, claims billed through the fee-for-service process will be denied. Providers will need to follow SCHA’s instructions, 2019 Changes Specific to Elderly Waiver Providers (PDF), for service authorization and billing for dates of service of Jan. 1, 2019, and after.

 

Beginning Jan. 1, 2019, all personal care assistance (PCA) and home care nursing (HCN) services for people under age 65 will be covered under fee-for-service (FFS). Members will continue to be enrolled in the MCO they were enrolled in, but managed care organization (MCO) contracts for Minnesota Health Care Programs (MHCP) members under age 65 will no longer cover PCA and HCN. MHCP will cover the services on a FFS basis beginning Jan. 1, 2019.  Counties or tribes are responsible for annual assessments for service agreements that ended on Dec. 31, 2018, and after. Provider agencies should submit a Referral for Reassessment for PCA Services (DHS-3244P) to the member’s tribe or county of residence 60 days before the end date of a service agreement.

The METS 2019 roadmap was approved by the METS Executive Steering Committee (ESC) on November 27th (see attached).

 

Requested Actions needed from MACSSA in the next month:

A METS Appointment Nomination request has been sent out to the membership, seeking someone to sit on the METS Program Management Team (PMT) replacing Tiffinie Miller from Dakota County.  Please seem emails from Pam Siebert for the nomination form and more information about the appointment.

APPARENT TRENDS IN THIS TOPIC AREA:

Statewide implementation of Periodic Data Matching (PDM) on an ongoing basis will start with the PDM month of February 2019.  An email titled “PDM Update and Timeline” was sent to County Directors on 12/12/18.

Legislative Impacts:  

Supporting Materials:  See email.

Contact(s):  Kari Ouimette

Long Term Services & Supports Update - December 2018

Key Highlights This Month:  

Case Management Redesign – Lisa Carveau and Jennifer Blanchard, DHS

PPT –

TCM, Waiver case management and Rule 185

Create a planning infrastructure to support a long-term collective approach to case management redesign, solidify a universal definition of case management and core set of activities, document the current county and state finances, ensure community and civic engagement.

Vision for CM – services are simple, flexible, person-centered, culturally responsive, universally available to those who qualify for them, and are effective in assisting people and families to access formal and informal supports.

 Training for Disability Wavier and DD Services Case Managers – Lori Dablow, DHS

The department is interested in feedback regarding the training that is being provided. Lori is responsible for the RSS, training and policy.  Training planned for  2019 is in this document, titled SPP LC 2018 Topics.  The document outlines the trainings that were provided via the Support Planning Professionals Learning Community.

The department is interested in discussions about OBRA and has a meeting with Hennepin County and St. Louis County will attend to discuss the process and how confusing it is.  This will hopefully lead to changes in this area to simplify process.

 Waiver Reimagine Project – Colin Stemper and Meghan Lindblom, DHS

PPT –

What has been learned is most states use individual budgets.  The project team has looked at other states what has worked and what has not.  The recommendation is to consider legislation for 2019 to simplify the service menu (slide 9) – but this would not be implemented until after the banding period for rates is completed.  Banding will end December 31, 2019 unless CMS adds an additional year as providers have been requesting via legislation.   The report will include new levels of support.  At this point, the levels only address level of need for adults.  They do not address budgets or levles for children – if this goes forward children and how this works with MnCHOICES 2.0 will need to be addressed. 

Proposed timeline:

  • 2019 - 2020:
    • Service alignment between waivers
    • Continued stakeholder engagement
    • Policy development and systems adaptation
    • Recalibrate individual budgeting model
  • 2021 - 2022:
    • Legislative approval of reconfiguration & individual budgeting model
    • Federal approval

Elderly waiverPDF: MN 2030 the Future of the Elderly Waiver

Requested Actions Needed From MACSSA:  

New Trends in This Area:  

Issues/Concerns Regarding This Topic:  

Legislative Impacts:  

Supporting Materials:  See above links in text.

Contact(s):  Deb Sjostrom, Paul Bukovich

Modernization Update - December 2018

Key Highlights This Month:  

Update on Governance and Communication Planning for MACSSA

 

Modernization Steering Committee

On Tuesday, December 4th, members of the all the governance teams involved in modernization got together for a retreat. Previously we have had phone conferences, but we thought it was good to spend an afternoon together to plan and prepare given all the groups working on modernization. The agenda included:

  1. How is governance structure working? Do we want to propose optional ways for counties to provide input and feedback rather than having to free up people for significant amounts of time?  How does each group see their role and how do they fit together, our role collectively in moving Modernization forward. What does each group hope to influence?  Concerns identified (make a list), look to solutions
  2. What “positions” does the group want to develop and agree on for 2019?  For example, do we want one on METS, outlining the need for continuing to prioritize improvements to the system. Take time to brainstorm the potential issues and how we as counties will navigate/negotiate with DHS and MNIT.
  3. What is coming up in 2019 and how would we prioritize? Sarah Small will talk on Modernization Strategic Plan and related work. How will this inform Governance Group prep, positions, etc.? We will work with a draft timeline that we can start to fill in.
  4. What is our communication strategy?  Alternatives to email for MACCSA members state-wide. How to communicate Governance work with all counties?

It was a very good meeting with some good outcomes. We have decided to meet in person again to continue planning.

MACSSA Reps for PMTs MACSSA Reps for PMTs are still being have been identified, although not given the number needed. They are:

  • Dan Jensen, Olmstead County, Information and Data PMT
  • Linda Bixby, Dakota County, People PMT
  • Carol Jud, Hennepin County, Services & Payments PMT
  • (No referral identified), Infrastructure PMT

If others are still interested, please contact MACSSA. Individuals serving on PMTs have an important role: understanding the details of various projects within the portfolio. PMT members do not need to be experts about all projects that impact their administration/agency, but they do need to have an ability and methodology to obtain information about projects from the administration/agency they are representing and report back to the PMT regarding those projects. Timeline for PMT:

  • December 17, 9-11am – Kickoff meeting for all members of the new PMTs (invitations will be sent shortly)
  • January 18 – Existing PMTs sunset
  • January 22 – Project portfolios transfer to new PMTs
  • February 1 – First meetings of PMTs occur by this date

 

  • Modernization 5 –year strategic plan
  • Janet gave heads up that there will be a request coming for county involvement in the strategic plan. And for clarity, this is a different plan that the ISBM roadmap.
  • The DHS Strategic Plan aligns nicely with the Modernization Stratregic Plan. DHS just posted the agency strategic plan to the public website: https://mn.gov/dhs/general-public/about-dhs/strategic-plan/
  • Presentation to AMC – Jane, Rachel, Kelly and Janet presented at AMC Conference at it went well. They adjusted the presentation after providing similar information to the MACSSA/AMC workgroup.

Requested Actions Needed From MACSSA:  

New Trends in This Area:  

Issues/Concerns Regarding This Topic:  

Legislative Impacts:  

Supporting Materials:  

Contact(s):  

Owners: Brad Vold and Marti Fischbach

Experts: SSIS – Gary Sprynczynatyk; PRISM - Todd McMurray; Chisago MnChoices – Julie Ellis; METS/MAXIS – Deb Huskins; Technology – Chris Lancrete/Hennepin

Data – Scott Jara

Self-Sufficiency Update - December 2018

Key Highlights This Month:  

Child Care Assistance Program/CCAP

 Child Support

Highlights/Hot Topics/Concerns

 Minnesota is one of four sites in the nation testing how extra income can make a difference in the first three years of life for babies born into poverty. Baby’s First Years is a randomized control trial aiming to better understand the link between poverty and children’s social, cognitive, and brain development.

Recent and Upcoming Events

  • The next Child Support Task Force meeting is on December 19 in St. Paul.

Upcoming Grants and RFPs

  • CSD closed the joint receipting RFP between the Child Support Payment Center and FOD. The division received one proposal and is considering next steps.
  •  The RFP for genetic testing, to provide testing services for the next five years, is entering the evaluation stage. The division will prepare contracts for selected vendors beginning in February.
  •  The RFP for the division’s access and visitation grant posted November 30. The division hopes to select vendors in January and begin contracting in February.
  •  The division continues its work drafting an RFP for its system modernization feasibility study.
  •  Work continues on the digital marketing grant the division received from the federal Office of Child Support Enforcement. This demonstration grant will test digital marketing approaches to reach parents who could benefit from child support services and create or improve two-way digital communication and engagement with parents.

Reports

  • The division is routing its Evaluation of Minnesota Child Support Division Mechanisms and Programs report. The Minnesota Legislature requires the Minnesota Department of Human Services to submit this report as an evaluation of the child support program every two years. The department will send the report to the Legislature by the end of January 2019.

Major Staff Changes

  • The division hired Michele Schreifels as its deputy director starting on December 17. Ms. Schreifels comes from Washington County where she was the Economic Support Supervisor.

Success Stories

  • CSD staff continue to build a close partnership with the FATHER project to assist parents through in person orientation to child support, identifying barriers, and providing resources.
  • Division staff established a partnership with Ujamma Place, a local nonprofit that empowers and teaches young African American men how to navigate inequality, poverty and the criminal justice system to collaborate on a driver’s license workgroup. Ujamma will join the FATHER project as community partners in identifying barriers and helping to address disparities. 
  • CSD staff will present an overview of the child support program to staff at Parents in Community Action (PICA) Headstart.  PICA is a private, non-profit agency designated by the federal government to operate Head Start and Early Head Start programs.

Requested Actions Needed From MACSSA:  

New Trends in This Area:  

Issues/Concerns Regarding This Topic:  

Legislative Impacts:  

Supporting Materials:  

CCAP:

See Bulletin #18-68-16 Child Care Assistance Program Asset limit for changes that took effect October 1, 2018.

See Bulletin #18-68-22 Child Care Assistance Program legal nonlicensed (LNL) provider requirements for changes that took effect October 1, 2018.

See Bulletin #18-69-02 New Spouse Income Policy for Cash and Child Care Assistance Programs for changes that took effect December 1, 208.

Contact(s):  Barb Dahl, Brad Thiel

ISBM Update - December 2018

Key Highlights This Month:  

I.        Stakeholder Engagement

  • MACSSA presented to AMC Fall ConferenceOn December 3, a session on integrated services was presented to the AMC/Association of Minnesota Counties Annual Conference in Bloomington by Jane Hardwick, Kelly Harder (Dakota), Janet Goligowski (Stearns), and Rachel Grimes (Crow Wing). About 50 participants included county commissioners and county administrators. The presentation was described as:
    • Why do integrated services matter? In 2017, county human services agencies, White Earth Tribal Nation, and the state further developed the vision for integrated services in Minnesota. The resulting model serves as a blueprint that will transform many aspects of how people experience the human services system and that will guide supporting technology.  Hear how these two counties’ initiatives are already moving in that direction. Come share your thoughts, questions, and considerations.
    • Reactions were generally positive and the questions were thoughtful. MACSSA Modernization Steering Committee debriefed and will be continue to be guided by the commissioners’ comments and questions.
      • Commissioners Questions:
      • Have you considered partnering with school systems to access their resources, such as mental health and truancy resources?
      • Sounds like everyone will do every kind of assessment, for example who will do chemical health assessments?
      • What can AMC do to help? Should AMC convene MACSSA and the other affiliates, like MnCCC and LPHA to work together on this?
      • What can the state do to help?
      • How will you determine if anyone is better off?
      • Can/will modernized data systems help do this?
  • The MACSSA AMC Human Services Subgroup will continue to receive updates on integrated services on a regular basis
  •  Christina (Tina) Klaphake and Wright County starts December 17! Wright County stepped up and offered 50% time for this!  She will connect with you and county staff across the state to gather input on the integrated model and to promote innovation to guide implementation.  Wright County used an interagency agreement with DHS to be reimbursed for Tina’s time.
  •  Wanted: Another .5 FTE to work with Tina and all 87 counties. Please consider who you may have that would appreciate this state-wide exposure, is ready for a new challenge, and who’s county wants a closer connection to how this will be rolled out. Costs for current county staff will be reimbursed to the home county through Modernization funds via a DHS interchange agreement. Contact Pam Siebert to access the request form.
  •  Personae Workgroup: This work group will lead efforts to develop personae, use cases, and journey maps that provide examples of the experience of Minnesotans who receive public health and social services as they navigate the service delivery system. The work group will also support research efforts to identify real Minnesotans’ experiences seeking public services to inform improvements needed in the process. County input is needed.
  •  5 By 5, DHS messaging vendor:  Will be completing their work in February, including December proposed message framework and name recommendation options and February final integrated services business model name, message framework and verbal brand guidelines.

II.        Data Analytics

Hiring data analytics specialists:

  • County Data Scientist (.5 FTE): Stephanie Radke and Kathleen Simon, Dakota County, and Erik Erikson, Hennepin,are helping to clarify this request to coordinate and avoid duplicating work in DHS. Money is set aside in Systems Modernization funding for this until 9/30/19. Stay tuned.
  • DHS: Data Strategy Lead (1 FTE): A position description is being finalized. Several partners have provided input; the position will be on the DHS Business Solutions Office (Lisa Barnidge’s) Data Alignment Team. Working on the ISBM “Outcomes” narrative will be an initial task of this new position.

Below is an interesting article from the MACSSA e-News on Why Data Culture Matters. Link here: article in the recent McKinsey Quarterly.  Highlights in yellow below are mine.  As you know, data analytics is critical for the future of the MN Integrated Services Business Model. 

  • Note: you can read the article and/or listen to it.
  • Below is an excerpt to help us continue to move toward a common understanding

…understanding of the difference between traditional analytics (that is, business intelligence and reporting) and advanced analytics (powerful predictive and prescriptive tools such as machine learning).

  • “It’s almost like a yin and yang, or a dark side and a sunny side. Introduction of the data-management policy documents, procedures, data catalog, data dictionary—the fundamental setting is common for the [financial] industry. And the mind-set necessitated to this area is more of “rule orientation.” The other side, the sunny side, I would say, is more Silicon Valley–oriented, more of the data usage, data science, data analytics, innovation, growth. Housing those two ideas into one location is so important. “

 

III.        Innovation

What is it? Providing the required level of time and budget to take the MN integrated services business model, refine it, experiment on it and finally turn it into a real solution. Collect lessons learned, vet them with MASCSSA and DHS, and edit ISBM to reflect new understanding and hands on experience. Think of it from two viewpoints,

  • From an internal, organizational viewpoint, such as whether service is more efficient for workers
  • From the viewpoint of people we serve, their perceived value; look at every new thing you are trying from various customers’ perspectives.

This approach to fleshing out the integrated model depends on counties sharing their experiences with each other and an intentional approach to vetting learnings with DHS into the business model

Examples:

  • Ignite Sessions (see 2018 Fall MACSSA Conference materials): On-the-ground examples of efforts already underway in Minnesota counties moving towards the integrated services business model.
    • Social Determinants of Health: Bringing Social Determinants of Health to Life in Dakota County, Kelly Harder, Dakota County
    • Data analytics: TIES, Rachel Grimes, Crow Wing County
    • Person-centered practice: Small Counties Accessing Grants with Huge Commitments, Phyllis Reller, Pope/Grant Counties
    • Person-centered practice: Person Centered Incident Matrix, Linnea Mirsch, St. Louis County
    • Multi-gen: Case Study: Improving Screening and Referrals for Citizens, Janet Goligowski, Stearns County
    • Minnesota Local Government Awards 2018 http://lgia.umn.edu/lgia-winners-2018

Innovation via data: Data, applied to a business problem, creates innovation and then people have the ability to act on their innovative ideas and create value.

Requested Actions Needed From MACSSA:  None

New Trends in This Area:  NA

Issues/Concerns Regarding This Topic:  

  • Need to hire another .5 county stakeholder engagement specialist.  
  • Bina Nikrin is retiring as of 2/28/19. MACSSA is committed to this role and Bina will work to ensure a smooth transition. Please contact Eric Ratzmann with questions/concerns.

Legislative Impacts:  NA

Supporting Materials:  MACSSA Presentation to AMC Conference

Contact(s):  Bina Nikrin

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