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Behavioral Health Update - October 2018

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

  • SUD Reform:  Withdrawal Management was to have been included in the CMS waiver which would have allowed us to bill earlier than 7/1/19.  It was not included and this could have a negative impact on the few facilities that continue to provide this care due to the low rate of reimbursement from county levy funds only.  We received word this week that one facility is closing.  Withdrawal Management services should be billable sometime next year.  Once billable it will take a while to build the rate into the infrastructure so may not see immediate relief.  These facilities will also need to contract with various PMAPs before payment will be available.  Providers have appreciated the assistance from Counties in SUD planning and technical assistance. CCBHC connection to SUD reform:  they are connected through the 1115 waiver.  DHS is using SAMHSA funding and planned legislation to expand sites from 6 to 11. Also, will extend funding for the next 5 years.
  • MMIS billing codes are being tested; once that is done the assurance statements will be posted to e-docs however they are not ready yet.  While we wait, it might be a good idea for counties to begin working on gathering this data if they are planning to provide any services under SUD reform. 
  • Detox payment responsibilities: Couple of interpretations going on.  Some relying on new SUD reform language/statute and other using CFR/residency statute.  It will be important that one approach is used.  We should have one method of determining CFR for CD and mental health. 

Competency Restoration Program:

  • There continues to be confusion regarding CRP responsibilities as DHS moves forward with their changes. Hennepin having examples of State Operated Facilities notifying courts once a person has stabilized and they then appeal to the court to discharge them.   Where are these clients supposed to go?  And how will they be restored?  We would need a whole network of providers to provide secure CRP and do not have it nor is there a mechanism for payment.  Counties are not required by statute to pay these costs.  It is anticipated that the State will move forward with a legislation change that would put counties in a position of payment and may look like the AMRTC cost shift.  Suggestion of bringing another CRP forum forward for a future MACSSA meeting.

 Crisis Grants: 

The impact of crisis grant reductions and/or giving monies to other counties for mobile service expansion continues to leave questions of affordability for counties and sustainability.  We need to know the total by county to try to determine what happened (why most counties are seeing a 25-30% decrease). DHS will be contacted.

Behavioral Health Crisis Bonding RFP:

Counties should be sure they understand the bonding requirements (separate from DHS requirements); there are some concerning pieces in it.  Stearns is hosting a phone call biweekly to share progress/ideas.  If your county is pursuing this RFP and you would like to participate in the call, please email Julie Ellis (Julie.ellis@co.stearns.mn.us)

 

Mental health issues in local jails: 

Most counties continue to struggle with this and are working on some potential responses.  Hennepin has been working on for about 4 years and will share information. 

  • It continues to be a concern that counties will have little say in the actual operational and eligibility requirements for the Chemical Dependency Treatment Fund (CDTF)
  • There is delay in CMS approval regarding Withdrawal Management Service development and is now targeted for mid-2019.

Requested Actions needed from MACSSA in the next month:

SUD Forum time

CRP Forum time

 

APPARENT TRENDS IN THIS TOPIC AREA:

 

Issues/Concerns regarding this topic this month:

SUD Reform Impact

CRP legislative cost shifts. 

 

Legislative Impacts:

 

 

Bulletins, Publications, or supporting materials to be included with this update:

 

 

CONTACTS:

Julie Ellis

Jerry Pederson

Case Management Update - October 2018

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

The case management initial design team had its last meeting on Monday, September 24th. It was an all-day meeting focusing on some last issues related to a final service design.  A draft of the service design is currently being finalized and shared with design team member for final comments. That draft will subsequently got to the Case Management Redesign Leadership Alignment Team at the end of October for final review. Following that, the draft design will be shared broadly across Minnesota to gather statewide stakeholder input. County reps who are on this committee have been invited to the fiscal committee meetings so we can continue to follow up on the work that Navigant is doing and ensure county participation.  That group met in October with the following information to share:

  • Navigant (our financial contractor) is completing its preliminary analysis of the three counties (Sibley, Dakota, Carlton).
  • The Finance Team has regrouped, with essentially all of the former Policy Team being added into it. The addition of the Policy folks is to better equip the Finance Team to begin working through the upcoming unit and rate methodology discussions.
  • The first step is to study a Decision Map so that we are more able to evaluate options. 
  • The Finance Team discussed again that the only item that the feds are REQUIRING us to fix at this time is that Minnesota permits each county to set rates for any case management providers that they contract with, and set the rates in any manner at all without statewide consistency. Making things more consistent across different types of case management at this point is a state initiative rather than driven by federal concerns.

 

 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:

Too soon to know if there are legislative topics for the 2019 session

 

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

 

CONTACTS:

Stacy Hennen and Mike Herzing

Child Wellbeing Update - October 2018

KEY HIGHLIGHTS IN THIS TOPIC AREA FOR THE MONTH

• SOC (System of Care) Update: Contracts are being developed for training on wraparound and bridging. Wraparound training will allow for up to 50 attendees per session. An overall training plan is being developed to include training on family involvement, youth involvement, marketing, etc. As wraparound training is one of the biggest investments of the grant, a possible MACSSA forum could be provided in early 2019 to introduce the training and concepts to all counties. Wraparound is one of the biggest investments so how can this be inclusive of counties who did not get any of the grants.

• The Legislative Task Force on Protection of Children will be meeting on October 22: DHS was asked to present on the 93 task force recommendations. Jamie Sorenson and Lori Munsterman are revising the document developed last year and will share with MACSSA. DHS will also provide an update on Families First Prevention Services Act. Tentatively, Senator Julie Rosen will be co-chairing with Representative Kresha.

• Bulletin: Title IVE Foster Care Maintenance Payments for Children Placed with a Parent in Residential Substance Use Disorder Treatment: The changes in this bulletin needed to be reflected in the State Title IV-E plan by October 1. The bulletin needed to be provided timely. There will be implications of this change including changes to Brass codes, elements of treatment facilities, etc. It is not yet clear whether counties will need to expend money to get the services in substance use programs in order to obtain the federal funding. This would be a change from past practice. There will be a preliminary discussion at the next MACSSA/DHS Fiscal Meeting in late October and a potential MASCSSA forum on how to carry out the bulletin requirements. See attachments for bulletin.

• Representative Kresha will be meeting with the MACSSA membership at the November meeting regarding the counties’ perspectives on the Families First Prevention Services Act. This is a great opportunity to meet with Representative Kresha who co-chairs the Legislative Task Force on Child Protection.

• Safe Passages/Rich Gehrman has been meeting with MACSSA CP Fiscal Work Group members regarding the total costs to the system of the child protection reforms in 2015. He is developing a preliminary “coalition” meeting on the total cost of child protection services and has invited numerous stakeholders, including MACSSA.

• Minneapolis Health Department has requested a connection with counties through AMC on their Focus on Father’s project. Hennepin County Human Services will follow up on some initial involvement on this.

REQUESTED ACTIONS NEEDED FROM MACSSA IN THE NEXT MONTH

DHS Child, Safety and Permanency will be requesting involvement in workgroups addressing specific areas of the Families First Prevention Services Act. The specifics of the request may change dependent on the MACSSA/DHS meeting with Casey on 11-1-18 to develop a process for creating a vision for our child welfare system. Potential Forum proposals on the following topics:

• Wraparound services and training through the SOC grant

• Title IVE Foster Care Maintenance Payments for Children Placed with a Parent in Residential Treatment

APPARENT TRENDS IN THIS TOPIC AREA ISSUES/CONCERNS REGARDING THIS TOPIC THIS MONTH

Potential fiscal and policy implications of DHS Bulletin Title IVE Foster Care Maintenance Payments for Children Placed with a Parent in Residential Substance Use Disorder Treatment: Implications are not clear yet. There may be a requirement to expend funding where not previously a human services expenditure in order to access the federal funding. More information will be sought and provided in a future update.

LEGISLATIVE IMPACTS

U of M and DHS are seeking assistance from MACSSA in pursuing funding for the Child Welfare Training Academy. Information has been obtained and a potential policy position will be formulated.

Save the Date: Educational Stability Work Group Meeting

Thursday, November 8, 2018; 11:45 – 1:15 PM (following MACSSA Monthly Meeting)

MCIT - 100 Empire Drive, St. Paul, MN 55103

This will be an important meeting, anticipating an update on the state’s plans for distribution of the first year of ESSA transportation funding, and plans for the pilot for year two. There will also be discussion on how to seek ongoing funding in the governor’s budget plans for the next biennium. The agenda will include the following:

1. What data has been reported from year one of pilot? a. How many school district/county agreements were completed? b. How many students were ‘kept in home district’? c. What was cost of transportation? d. other data?

2.What is plan for distribution of funds?

a. Timetable

b. How much (%) of costs will be reimbursed?

c. cash flow

d. any provisions or guidance re: assurance of sharing between counties and districts?

3. What are plans, if any, for inclusion of funding in State budget plans for next biennium? MDE? DHS?

a. What can we do to help promote this?

4. What else did we learn from the first year of pilot? E.g. how many kids went to relative placement and were able to remain in same school?

5. Are there suggestions for simplifying the process for pilot yr 2 (and beyond)?

6. What kinds of TA or peer support would be beneficial to counties and school districts as they seek to develop and implement local plans?

a. Are there specific issues or barriers folks have encountered during past year that should be addressed?

7. What are communication plans going forward?

8. Status of getting a roster that names the ESSA Foster Care points of contact in all school districts and counties in MN

BULLETINS, PUBLICATIONS, OR SUPPORTING MATERIALS TO BE INCLUDED WITH THIS UPDATE

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=Bulletins_2018#b68

DHS bulletin 18-68-19: Title IV-E Foster Care Maintenance Payments for Children Placed with a Parent in Residential Substance Use Disorder Treatment

CONTACTS:

Suzanne Arntson, Brenda Mahoney

Healthcare Update - October 2018

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

2020 MA and MinnesotaCare Managed Care Procurement – bids for the 2020 contract year will be for Greater Minnesota counties outside the metro region.  The metro includes Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington counties.  The metro counties will be procured for the contract year 2021.  An invite to a webinar went out on 10/3 to county directors from the 80 counties procuring in 2020.  Questions can be sent to DHS.PSD.Procurement@state.mn.us or contact PJ Weiner at 651.431.3487

The METS Program Management Team (PMT) is working to finalize a list of candidates for 2019 projects.

 

The METS PMT is also finalizing the "Operationally Efficient" list of functionality as directed by the Enterprise Architecture Board (EAB).  The list is now with MNIT to determine high levels of effort.  The final document will be presented to EAB sometime in November.

 

In 2016, Minnesota began using spousal impoverishment protection rules rather than deeming waiver rules for determining Medical Assistance (MA) eligibility for certain married people applying for home and community –based services (HCBS) waivered programs.  Beginning January 1, 2019, Minnesota will return to the previous rules to determine eligibility for these programs.   Only the income and assets of the person applying for MA and long-term care services count when determining financial eligibility.  See DHS Bulletin #18-21-08 for more details.

 

On October 2nd, MMIS implemented new functionality that continues to improve the interface from METS to MMIS.  The new functionality includes a change in the hierarchy of major programs to reduce errors in the interface, prevention of IM eligibility spans from being overwritten by new coverage that interfaces from METS, MMIS is now able to handle MinnesotaCare eligibility spans that begin 60 days or more in the future.

 

Beginning October 22nd, the Appeals Division at DHS will enter appeal cases into METS.  Many ONEsource procedures have been updated to reflect this change.

 

Requested Actions needed from MACSSA in the next month:

None

 

APPARENT TRENDS IN THIS TOPIC AREA:

The Periodic Data Matching (PDM) Field Test is nearing conclusion, as October 1st was the first day of ineligibility for enrollees who did not respond to their PDM notice.  The assessment workgroup has been meeting regularly to share and discuss County experience during the field test.  Some issues have been reported, but overall, the workgroup agrees that the work and call volume has been less than anticipated.  The workgroup is currently working on the final report that will be presented to the METS PMT, METS Executive Steering Committee (ESC) and the Enterprise Architecture Board (EAB) by the end of November.

 

Issues/Concerns regarding this topic this month:

Information continues to be communicated about changes to Medicare in 2019.  As mentioned in the September update, Medicare Cost Plans will not be available in some counties in 2019.  These are counties in which there are two or more Medicare Advantage plans that meet enrollment numbers.  See Medicare Cost County map and Cost Plan Transition attachments for more information.

 

Legislative Impacts:

 

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

 Medicare Cost County map
Cost Plan Transition

 

CONTACTS:

Kari Ouimette

© Minnesota Association of County Social Service Administrators

125 Charles Avenue, St. Paul, MN 55103

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