Behavioral Health Update - February 2019

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

Competency Restoration Program/Rule 20:

Leah Kaiser from Hennepin County reported in on a meeting she attended along with Angela Youngerberg in which the County Attorney’s Association is bringing forward a legislative proposal that would expand the pool of individuals needing to be restored to competency, regardless of the offense and would subsequently be prosecuted upon restoration. This would include all Targeted misdemeanors.  Considering the current position being taken by DHS on Competency Restoration responsibility this expansion creates numerous concerns for counties.  It had been hoped that the County Attorney Association efforts around CRP would help navigate through the current concerns MACSSA has around CRP.  This appears to make the situation worse. (Attached MCAA PowerPoint)

SUD Reform: 

Representatives from SUD Reform State/County workgroup met with Maisha Giles and Matt Burdick yesterday to discuss the future of this workgroup.  DHS is interested in having new players at the table from DHS.  County workgroup members will meet soon to plan future efforts.  The question was discussed about what counties are doing while direct billing is not available to providers for the new services.  Are counties opening spans of eligibility in CCDTF for straight MA individuals for the new SUD services (billing mechanism is not working currently)?  No:  Stearns and Anoka.  Yes:  Hennepin and Blue Earth.  

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.   The latest is that our author in the house (Zerwas, with Liebling support) indicates that we should not be so concerned about the fiscal note that will appear on a position that includes an Administrative Law Judge being the deciding voice, and really opposes any position of ours that includes the Commissioner being the decision-maker.  DHS will not be thrilled with this position.  Essentially, Zerwas wants to continue with the plan we all agreed upon last year.  The criteria as drafted is very similar to what was presented at MACSSA with only a slight adjustment in the final bullet. The recommendation now is to go with the appeal to an Administrative Law Judge (not directly to the Commissioner or a 5-person panel). 

  • the county is not given notice of not meeting medical criteria; orhe hospital paperwork is not complete, delaying the discharge; or
  • the determination of not meeting medical criteria is made on a holiday or weekend; or
  • the discharge does not occur because the hospital does not agree with the discharge plan; or
  • the discharge is delayed due to lack of bed availability for individuals who meet “safety net criteria,” resulting in state-operated services as the only option.

Local Mental Health Authority Discussion:

There is so much going on in the mental health area and legislative items.  It feels like the LMHA structure is changing and/or being impacted with no County specific position.  How do we have an intentional conversation about LMHA?  How do we have the right people involved in the right areas at the right time to have impact?  Could we identify point people for target areas and they stay up to date on the issues and respond/coordinate what is happening?  A follow up conversation with the topic leads and others will follow to try and identify target items and an approach with this.


Requested Actions needed from MACSSA in the next month:



.Issues/Concerns regarding this topic this month:

LMHA Direction and MACSSA Position


Legislative Impacts:

MACSSA has numerous support and promote positions around Behavioral Health.  SUD Reform and CRP are top items.


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

MCAA Power point

Child Wellbeing Update - February 2019

Key Highlights This Month:  

  • MACSSA/DHS CP Fiscal workgroup met on 2/7/19.  See minutes from the meeting attached.  Of note, the CP Fiscal workgroup was asked to review the African American Family Preservation Act and provide an analysis of the potential impact to county staff and resources.
  • MACSSA/DHS Legislative workgroup met on 2/8/19.  Minutes attached.  DHS was not able to offer detail about proposals at this point because they are awaiting budget and policy decisions by the Governor. 
  • Educational Stability-Jamie Halpern (Hennepin) and Amy Shillabeer (Olmsted) continue to work on options for either a continuation of the pilot or a permanent funding solution.  Amy and a representative from Rochester Public Schools met with Senator Carla Nelson who is supportive and currently bill language is being drafted with an initial hope of securing a permanent funding solution.
  •  The African American Family Preservation Act (see attached) has recently been introduced in both the House and Senate.  Members of the CP Fiscal Group are trying to determine the potential fiscal impacts to counties.  The current plan is to reach out to counties with a higher number of ICWA related cases and ask for an estimate of increased staff time and services for cases requiring active efforts to assist in our effort.  We hope to gather some information from Hennepin, Beltrami, Ramsey, St. Louis, and Mille Lacs Counties. 
  • MACSSA/DHS Child Well Being Group met on 2/13/19.  See minutes attached. 

Requested Actions Needed From MACSSA:  
The CWB workgroup is interested in adding to the list of content experts, particularly there is a need in the area of children’s behavioral health.  If interested, please contact Amy or Jodi.

New Trends in This Area:  

Issues/Concerns Regarding This Topic:  

Legislative Impacts:  

Supporting Materials:  

MACSSA-DHS Leg Meeting Notes
CP Fiscal Meeting Notes
MACSSA CWB Team and DHS Phone Consult Agenda


Amy Shillabeer
Jodi Heurung

Healthcare Update - February 2019

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

DHS’ Financial Operations Division (FOD) sent an email on December 14, 2018 regarding detailed Income Maintenance Random Moments Time Study (IMRMS) and the Social Services Time Study (SSTS).  Beginning with Q3 2018, the FOD will provide all counties with their County specific time study result reports.  The spreadsheet contains three tabs – observation detail, observation net and group summary.  For example, the observation detail tab shows specific random moment response detail by participant for each time study observation.  The email includes two memos and your County’s detailed report.  Contact your accounting/fiscal staff if you have not seen this report.  You may contact Molly Klismith at molly.klismith@state.mn.us or Cindy Bayles at cindy.bayles@state.mn.us if you have any questions regarding your County's report.

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 Managed Care Organization (MCO) they were enrolled in, but MCO contracts for Minnesota Health Care Programs (MHCP) members under age 65 will no longer cover PCA and HCN. MHCP will cover these services on a FFS basis beginning Jan. 1, 2019.

Todd McMurray from Chisago County has been appointed to the METS Health Care Program Management Team (PMT), replacing Tiffinie Miller from Dakota County.

The METS PMT is currently working on setting initial priorities for the Advanced Planning Document (APD) funded projects for APD year 2020.

The IRS standard business mileage rate increased from 54.5 cents to 58 cents per mile Jan. 1, 2019. Minnesota Health Care Programs (MHCP) will reimburse 58 cents per loaded mile for NEMT volunteer driver and foster parent appropriate and most-direct-route transports for dates of service beginning Jan. 1, 2019, through Dec. 31, 2019.

DHS will mail approximately one million Forms 1095-B in February.  Approximately 50,000 will be mailed each day in order to meet the March 4th deadline.  Members who have changes to their eligibility after January 23, 2019 will get a corrected form sometime in March or April 2019.

 Requested Actions needed from MACSSA in the next month:



Periodic Data Matching (PDM) - February 28, 2019 is the last business day of the month and the last day for enrollees to resolve PDM discrepancies or request an extension.  March 1, 2019 is the first day of eligibility loss for enrollees who did not respond to their PDM notice.

PDM cases with a February PDM month: 24,389

Cases with a discrepancy: 3,576 (14.6%)


During the PDM field test, between August and October DHS facilitated a total of 7 Supported Sessions for workers. During that time they received approximately 10 questions. Based on this experience, they do not currently have any supported sessions scheduled in the future.  DHS will continue to check in with Mentors to see how it’s going.



Issues/Concerns regarding this topic this month:

DEED data was added to the METS system for renewals in 2017, and the first batch of renewals that it impacted was July 2018 MA renewals. There were several issues with what was being populated on the renewal.  DHS HCEO worked with MN.IT on the analysis of the issues which were not considered defects, but further analysis was needed to figure out why this was happening.  It was noticed that the most recent DEED data was not populating on the renewal.  It was discovered there is a two-step process for MN.IT to put the information into the data warehouse, but MN.IT only completed the first step and not the second.  MN.IT fixed this and completed both steps; but no changes were found on the next batch of renewals run at the end of Dec 2018, other than it appeared to populate more recent data. Further analysis is needed.


The State Medical Review Team (SMRT) has shut down the following email addresses in order to ensure that members’ private data and protected health information is not compromised:  dhs.smrt@state.mn.us and dhs.smrtcases@state.mn.us.  If you want to check the status of a SMRT referral, or update contact information for a member, you may contact the SMRT hotline at 651-431-2493 or 800-235-7396.


Legislative Impacts:



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



CONTACTS (For Topic Groups):

Kari Ouimette


Modernization Update - February 2019


Update on Governance and Communication Planning for MACSSA Modernization Steering Committee

• Todd McMurray, Chisago County, replacing Tiffanie Miller on the METS PMT
• Christina/Tina Klaphake, Wright County, new ISBM Stakeholder Engagement Lead (half time), will attend these meetings as time permits.
• Pam Siebert taking over convening this group from Bina, as of March1.

METS Position statement
• Janet presented draft position statement
• Considerations included: our credibility is on the line; we need systems that function for end users; ensure all our current systems are functional, while preparing for new ones.
• Eric, consulting with Janet, will revise this for further discussion at the March Steering Committee Meeting. Will set in overall context of Modernization.  Considerations include:
• Dakota did study compared task time between METS and MAXIS (was additional time due to system or increased caseloads?)
Group decided this would be used internally, not for a legislative position.

APD Process
• IESC members, Marti, Chris, and Janet described some frustration with beginning of APD (federal funding proposal) discussion. Members of other governance groups shared similar perspectives. This led to the following discussion of possible ways to address this.
• NOTE: PMTs oversee anywhere from 80 – 300 projects.
Consensus: a technology roadmap is needed.

Alternatives to relying on current governance structure:
• Factors:
o Adequate time to make informed decisions
o Challenge getting MACSSA “volunteers”, e.g. PMT members
o Assessing/collecting statewide input to decisions
• Alternate ideas that could be explored further o Invite DHS/MNIT to organized MACSSA meetings to provide background and context to upcoming decisions or topics
o Communicate to MACSSA members to solicit input in context. Consider sharing official monthly update with MACSSA (see attached email)
o Ask for a Modernization Liaison position, similar to Matt Freeman, but focused on Modernization.
• DIGT MACSSA members are disconnected from other counties. Their feeling of isolation causes them to draw almost exclusively on their experience in their own counties, rather than state-wide. Modernization Strategic Reframe Feedback: - NOTE: Change terminology from partnership with “MACSSA” to partnership with counties.
Like: helpful for phasing (like prototypes and pilots; explains the “what”; good person-centered design and project funding;
Needs improvement: lots of jargon, innovation missing; need more reference to iterative work and testing/innovation rapid cycle; need to call out intention of county / state partnership; how to operationalize (no connect to IESC) ?
Add 4th initiative on “Enable” technology to effectively support… (look at Cúram strategy to leverage technology?)
Questions: Where do tribes fit? When referring to “resources” can we assume it means state resources, not county? Expect invitation from Pam for future meetings

Ideas for Future Agendas
• Dakota report on their study related to METS work – Marti
• METS/Modernization position revised proposal – Eric and Janet
• DIGT members share more about their work and Steering Committee discusses how it fits into the other work – Erik, Scott, and Dan
• Self-service tools for people we serve - Chris
• Invite Chuck Johnson and/or Greg Poehling,
• Ask DHS/MNIT to do context setting.
• Revisit best way to communicate each governance group’s activities with MACSSA members – Brad and Marti
• APD Process Update – EAB and/or IESC reps

Enterprise Architecture Board (EAB)

EAB topics in January included a discussion on FFY2019 APD financials, and an overview of the approaching APD process for FFY2020.

In addition to the APD financial and process information, the I-ESC presented proposed goals and criteria for FFY2020 APD prioritization. EAB will continue to discuss strategic priorities with I-ESC at future meetings, but voted in support of the direction of the I-ESC proposal and continued efforts.

EAB received an update and initial draft from their subgroup working on proposed updates to the Modernization Strategic Plan. Work will continue and the topic will return at a February meeting. An overview of conference calls with other states (Arkansas, Ohio, North Carolina, and Michigan) undertaking human services modernization was presented. The calls are focused on approaches, results and learnings from experiences with systems modernization initiatives. More calls will take place with other relevant states in the future. Integrated Human Services Executive Steering Committee (I-ESC) A major topic in January was preparing for the Federal Fiscal Year 2020 (FFY20) Advance Planning Document (APD) submission annual updates. I-ESC members received a presentation from the Business Solutions Office (BSO) about the high-level timeline for the Federal Fiscal Year 2020 (FFY20) Advanced Planning Document (APD). The presentation covered the budget and resource planning approach, project alignment guidelines, and the review and submission process.

The group developed recommendations for prioritizing APD projects, including goals, operational criteria, prioritization tools, working assumptions, and other considerations. The aim of APD prioritization is to present EAB with a package of initiatives that meet agency needs and goals and are most likely to be implemented successfully. The recommendations were shared and accepted by the EAB at its Jan. 24 meeting.

I-ESC members also received a more in-depth presentation about APDs from the Business Solutions Office (BSO). The presentation covered the I-ESC’s role and responsibilities in the APD process, factors that drive APD priorities, and work that can be included in APDs.

Another topic for the I-ESC was maintenance and operations work. The MAXIS/MEC2 Business Change Request (BCR) Team shared concerns that there are not enough MNIT resources to support systems maintenance work, not only in terms of numbers but also MNIT staff that have in-depth system and program knowledge. Work is underway to develop an approach for that work going forward in the new governance structure. This includes aligning goals, setting the framework for prioritizing projects, scoring projects, ranking projects and validating decisions.


APPARENT TRENDS IN THIS TOPIC AREA: Communication and education with AMC is a focus right now as well as trying to figure out if counties collectively have the bandwidth to fill all the governance roles.

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


Marti Fischbach – Modernization Co-Lead; IHSM ESC
Co-chair Brad Vold – Modernization Co – Lead; BADT member
Jane Hardwick, Stephanie Radtke, (vacancy due to Denise Moreland retirement) - EAB

Self-Sufficiency Update - February 2019


Child Care 
• 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 intends to 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. o A joint bulletin was published Nov. 20. See Bulletin #18-69-02 New Spouse Income Policy for Cash and Child Care Assistance Programs. o MEC² Temporary System Guidance was posted to SIR on Dec. 3. 
• 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. The Governor intends to release his budget proposals this month and CCAP expects that there may be additional changes proposed that impact CCAP. 
• DHS CCAP has recently updated and created documents for child care providers and families about the Child Care Assistance Program. Printed copies will be available soon. All documents are available on eDocs: o The Child Care Assistance Program (CCAP) Provider Guide (DHS-5260) (PDF) has been updated. o Do You Need Help Paying for Child Care (DHS-3551) (PDF) has been updated. o The Child Care Assistance Program (CCAP) Family Guide (DHS-3944) (PDF) is a new document developed for families who are eligible for child care assistance. 
• DHS CCAP recently published two reports:

o Minnesota Child Care Assistance Program: State Fiscal Year 2017 Provider Profile (DHS-7819) (PDF), published January 2019

Child Support Recent and Upcoming Events 
·The next Child Support Task Force meeting is on February 27 in St. Paul. 
Upcoming Grants and RFPs
·The division is conducting its annual verification of security and permissions for its own staff and with county security officers to ensure individuals have appropriate access for their role. 
· The division published its 2018 Minnesota Child Support Performance Report. The report highlights program performance, provides updates, and presents the most recent data including statewide and county performance for the five federal performance measures. 
Success Stories 
· Last year, the division implemented a new payment method using PayNearMe and MoneyGram, which allows parents to pay their child support in cash at retail locations across the country. PayNearMe began in January 2018 and MoneyGram started in June 2018. As of the end of January 2019, parents made nearly 3,200 child support payments using this method totaling nearly $1.1 million.




• See Bulletin #18-69-02 New Spouse Income Policy for Cash and Child Care Assistance Programs for changes that took effect December 1, 2018. 
• The Child Care Assistance Program (CCAP) Provider Guide (DHS-5260) (PDF) has been updated. 
• Do You Need Help Paying for Child Care (DHS-3551) (PDF) has been updated. 
• The Child Care Assistance Program (CCAP) Family Guide (DHS-3944) (PDF) is a new document developed for families who are eligible for child care assistance. 
• Minnesota Child Care Assistance Program: State Fiscal Year 2018 Family Profile (DHS-6664F) (PDF), published January 2019 
• Minnesota Child Care Assistance Program: State Fiscal Year 2017 Provider Profile (DHS-7819) (PDF), published January 2019

ISBM Update - February 2019

Key Highlights

For more information, link to 20-minute Integrated Services Business Model Webinar.

Counties Continue to Implement ISBM Innovations in 2019” Don’t miss this presentation at the February 27 Monthly MACSSA Forum.

  1. Wright County Public Health went through a year-long Health Equity Data Analysis (HEDA) process in the community of Montrose in 2017-2018. This process included relationship-building, community engagement, and data collection and analysis to find the root causes of health inequities. Two staff members who worked on this project, Joel Torkelson and Ellie Vanasse, will be there to present on the HEDA process, their findings, and how they partner with communities to guide their work. Wright County Public Health Director Sarah Grosshuesch will also be attending.
  2. Bina Nikrin and DHS Kate Kunitz will present ISBM year in Review
  3. Tina Klaphake will share her goals for ISBM stakeholder engagement statewide.
  4. Attendees will consider what their counties can do or are doing to move into best practices of the statewide integrated model.


Personae/journey mapping work has begun. To provide the county perspective, Kathleen Simon, Dakota County, Ryan Selock and Brian Doerner, Hennepin, joined a short-term DHS workgroup. This group of early adopters are working on personae or use cases and journey maps that will provide insights into the experience of people we serve as they navigate the human services system. This work was identified as a key 2019 activity in the State Modernization Roadmap. This will guide how the integrated services model will be further fleshed out and implemented.

Students from Prime Digital Academy | Minnesota's Code & UX Bootcamp‎ completed some interviews with workers as a trial run.  Good news is that this work will NOT require IRB/Institutional Review Board approval to interview people we serve, so this should move ahead more quickly now. For more information, see

7 Core Ideas about Personas and the User Experience

This usability.gov article describes that personas are based on interviews, data, demographics … i.e. research – not assumptions or stereotypical ideas


Counties share initiatives to move closer to integrated model.

What: Collect lessons learned, vet them with MASCSSA and DHS, and edit ISBM to reflect new understanding and hands on experience.


1st) Complete the MACSSA Integrated Services Business Model Innovation Tracking form available 2/27 at February 2019 MACSSA Forum ISBM Handouts.

2nd) Submit Lessons Learned to Christina.klapahke@co.wright.mn.us and/or PSiebert@mncounties.org.

Why: 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.

This approach to fleshing out the integrated model depends on counties sharing their experiences with each other and an intentional approach to vet learnings with DHS and propose ways to incorporate needed changes into the business model. These need to be approved by BADT/Business Architecture Domain Team, which includes four MACSSA reps, along with DHS and MNIT members. 

Future ISBM Topic Reports will come from Tina Klaphake and focus on her work with counties across the state. Stay tuned! Bina Nikrin is retiring as of 2/28/19. “I have thoroughly enjoyed working with you all this last year!  Thanks for the opportunity and for all your support! Keep up the great work.”

Requested Actions Needed From MACSSA:  Reimbursable from DHS Interchange Agreement,

  • .5 FTE to work with Tina to engage all counties in ISBM
  • .5 FTE to coordinate MACSSA ISBM implementation work with DHS

New Trends in This Area:   

Issues/Concerns Regarding This Topic:  

Legislative Impacts:  

Supporting Materials:  February 2019 MACSSA Forum ISBM Handouts



Jane.Hardwick@mnprairie.org, MACSSA ISBM Sponsor

Christina.Klaphake@co.wright.mn.us , MACSSA ISBM Stakeholder Engagement Lead

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