Partner spotlight: Creative person-centered best practices
Have you
been wondering how to incorporate more person-centered practice into your agency?
Well, we have a great example for you.
Washington
County is developing a person-centered training process and curriculum for
community services staff in conjunction with STAR Services. The program is
funded through a local planning grant for developing alternatives to corporate
foster care and community residential settings for people with disabilities. One
of the things the county is doing in 2018 is holding monthly “peer learning circles”
and requiring case managers and assessors to attend five of the 11 monthly
sessions.
Washington
County began to offer the “peer learning circles” at two locations beginning in
January. These learning circles will be one- to two-hour sessions made up of
two parts: training and consultation. The first part of the session will focus
on a variety of topics, including:
- Planning
practices
- Community
participation and inclusion
- Competitive
employment
- Informed
choice
- Risk
- Working
constructively with team members
- Meaningful
outcomes
- Developing
organizational alignment with person-centered principles
Washington
County plans to have people who receive services and their families speak at
the sessions to provide a different perspective to case managers. The second part
will focus on consultation for case managers to bring up challenges they are
facing.
The learning
circles will initially be led by STAR Services’ staff. During the first year,
STAR Services will also work with a small group of Washington County staff to
take over facilitation of the learning circles. The goal is that by the end of
the grant cycle, the learning circles will be led solely by Washington County
staff.
According to
Washington County, it is still developing the learning circles. But, the idea
is to have a guided and open discussion about person-centered practice, things
that feel uncomfortable and ways to have these conversations with the people
they assess and serve. Thank you to Washington County and STAR Services for
sharing their best practice and for taking person-centered practice to the next
level.
Thank you to pilot agencies
The MnCHOICES project team wants to extend a huge thank you to Becker, Washington and Winona counties, our MnCHOICES Assessment 17.1-17.3 release pilot agency partners. A partnership with all our lead agencies is a vital part of the MnCHOICES project. Pilot agencies and the work they do during release testing are a huge reason for the progress we have made. Thank you for the continued commitment to our mission and vision!
If your lead agency is interested in being a pilot agency for any future projects, contact the help desk at 651-431-4801 or dhs.mnhelp@state.mn.us.
Denise
Hauge joined the MnCHOICES
Assessment and Support Planning unit on Oct. 25. Denise is filling the
MnCHOICES communication and training position. Her primary role is coordinating
and creating communications for both the MnCHOICES Assessment and Support Plan.
Denise has five years of experience in health and human services. She worked as
an office manager of a personal care assistance/home care company. She
has also worked as a health educator for Lutheran Social Service.
New policy for six-month developmental
disabilities and Rule 185 case manager visits
Since the
MnCHOICES post-launch call in November, we have reviewed our policy for when face-to-face
visits are required and determined there
is a need for greater flexibility for an in-person visit for people who use DD services.
This policy is now aligned with the existing timelines for CADI, CAC and BI waiver
case management.
DHS
recommends case managers conduct in-person visits to meet the needs of the
person, which may exceed the minimum standard below.
Disability waiver
and Rule 185 recipients require, at a minimum, two in-person visits within a 12-month
period. An assessment qualifies for one of those visits. DHS no longer requires
these visits to be made every six months.
Notice of action
DHS has updated the Community-Based Services Manual (CBSM) to provide
guidance to county and tribal staff about the notice of action and appeals
process for people who use long-term services and supports. DHS has
updated/added the following CBSM pages:
- Appeals page: This page gives an overview of appeals.
- Appeals process page: This page gives information about the
appeals process, including what the county/tribe is responsible for completing.
- ·Notice of action page: This page gives information about which notice
of action form to use and when to use each of the forms.
DHS has replaced the previous DHS-2828-ENG Notice of Action form
with DHS-2828A-ENG (PDF) (Assessments and Reassessments) and DHS-2828B-ENG (PDF) (Service Plan). See the updated publications
section below for more information.
With 2017
coming to a close, the MnCHOICES Team wanted to highlight some of the positive changes
for the year and look forward to the work that will be done in 2018 to make the
MnCHOICES Support Plan even better.
Support
Plan highlights in 17.4
- Creation of a
more meaningful “face sheet.” DHS added fields such as plan creator, a snapshot
of the person’s demographic information and general notes.
- Reduction of page
breaks to shorten the printout.
- Compliance with
requirements for readability (margins, font size, font type, etc.).
- Alignment of left
and right margins across pages.
- Reduction of data
in the repeating headers and footers to leave more space for the actual plan.
- Reformatting of
the Recommended Referrals section to take up less space in the printout.
Support
Plan application changes coming in 18.1
- The MnCHOICES team
continues to make printing a high priority. Some of the blank spaces and
formatting that were not resolved in 17.4 are scheduled to be applied in the
18.1 release planned for Feb. 16, 2018.
New scope
- Allow user to
select a specific National Provider Identifier (NPI) when printing a CSSP or rate
plan.
- Allow users to print
the entire plan but limit the services and goals to those with the selected
NPI.
Emergency contacts
- Allow users to
edit in the support plan. This will print out in a user-friendly table.
- Allow users to
enter as many emergency contacts as needed.
- Reduce the
required fields for emergency contacts.
Legal authority/Non-legal
authority
- Allow users to edit
decision-making representatives. This will combine legal and non-legal
authorities.
- Allow users to
enter as many representatives as needed and to add more than one person to each
representative type.
- The fields are being
reduced and the printout will show the data in a concise table. This will
reduce a large number of pages in the printouts.
Health insurance
and payers
- Allow users to
edit health insurance and payers. This information will copy from one plan to
the next.
- The number of
fields is being reduced and the printout will show the data in a concise table.
Providers
- Allow users to
edit providers. Information will copy from one plan to the next.
- The number of
fields is being reduced and the printout will show the data in a concise table.
Caregivers
- Allow users to
edit caregivers in the support plan.
- Allow users to
enter as many caregivers as needed.
- The number of
fields is being reduced and the printout will show the data in a concise table.
Disability
& Aging PolicyQuest is an online, searchable,
question-and-answer library. PolicyQuest is available to lead agency staff and
the public who have questions about home and community-based services, programs
and waivers administered by the Aging and Adult Services and Disability
Services divisions. Members of the public do not need an account or password to
search the question-and-answer library. If you are unsure if you can submit
questions to PolicyQuest, talk to your supervisor.
Disability & Aging PolicyQuest updates include:
- New link to launch PolicyQuest
- Updated look and feel
- Users now able to add attachments when submitting
questions
- New login process
See the PolicyQuest Updates eList announcement for full details and what lead agency staff need to do.
DHS encourages users to review the CBSM, DHS bulletins,
PolicyQuest and the MnCHOICES CountyLink site after they have worked with the
multidisciplinary teams.
Change in reassessment responsibility
As of Jan.
1, 2018, the county or tribal nation of residence (COR) is responsible for
completing all reassessments for people who receive long-term services and
supports. Notifications to the COR started Jan. 1, beginning with reassessments
needed for service agreements ending May 31, 2018, or later.
Example: A
person’s service agreement ends May 31, 2018, (meaning the assessment would likely
occur in April 2018). In that instance, the following timeline would ideally
occur: The county of financial responsibility (CFR) would notify the COR
between Jan. 1 and Feb. 20, 2018, of the needed reassessment. The COR would
begin to process the assignment of the reassessment during this time. The COR
certified assessor works to schedule and prepare for the visit during the month
of March 2018. The assessor completes the reassessment and the CSP and sends
necessary information back to the case manager during April 2018. The case
manager completes the CSSP and the service agreement in May 2018.
 The COR
continues to be responsible for all new assessments for long-term services and
supports requests. For PCA and aging programs, the county of residence or
service completes all assessments (reassessments and new assessments).
Good
communication between the COR and CFR is essential throughout the process to be
flexible in responding to individualized needs. DHS has published the MnCHOICES
Reassessment Communication Form (DHS-6791E) and Instructions to Complete the
MnCHOICES Reassessment Communication Form (DHS-6791F) to help agencies communicate the
work being done between agencies when the COR and the CFR are separate agencies.
DHS sent an eList announcement on Aug. 30, 2017, to announce the
addition of instructions and more information on the Activity timelines for reassessments
when the COR and CFR are different and Reassessments when the COR and CFR
are different pages in
the Community Based Services Manual.
Annual
data privacy courses through Systems and Security Access Management
MnSP users
will receive an email from the Handling MN Information Securely site 30 days
before their training expires. It will remind users that it is time to take their
annual data privacy courses.
Because DHS
has moved to this centralized security system, users no longer need to submit
their data privacy course completion to DHS or their security liaison. Handling
MN Information Securely will maintain the training records.
Some lead
agencies are having their users take their courses all at one time, even though
they might not all be due, in an effort to make it easier for staff to remember
to complete their course work.
Contracted
agencies will want their staffs to ensure their training roles are correct in the system.
Check your training role
When MnSP
users complete Handling MN Information Securely training, they must carefully
choose county worker as their training role. This includes contracted agencies.
This will ensure the user has the correct privacy and confidentiality courses
selected.
 MnCHOICES
Support Plan: Provider signature requirements
All waiver service
providers with whom the person agrees to share his or her plan must sign the
CSSP. It is the case manager’s responsibility to get the provider signature(s)
or to document two attempts to obtain signatures.
The lead
agency review (LAR) team will review the case file for evidence of the
signatures or the two attempts for signatures up to 60 days from the CSSP completion
date. If the documentation cannot be found, the LAR team will request the
documentation from the lead agency.
The
following circumstances will be considered compliant:
- All
providers (with whom the person agreed to share his or her plan) have signed
the CSSP.
- The
lead agency has documented that it made two attempts to obtain signatures.
Beginning in
early 2018, the LAR team review lead agency files for compliance with provider
signature requirements. The LAR team will begin issuing corrective actions and
requiring remediation as necessary beginning with reviews completed in July
2018.
MnCHOICES
Support Plan: Person-centered planning requirements
Lead
agencies must follow the Person-Centered, Informed Choice
and Transition Protocol (DHS-3825-ENG) (PDF), as directed in the March 4, 2016, Part 2 bulletin
(#16-56-02) (PDF).
The lead
agency review team reviewed case files and provided informational feedback to
lead agencies. In January, DHS stopped providing informational feedback and
now is issuing corrective actions and requiring remediation, as necessary.
For a
complete list of items reviewed during a home and community-based services lead
agency review site visit, visit the HCBS Lead Agency Review website. If you have questions about these
requirements, email the LAR team.
MnCHOICES Support Plan: Frequency of service
When
completing a service line in a CSSP, the user must include the frequency of the
service. The bullets below clarify the intended use of the “Frequency Code,”
“Service Frequency” and “Support Instructions” fields when completing a service
line for a CSSP in the MnCHOICES Support Plan application.
- The “Frequency Code” field is
completed for PCA services only. For all other services, this field does not
need to be completed.
- The “Service Frequency” field does
not print on the CSSP nor the Rate Plan. Therefore, this field is an optional
field that may be used for internal communication.
- The “Support Instructions” field
prints on the CSSP. The user should explain the “Service Frequency” in plain
language for the person. The person writing the CSSP should provide guidance to
the service provider about delivering services for the person. Consider this
person’s unique preferences, challenges and goal(s) for receiving the service
when completing this section.
If you have questions about how to use the MnCHOICES Support
Plan application, check out the MnSP user manual, which provides directions and
useful tips. To use the MnSP user manual:
- Go to the MnCHOICES
CountyLink home page under the Quick Links Support Plan section.
- Click the question mark in the upper right
corner when at the log-in page of the MnSP. The question mark will take you to
the user manual log-in page. When you click on the menu option in the upper
left corner a list of tabs will appear.
- Click the question mark in the upper right
corner when already logged into the MnSP. The question mark will take you to
the user manual page specific to that tab.
Common questions
answered in the MnSP user manual
Links below are direct links to the information page. Users
will need to scroll down the page to find the answer. The user manual is
organized in the order it displays in the MnSP.
Questions that are not answered by the MnSP user manual
- Q: How do I take MnSP offline? A: There is no
option to work in offline mode for the MnSP.
- Q: How do I find the web link for the MnSP if I
lost my bookmark? A: Contact your mentor.
DHS has
posted or updated the following MnCHOICES-related publications and forms in the
eDocs library:
-
DHS-2828A-ENG (9-17) Long-Term Services and Supports Notice of Action
(Assessments and Reassessments)
-
DHS-2828B-ENG (9-17) Long-Term Services and
Supports Notice of Action (Service Plan)
-
DHS-3730-ENG (11-17) Adult Rehabilitative Mental Health Services (ARMHS)
Recertification Recipient Record Review
-
DHS-3730A-ENG (11-17) Adult Rehabilitative Mental Health Services (ARMHS)
Recertification Personnel Record Review
-
DHS-3751-ENG (11-17) Individual Community Living Support (ICLS) Planning Form
-
DHS-4159A-ENG (11-17) Adult Mental Health Rehabilitative Services
Authorization Form
-
DHS-5504-ENG (10-17) HCBS Waivers/AC Program
Reimbursement Request for Unforeseen Circumstances
-
DHS-6368-ENG (11-17) Direct Care and
Treatment Organization – Provider Enrollment Application
-
DHS-6791B-ENG (11-17) Long-Term Services and Supports (LTSS) Community
Support Plan with the Coordinated Services and Supports Plan
-
DHS-7611A-ENG (10-17) Person's
evaluation of his or her Coordinated Service and Support Plan (CSSP) (offline
version)
-
DHS-7611B-ENG (10-17) Person’s
evaluation of his or her service provider for day services (offline version)
-
DHS-7611C-ENG (11-17) Person’s
evaluation of his or her service provider for non-day or non-residential
services (offline version)
-
DHS-7611D-ENG (10-17) Person’s
evaluation of his or her service provider for residential services (offline
version)
For more information about MnCHOICES, visit us on the DHS
website. For technical assistance about MnCHOICES, visit us on CountyLink.
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