DHS Systems and IT Updates MnCHOICES

MnCHOICES Assessment development

May 13, 2019

Background of MnCHOICES Assessment

In 2013, the Department of Human Services (DHS) began using a person-centered, comprehensive assessment called MnCHOICES. This application is used to assess people’s needs and preferences, determine eligibility and provide information and service options. The person being assessed can make informed choices about the services and supports in his or her support plan with this information. This statewide process has improved the consistency and equitability of access to services across the state.

DHS’s continuous improvement effort has led to enhancements in the application, efficiencies in the system, the addition of an electronic support plan, service rate methodologies, an evaluation of services through the Long Term Services and Supports Improvement Tool and the design of the next version of the assessment, called MnCHOICES Assessment 2.0.

As of 2018, 485,000 individual MnCHOICES assessments and reassessments have been conducted by 1,700 certified assessors across the state. From the assessments, 83,000 people have received annual community support plans, 70,000 people have created coordinated services and support plans and 25,000 people have evaluated their services in the Long-Term Services and Supports Improvement Tool.

In a survey of counties conducted in March 2019, 100% of counties reported they are using MnCHOICES. Out of the 65 counties who responded to the survey, 82% are using it for all initial assessments and 80% are using for all reassessments.

MnCHOICES Assessment and Support Plan progress

Through the collaboration with lead agencies, DHS and Minnesota Information Technology Services (MNIT) have made technical and policy changes to improve the assessment process and functionality of the MnCHOICES Assessment 1.0 and Support Plan. We will incorporate these changes in the MnCHOICES Assessment 2.0. Some progress highlights include:

Completed improvements

• Reduced the number of required questions in the assessment
• Launched an electronic support plan that automatically transfers information gathered from the assessment to the support plan where it also calculates services rates; lead agencies report a time savings of 30-90 minutes per support plan.
• Extended the timeline to 80 days for nursing facility assessments after an admission for people younger than 65 to reduce the number of needed assessments. For example, had this been effective throughout 2016, it would have resulted in a 14% reduction in the number of needed assessments.
• Changed the requirement to complete a face-to-face assessment from 30 days to 60 days after a person is authorized to receive Developmental Disabilities (DD) waiver services
• Updated MMIS to allow lead agencies to check for a MnCHOICES assessment date to reduce duplicate effort and entry
• Discontinued the requirement of a face-to-face visit after a change in county of financial responsibility for the DD waiver

Improvements in process

• Implement a package of 12 developmental disabilities services process improvements. Examples include:
• Eliminating the face-to-face visit when there is a change in guardianship status
• Eliminating the need for a reassessment when a person moves to a new county
• Expand the methods for legal representatives to participate in assessments to include phone, FaceTime or Skype in addition to attending in person
• Allow the assessment process to continue when the assessor identifies that the person may need support to make decisions

We continue to evaluate the potential of other recommended efficiencies in MnCHOICES Assessment 1.0 or Support Plan. Our primary focus is achieving outcomes through the completion of the MnCHOICES Assessment 2.0 project while maintaining the stability of MnCHOICES Assessment 1.0. We will weigh opportunities for efficiencies against risks of destabilizing the current system, as well as consider the competition for resources to complete MnCHOICES Assessment 2.0. We have recommended improvements or efficiencies based on our collaborative work with counties and tribal nations that are being evaluated for inclusion in MnCHOICES Assessment 1.0. Stakeholders have identified opportunities to improve the current electronic support plan process that we will explore to determine if we can make them before MnCHOICES Assessment 2.0 is available. We will keep you informed of any approved efforts, including a timeline to completion.

MnCHOICES Assessment 2.0 revised timeline

MNIT facilitated an in-depth review of the MnCHOICES Assessment 2.0 project this winter to ensure it was on track and would meet the needs of users. We determined that MnCHOICES Assessment 2.0 should be delayed to ensure we deliver a high quality product and a smooth rollout.

The revised timeline allows MNIT and DHS to perform an external review through a request for proposal (RFP) process of new vendors and technology solutions that may meet the needs of MnCHOICES. The goal of the RFP is to see if a vendor can provide products and/or services to complete the project. We will consider three different outcomes:

• Continue partnering with MNIT until the project is complete
• Use an off-the-shelf product and or services from a vendor
• A combination of the two previous options

We are designing the RFP for the best possible solution.

An important piece in the development of MnCHOICES Assessment 2.0 is updating the technology that supports the application. MnCHOICES Assessment 1.0 uses Silverlight version 5, a Microsoft application used to write and run internet applications. After Oct. 12, 2021, Microsoft will discontinue support and updates for Silverlight version 5, which causes a potential risk in the MnCHOICES Assessment 2.0 delay. MNIT confirmed that it is possible to access extended support for technologies and they don’t anticipate this will cause system stability issues.

Additional impacts of the delay

We are still evaluating the full impact of the delay. For example, we know that the Waiver Reimagine individualized budgeting effort was projected to use data from the MnCHOICES Assessment 2.0 process. We have data from 1.0, which we used to complete the initial analysis and recommendations for individualized budgets. We will evaluate the continued use of 1.0 data for this purpose until 2.0 is available.

The delay also affects the timelines for when managed care organizations will begin using MnCHOICES Assessment 2.0. DHS will work with health plans and counties to adjust timelines and prepare for launch. DHS encourages lead agencies to continue the transition of personal care assistance services (PCA) to MnCHOICES as there is value in the data and operational efficiencies with support planning. However, we will extend the option to use the legacy document with people accessing PCA services to alleviate workload demands until MnCHOICES Assessment 2.0 is operational.

DHS will not add home care nursing services into MnCHOICES Assessment 2.0 as originally anticipated when MnCHOICES first was conceptualized. The oversight of the service requires frequent assessments and flexibility in responding to the unique service provision. This is beyond what can realistically be done by MnCHOICES certified assessors.

During the delay, MnCHOICES and MNIT staff will continue to work on the MnCHOICES Assessment 2.0 project to help refine the requirements of the RFP and to develop a high quality MnCHOICES Assessment 2.0 application.

Since fiscal year 2018, statute requires counties and tribal nations to be responsible for 8% of the cost of administering the MnCHOICES Assessment and related activities. They are not responsible for the cost of developing the technology system. Lead agencies will not have any additional costs because of the revised MnCHOICES Assessment 2.0 timeline. However, according to Minn. Stat. § 256B.0911 subd. 6(i), the state will pay 81.9% of the non-federal share as reimbursement to the counties and tribal nations, raising the county share to 9% starting in fiscal year 2020 (July 1, 2019).

Feedback on MnCHOICES Assessment

We have requested and analyzed feedback from our lead agency partners and people who are being assessed through the entire MnCHOICES development. In addition to information gathered in group meetings and trainings, we have specifically sent surveys to stakeholders. Some examples of the more recent surveys include:

• Virtual insight panel survey of people who have been assessed or their family members – 2018
• Vital Research survey of people who have been assessed – 2018
• Lead agency survey to measure each county’s progress on the implementation of MnCHOICES– March 2019
• Lead agency survey after the revised timeline – April 2019

We received 60 responses from the April 2019 survey of lead agencies. Respondents shared many benefits of using MnCHOICES Assessment and Support Plan applications. Some of the highlights include:

• “One assessment for all programs. It is person-centered. We do better in audit outcomes because of it.”
• “Using a broader lens in assessing clients for services has opened up greater discussion in meeting client needs. A focus on what the client wants and what the clients need with a person-centered approach has been a benefit to meeting clients’ needs.”
• “More thorough and comprehensive assessments. People getting services that they may not have known to ask for in the past.”
• “The positive impact on recipients of having the assessment process separated from case management. The assessors are identifying unresolved and unaddressed issues with providers, medical needs and the service case management. In addition, we believe the DD recipients have been empowered by the new MnCHOICES assessment model that separates the assessment from their annual meeting. The assessment now centers on them rather than their provider’s, case manager’s or guardian’s needs.”

There were also some examples of the revised timeline providing relief to counties:

• “Gives time for our agency to concentrate on the transition of PCA PMAP reassessments to the county and to determine the number of assessors needed to assess this additional population.”
• “It creates the opportunity for us to focus on ways our agency can work with certified assessors and give them guidance on areas that we should focus in on for initial assessments and areas that can be completed at subsequent assessments.”

As the use of MnCHOICES has increased, we are seeing how the tool is supporting practices that lead to better outcomes for people by a marked increase in lead agency review compliance measures. In the 2016-18 cycle, lead agencies’ compliance with two person-centered measures resulting from the assessment (development of person-centered plans and record keeping of person-centered plans) had significant increases from the previous cycle.

Updates and information sharing  

The MnCHOICES team is committed to communication and feedback methods tailored to specific audiences and needs. The MnCHOICES CountyLink website is where we post all updates and information. Other important modes of communication include:

• Written communications – MnCHOICES Matters newsletter, memos and frequently asked questions to share updates and information with counties, tribal nations, directors, assessors, case managers, mentors, supervisors and stakeholders
• MnCHOICES office hours – Monthly online meetings to answer questions and provide technical assistance for assessors using MnCHOICES Assessment 1.0 and Support Plan applications
• MnCHOICES Mentors Alliance – A quarterly face-to-face meeting at which mentors of counties, tribal nations and contracted case managers come together with DHS staff to give feedback and to share best practices
• Launch webinars (WebEx) – A quarterly online meeting at which supervisors and mentors of lead agencies get details about the launch process for MnCHOICES Assessment 2.0. We will resume these meetings 18 months before the MnCHOICES Assessment 2.0 rollout.

Please continue to reach out to us with questions or feedback.