Skip To: Main Content | Subnavigation |
 
PartnerLink Home DHS Home Bulletins eDocs A-Z Topics
County Reports/Results DHS Program Resources DHS Systems & IT Updates Fiscal Reporting & Accounting Manuals Policy Inquiries Trainlink Performance Management Advisory Committees Program Integrity
DHS Systems and IT Updates MnCHOICES

Revised MnCHOICES assessment and support plan documents

Updated 5/16/24

Purpose: To inform lead agencies of documents that can be printed in the MnCHOICES application.
For additional information see CBSM – Forms for long-term services and supports (LTSS) assessment, eligibility and support plans.

Documents created using the MnCHOICES Assessment application

Document title

Purpose

Old title

Generated by

Completion timeline

Received by

Assessment results

To provide detailed information about MnCHOICES eligibility determination

MnCHOICES eligibility summary

Certified assessor

N/A

  • Person/legal representative (upon request)
  • Case managers and care coordinators can access this in MnCHOICES.

MnCHOICES assessment

To provide a copy of information documented in the MnCHOICES assessment

MnCHOICES assessment report.

Certified assessor

N/A.

  • Person/legal representative (upon request)
  • Case managers and care coordinators can access this in MnCHOICES.

Assessment summary

To provide a summary of what the certified assessor discovered through the assessment process and identifies next steps, based on a person’s needs

Community support plan (CSP).

Certified assessor (after every MnCHOICES assessment)

No later than 60 calendar days from the in-person assessment as indicated by the activity date

(Care coordinators: Follow MCO timelines)

  • Person/legal representative
  • Case managers and care coordinators can access this in MnCHOICES.

Functional assessment

To provide an abbreviated summary of the assessment for authorized reviewers (Not usually printed)

MnCHOICES functional assessment.

 

N/A

  • Person (upon request), but can create confusion because of greater detail
  • Case managers, care coordinators and consultation service providers can access this in MnCHOICES.

Supplemental summary charts

To provide information for the delivery of Community First Services and Supports/personal care assistance (CFSS/PCA) services, based on assessment results

PCA provider report

Certified assessor (when the person is eligible for CFSS/PCA services)

Within 10 business days of the assessment

  • Person/legal representative
  • Representative party
  • CFSS/PCA provider
  • Case managers and care coordinators can access this in MnCHOICES.
  • Note: if the person is not requesting/receiving CFSS, this report is sent to person and/or representative as requested.

    • Health risk assessment—Managed care organization (HRA-MCO)

    To provide a copy of information in the HRA

    HRA

    Care coordinator

    N/A

    • Person/legal representative (upon request)
    • Certified assessors and case managers can access this in MnCHOICES.


    Reports created using the MnCHOICES Support Plan application

    Document / report title

    Purpose

    Formerly titled

    Generated by

    Completion timeline

    Received by

    Support plan

    A summary of the person’s choice of supports and/or services and the person’s preferences for the delivery of supports/services

    • Coordinated services and supports plan (CSSP)
    • Collaborative Care Plan (CCP)
    • Certified assessor
    • Case manager
    • Care coordinator.
    • Within 60 calendar days after the in-person assessment. (Note: MCOs must send the support plan within 30 days after the assessment.)
    • A person using CFSS/PCA: Send the support plan within 10 days of the assessment
    • Person/legal representative
    • Provider(s) (including CFSS/PCA providers), with permission of person/legal representative
    • Certified assessors, case managers and care coordinators can access this in MnCHOICES.

    About me; My care team

    To highlight important information from the about me section, including a person’s care team

    NA

    • Certified assessor
    • Case manager
    • Care coordinator.

    N/A

    • Person/legal representative (upon request)
    • Certified assessors and case managers can access this in MnCHOICES.

    Care coordination next steps indicator report

    To provide a high-level summary of some responses to parts of the HRA or MnCHOICES assessment about staying healthy. It provides a report that highlights requested assistance and necessary follow up

    NA

    • Certified assessor
    • Case manager
    • Care coordinator.

    N/A

    • Person/legal representative (upon request)
    • Certified assessors and case managers can access this in MnCHOICES.


    MnCHOICES forms in eDocs or MnCHOICES Help Center

    Document / report title

    Purpose

    Formerly titled

    Generated by

    Completion timeline

    Received by

    MnCHOICES Assessment Summary Worksheet, DHS-6791A (PDF)

    To capture important information about the conversation with a person during a MnCHOICES assessment. Assessor uses this when developing an assessment summary

    Community support plan (CSP) worksheet

    Certified assessor

    Note: not used by MSHO/MSC+ assessor/care coordinators

    This form is left with a person at the time of the assessment (Note: Add a copy of this form to the person’s record in MnCHOICES)

    • Person/legal representative
    • Case managers and care coordinators can access this in MnCHOICES.

    MnCHOICES Communication Form, DHS-6791E-ENG

    To use for communication between case managers/care coordinators and certified assessors

    MnCHOICES Reassessment Communication Form

    • Certified assessor
    • Case manager
    • Care coordinator.
    • The case manager/care coordinator can send this form up to six months before an assessment is due. To make sure there is prompt communication, the case manager/care coordinator sends DHS- 6791E to the certified assessor, before or on the 20th day of the fourth month before the service authorization ends.
    • The certified assessor makes sure the assessment is completed promptly. They send the form back to the case manager/care coordinator after the assessment is done.
    • Certified assessor
    • Waiver case manager
    • Care coordinator.

    CFSS to PCA conversion worksheet

    • Lead agency staff use this worksheet to determine MnCHOICES assessment results until DHS implements CFSS. It converts CFSS programming to the current personal care assistance (PCA) rules.
    • Use the worksheet when the MnCHOICES assessment produces a CFSS home care rating of “P,” “Q,” or “R”.

    N/A

    • Certified assessor
    • Case manager
    • Care coordinator.
    • The assessor sends this form with the Assessment summary(when applicable)
    • Case managers and care coordinators include this form when they send the support plan to a person.
    • The person/legal representative
    • Waiver case manager
    • Care coordinator

    Report this page