MACSSA and MnCHOICES Reimbursement April 2013

MnCHOICES Reimbursement The new process for reimbursing counties for MnCHOICES will be a significant change and is a result of a federal requirement for the separation of duties between assessment and case management services. The MnCHOICES assessment functions are considered MA administrative services and must be reimbursed using a federally approved process, e.g., SSTS or LCTS. Direct client MA services such as Waiver Case Management will continue to be reimbursed using the current fee for service process. 2

MnCHOICES Reimbursement The current process is scattered all over and reimburses us for only portions of our costs. The new process will be unified into one process through random moments (SSTS or LCTS). It holds the promise of better reimbursement, because it should come close to reimbursing us for all or most of our costs. 3

MnCHOICES Reimbursement Currently, we get partial reimbursement for various activities that will be relabeled as MnCHOICES costs in a variety of ways. 4 Total Agency Costs MnCHOICES Costs (previously LTCC, assessments and reassessments of various kinds) They are often hidden inside something else, like LTCC (Long-Term Case Consultation), assessments and reassessments within case management, assessments and reassessments for personal care services.

MnCHOICES Reimbursement 5 MnCHOICES Costs Including: – Waiver Case Management billing – Targeted Case Management billing – Waiver Screening billing – SSTS Random Moments – LCTS Random Moments – Nursing home payments Currently, we get partial reimbursement for various activities that will be relabeled as MnCHOICES costs in a variety of ways.

MnCHOICES Reimbursement Remember, though, that we currently get only partial reimbursement for our MnCHOICES costs. We eat the rest – uncompensated care. 6 MnCHOICES Costs Including: – Waiver Case Management billing – Targeted Case Management billing – Waiver Screening billing – SSTS Random Moments – LCTS Random Moments – Nursing home payments

MnCHOICES Reimbursement 7 MnCHOICES Costs The current process pays us for only portions of our costs. The billings rarely cover our actual full costs. Targeted Case Management billings never pay for the non-federal 50%. The Random Moments also cover only the federal 50%. We currently eat the rest.

MnCHOICES Reimbursement Under the new process, MA Waiver billings, Targeted Case Management billings, and reimbursement from HMOs for waiver work will continue. But the MnCHOICES parts will be pulled out and combined with the rest into a single process through one or both of the Random Moment studies: – SSTS (Social Services Time Study) – LCTS (Local Collaborative Time Study) 8

MnCHOICES Reimbursement As a result, all of the old bits and pieces will be handled by the SSTS Random Moments, LCTS Random Moments, or possibly a combination of the two. Through the Random Moments, DHS will know what percentage of the time our staff (or our staff and similar counties) are spending on MnCHOICES activities. Time spent on activities that don’t earn revenue (breaks, lunch, general training, etc.) is allocated proportionally across all of the other SSTS activities, so that each one gets a share. 9

MnCHOICES Reimbursement The new process will be based on our costs. It starts with Random Moments (usually pooled with other counties). It multiplies the Random Moment percentages by the cost pool for our own county (specific to each county). 10

MnCHOICES Reimbursement11 MnCHOICES Costs The new process then pays us for all of those costs. It will cover the full cost instead of the allowable fee. Nothing to eat – no uncompensated care. It will cover the non- federal share that we currently have to eat. MnCHOICES Costs should equal what we get paid

MnCHOICES Reimbursement Compared side by side, the new process holds the promise of being decidedly better. 12 Current Process New MnCHOICES Process

MnCHOICES Reimbursement DHS did a test of the new reimbursement process, which bore out the idea that counties could earn additional revenue this way. 13

MnCHOICES Reimbursement Several counties have done analysis of the concepts that confirmed that it could work. But it’s probably not necessary to do a full- blown analysis to see how it might play out in your county. 14

MnCHOICES Reimbursement Consider a short-cut, using results from the SEAGR Report for your county. Check out the hourly rate for staff provided Long-Term Care Consultation services Brass Code 605. This hourly rate is a good stand-in for how much it costs for one hour of staff to provide these services. 15 $ /Hour

MnCHOICES Reimbursement Compare the SEAGR hourly rate to how much you get for successful Waiver billings. There’s a good chance that you’re not covering those costs even now, or if you are it’s not by much. And that’s the best reimbursement you collect under the current process. Remember that for Targeted Case Management and the Random Moments costs, you are already eating the 50% non-federal share. 16

MnCHOICES Reimbursement The new process holds good promise. All the MnCHOICES activities will be pulled together into one place. MnCHOICES will pay full cost, not an inadequate rate or only the federal 50%. 17

MnCHOICES Reimbursement Yes, the new process holds good promise. However, three things need to happen in order for that promise to actually be realized. Otherwise it could be a good idea that doesn’t actually work out in reality. What’s needed? 18

MnCHOICES Reimbursement What’s needed? First, staff need good training on how to complete the revised Random Moments (SSTS or LCTS). Training that includes lots of good examples from actual agency experience. 19

MnCHOICES Reimbursement What’s needed? Second, counties need to pay attention to the Random Moment process (SSTS or LCTS). Staff need to be reminded from time-to-time that the Random Moments are important and need to be attended to as best they can. There is no need to “game the system”, but simply use the best code whenever they get a Random Moment. 20

MnCHOICES Reimbursement What’s needed? Third, DHS needs to provide some better feedback to counties as to how staff are responding to the Random Moments. The feedback needs to be broken down by group in some fashion. Not so that counties second- guess their staff or “game the system”, but so supervisors can help staff who are using incorrect codes. 21

MnCHOICES Reimbursement DHS needs to take the lead on the training and the feedback points. Counties need to take the lead on paying attention. But it will work best as a partnership on all three points: training, attention, and feedback. 22 The End