The following findings are taken from the HCBS Lead Agency Review Summary Report for lead agencies reviewed between August 2015 and November 2018. During that time all 87 counties across the state and 2 tribal nations participated in the review process. Quantitative and qualitative information was gathered during these reviews via a number of data collection methods, including a review of over 6,000 case files, surveys completed by over 1,300 case managers and assessors and numerous on-site interviews and focus groups with lead agency staff.
As the emphasis on the use of person-centered planning practices continues, lead agency assessors and case managers are being challenged to focus not only on ensuring the health and safety of people with disabilities and older Minnesotans, but also on providing opportunities for them to live, learn, work, and enjoy life in the most integrated setting.
- >Results of the Lead Agency Reviews show that case managers are consistently meeting requirements for visiting people on HCBS waiver programs. The average number of visits made by the case manager and/or assessor in the 18 months prior to the lead agency’s site visit was 4.3 visits.
- Case managers and assessors in the focus groups consistently reported they have found it challenging to keep up on the numerous and substantial changes that HCBS programs have undergone in the past few years.
Choice, community access and inclusion
The mix of urban and rural regions within the state means that provider capacity often varies greatly across lead agencies. This impacts their ability to support people to live as independently as possible and access their communities. The Lead Agency Review process looks at external working relationships to gain greater insight into how the lead agency works together as a whole, how services are being delivered and how the agency interacts with others delivering these services.
- The Minnesota Olmstead Plan establishes statewide goals to improve housing integration and choice for people with disabilities. By 2017, 66% of those on the CCB waivers and 47% of those on the DD waiver were receiving services in their own home, up from 2013 numbers of 62% and 42%, respectively.
- The percent of people earning $250 or more has increased since 2013. In 2017, 26% of people the DD program were earning more than $250 which is eight percentage points higher than it was in 2013, and in the CCB programs, it was a two percentage point increase from 9% to 11.3%.
- The most common barriers to integrated, competitive employment were: lack of providers, staffing shortages and lack of transportation options.
- Lead Agency Review measures include confirming that all working-age adults are informed of their choices regarding employment; continued increases in this area were recorded during the course of Round Three reviews.
Since the first round of Lead Agency Reviews, overall compliance has improved significantly for many items.
- During Round Three, 27 items reviewed for general case file technical compliance were eligible for corrective action; CMS’s current quality assurance benchmark is 86% compliance. A total of 293 corrective actions were issued during Round Three, with 56% of lead agencies issued 1-3 corrective actions.
- The two most common corrective actions were issued for plans lacking information on an individual's assessed needs and lack of service details.
- Lead agencies working with individuals who were members of the Jensen Settlement agreement, individuals with Positive Support Transition Plans, and/or individuals who have recently experienced a transition in their living setting, were also reviewed for relevant technical compliance requirements. Reviews showed that nearly 90% of all Jensen Settlement members had a current person-centered plan and 77% of those experiencing a recent move had a completed My Move Plan. Evidence of a current Positive Support Transition Plan for those required was at 43%, showing more support and training is needed in this area across the state.
Figure 1: Corrective actions during Round Three
A new element of the Round Three review was monitoring the person-centered practices currently implemented by each lead agency. Over the course of Round Three, lead agencies across the state made significant strides in implementing person-centered practices. Over 90% of case managers and assessors surveyed reported they have received training in this area.
- Beginning in July 2016, lead agencies were reviewed on their implementation of person-centered support plans and person-centered record keeping. Person-centered support plans and person-centered record-keeping are not specific compliance measures, but rather overall categories, based on the compliance in 12 and 7 specific measures, respectively. As shown in the graphs below, both measures maintained an upward trend during Round Three review.
Figure 2: Development of a plan using person-centered planning elements
Figure 3: Development of a plan using person-centered record keeping elements
Lead agencies across the state have developed organizational systems and strategies to help utilize available resources for increased service delivery. The following is a list of successful techniques implemented by various lead agencies throughout Round Three.
Case File Review
- Use the most up-to-date forms available on e-Docs
- Separate the assessor and case manager role
- Implement a process for interpretation and dissemination of new policies;
- Balance roles and caseload capacity
- Utilize lead workers and case aides.
- Re-purpose old, unused buildings;
- Explore "tiny home" options;
- Increase use of CDCS;
- Utilize advancements in assistive technology;
- Increase use of Approval Option Services.
- Early intervention and engagement
- Strengthen relationships with local school districts
- Outreach to local employers to increase knowledge of employing individuals with disabilities;
- Working with local employers to "job-carve";
- Increase use of employment support services.