The new LTSS Improvement Tool will allow DHS and lead agencies to gather routine feedback from the person regarding his or her support plan and experience with providers.
DHS routinely uses data gathered from assessments, eligibility, service authorizations, health-care claims, etc., for program monitoring, state/federal reporting and quality improvement. We also use surveys to understand people’s service experiences. Gathering annual feedback about how services and supports work for each person helps all of us in making improvements to the service system.
The LTSS Improvement Tool focuses on a person’s experience with services and supports. There are five question sets:
DHS will implement the LTSS Improvement Tool in three phases to allow lead agencies time to adjust their workflow and incorporate these questions into the person’s visit.
DHS implemented Phase I in October 2017. This included two sets of questions:
We expect to implement Phase II in October 2018. This will include questions from Phase I and introduce two additional sets of questions (focused on the case manager’s feedback). These questions are not a part of a visit with the person. The case manager or certified assessor will respond to these questions on his/her own time.
We plan to implement Phase III with the launch of MnCHOICES Assessment 2.0. This will include questions from phases I and II with an additional set of questions about the person’s evaluation of his/her case manager. The certified assessor will complete this set of questions as part of the MnCHOICES reassessment (the case manager or certified assessor will continue to be responsible for completing Phase I and II questions).
It depends. For waiver programs, the case manager or certified assessor will complete the LTSS Improvement Tool evaluation at a semi-annual or midyear visit with the person. For non-waiver programs (e.g., State plan PCA only), this tool will be completed at reassessment (see “Program-specific questions”).
Yes. If a person finds a question within the LTSS Improvement Tool uncomfortable or difficult to answer, the person may make an informed decision not to answer. However, we encourage the case manager or certified assessor to ask the question in a way to make the person comfortable (e.g., if the person seems overwhelmed by a question, rather than just skipping it, you might repeat it and encourage the person to take a moment to think about it).
If the person decides not to answer, however, the case manager or certified assessor should include ‘Chose not to answer’ as the response. The case manager or certified assessor is encouraged to add a comment in the narrative text box at the end of the session about why the person chose not to answer specific questions.
No. The case manager or certified assessor must ask every question in the LTSS Improvement Tool. The person may decide whether or not to answer the question.
Using the LTSS Improvement Tool is a reimbursable activity under case management time (for both case managers and certified assessors).
In Phase I, there are two sets of questions.
Yes. Only people who use the MnCHOICES Support Plan application will have access to the LTSS Improvement Tool. If you still use the MnCHOICES Community Support Plan with Coordinated Services and Supports Plan form, DHS-6791B (PDF), you will not have access to the LTSS Improvement Tool. Once every person is in the MnCHOICES Support Plan application, the case manager or certified assessor will be able to complete this tool for everyone who receives services. (For people who use managed care, see “Program-specific questions” section.)
The link to the “LTSS Evaluation” will appear when the case manager or certified assessor closes a CSSP in the MnCHOICES Support Plan application. Once the user selects the link, he/she will be able to select the ID number associated with the evaluation he/she plans to complete.
Yes. The questions in the LTSS Improvement Tool are based on the person’s last closed CSSP. The support plan application programming will select one service provider per year as identified in the person’s CSSP.
No. The case manager or certified assessor only needs to complete one LTSS Improvement Tool evaluation per year for every person who has a CSSP. If the case manager or certified assessor completes the LTSS Improvement Tool before he/she updates the person’s CSSP, he/she does not need to complete a new improvement tool evaluation until the next annual reassessment or midyear quality visit.
No. If the person changes to a new provider after the case manager or certified assessor submits the LTSS Improvement Tool, then the case manager or certified assessor does not need to complete a new LTSS Improvement Tool evaluation. Only one LTSS Improvement Tool evaluation needs to be completed per year.
The case manager or certified assessor should determine the appropriate time to gather the person’s feedback before doing a new evaluation set (i.e., ensure the person has interacted with the provider enough to provide feedback on services received).
For a person who uses multiple services, the system randomly selects one service and associated provider. The system weighs residential and day services more than other home and community-based services (e.g., chore services, homemaker, etc.).
If the person has more than one provider for a service, the system randomly selects one provider associated with that service. For example, if a person only receives PCA services and has more than one provider in the last closed CSSP (e.g., one provider for Monday and Friday and another provider for Tuesday through Thursday, etc.), the system randomly selects one PCA provider.
The tool may or may not select a different provider each year. If a person uses multiple services, the system will select one service and an associated provider. The system will not exclude a provider if it was selected in the previous year.
If a person does not have changes in services nor providers for several years, it is possible the system could select the same provider each year.
If the certified assessor or case manager has an internet connection in the field, he/she will collect and submit responses directly through the electronic Support Plan application.
There are two options for completing the LTSS Improvement Tool when the user does not have internet connection in the field:
DHS is continuing to look at a long-term option that will allow the certified assessor and case manager to download the tool to his or her desktop, enter responses during face-to-face meetings and automatically update the responses in the support plan application (similar to the MnCHOICES Assessment offline feature).
Yes, but only if the person uses residential and/or adult day services.
MCOs still must gather feedback on the person’s experience with a provider though (as part of the HCBS settings rule transition plan), so DHS is in the process of adding a limited number of questions from the LTSS Improvement Tool to the Long-Term Care Screening Document, DHS-3428 (PDF). MCOs will ask these questions only if a person receives residential and/or adult day services. DHS will not release feedback on the CSSP and satisfaction questions until MnCHOICES is available for use by MCOs.
For recipients younger than 65 years old who use managed care, the MCOs do not manage the HCBS and PCA services. The care coordinator will ask the evaluation questions instead.
No, the LTSS Improvement Tool does not apply to the Essential Community Support program.
No, the LTSS Improvement Tool does not apply to the Consumer Support Grant.
Yes. Questions in the LTSS Improvement Tool are applicable for people who self-direct their services through the CDCS service option. For a person who self-directs services, the case manager or certified assessor will ask 18 questions in the Person’s Evaluation of his/her CSSP section and nine questions in the Person’s Evaluation of a Service Provider section. Although the CSSP will list a designated fiscal entity instead of a service provider, the person’s responses about satisfaction with services still are relevant. We encourage the case manager or certified assessor to ask the person for his/her feedback about how his/her services are working (even though the system does not select a single service and a service provider). The case manager or certified assessor should write this feedback in comments at the end of the evaluation.
For a person who only receives Rule 185 case management, the LTSS Improvement Tool Phase I questions do not apply. DHS will include the person’s evaluation of his/her case manager at Phase III.
For a person who receives Rule 185 case management and a waiver/non-waiver service, the LTSS Improvement Tool does apply. The case manager or certified assessor will ask these questions either during the midyear visit or at reassessment.
DHS values feedback from all people who receive services, regardless of situation. We respect the preferences and goals of a person who is committed. We must also consider the restrictions of his/her circumstances. The role of the support planner is to find the balance of “important for” and “important to.”
When state plan service recipients are included in the tool requirement, the certified assessor will complete the LTSS Improvement Tool with the person and submit the responses on his/her behalf when there is no case manager (i.e., when a person only receives fee-for-service PCA).
A person who receives fee-for-service PCA either directs his/her own care or has a responsible party. If the evaluation leads to a need for a more in-depth follow-up, the person who receives care (or a responsible party) should take the necessary steps for follow-up.
The follow-up that the certified assessor would complete would be similar to what is done currently in this situation. For example, the certified assessor would share resources (i.e., Disability Hub MN, ombudsman information, etc.) with the person/responsible party if the person indicated he/she was interested in more information. The certified assessor does not have to complete extended/in-depth follow-up tasks that would typically be considered case-management tasks.
DHS encourages the responsible party to participate in the LTSS evaluation process if the person needs help reporting his/her needs. DHS’ intent is to allow the person to continue the tool’s evaluation process even if, during the assessment, the assessor feels a responsible party is necessary. The certified assessor may call the responsible party if needed.
The new LTSS Improvement Tool aligns with the statutes for states that have an approved transition plan for home and community-based services. This tool meets data requirements for the Centers for Medicare & Medicaid Services (CMS) HCBS Settings Final Rule and some reporting requirements for the Olmstead Plan and CMS Access Rule, as well as program monitoring and reporting (e.g., Community First Services and Supports [CFSS], Alternative Care Program [AC], etc.).
Lead agencies will not need to use the LTSS Improvement Tool until six months after they begin using the MnCHOICES Support Plan application. The certified assessor will incorporate these questions during the person's annual reassessment visit.
DHS does not require the guardian to be present or provide input during this visit. The purpose of the LTSS Improvement Tool is to capture the person’s experience with his/her service provider and case manager/certified assessor.
While completing the LTSS Improvement Tool, the case manager/certified assessor will be asked “who is responding to these questions?” The case manager/certified assessor will then be directed to “check all that apply.” If a guardian is present, the case manager/certified assessor should select both the person and guardian. Then, a text box will display so the case manager/certified assessor can provide additional information, if needed.
The LTSS Improvement Tool will serve as an important data source for program reporting as well as continuous quality improvement and program redesign for the:
DHS will use this data, integrated with assessment and utilization data, to:
We will construct performance measures at program level, lead agency level and statewide level for different populations (e.g., race/ethnicity, geographic regions, diagnostic groups, settings, etc.).
No. We do not plan to collect/organize information at the case-manager level: DHS will not determine any global measures for specific case managers.
DHS is working with lead agencies to determine how to share and use the data.
DHS can analyze data by populations (e.g., race/ethnicity, geographic regions, diagnostic groups, settings, etc.). DHS is working with lead agencies to determine how to share and use this data.