Implementing Changes to Nursing Facility Level of Care

Implementing Changes to Nursing Facility Level of Care Overview and Update Aging and Adult Services Minnesota Department of Human Services Jolene Kohn, State Program Coordinator, Aging Doug Silverman, State Program Administrator, Aging October 16, 2014 1

Topics to Be Covered Today New criteria for NF LOC 2014 legislative changes How and when LOC is determined Effective dates and potential impact on HCBS participants and NF residents Qualifying 90-day stay criteria Communication tools Resources for people 2

Level of Care - Ensuring Sustainability in LTC Strengthening the nursing facility level of care (NF LOC) criteria is part of Minnesota s strategy intended to ensure sustainability in its health care system, including the long term care services sector. Strengthening the criteria that establishes the need for NF LOC is paired with efforts to redirect people with lower care needs to other types of supports, including: Return to Community Moving Home Minnesota Essential Community Support services PCA ->CFSS 3

Level of Care and Eligibility for LTC Under MA Long Term Care (LTC) under MA includes both facility and home and community-based services. MA eligibility for LTC includes both financial and service eligibility determination. LOC is the service eligibility for LTC under MA. 4

LOC and Eligibility for LTC Under MA The requirement that an individual meet NF LOC (or other institutional LOC) in order to establish MA eligibility for LTC is not new policy. The same NF LOC criteria must be applied for both facility- and community-based LTC services under MA. 5

Level of Care This change in NF LOC criteria applies only to individuals aged 21 and older. Revised criteria will be applied to younger folks October 1, 2019. The changes are effective January 1, 2015. Will affect MA eligibility and payment for nursing facility services and eligibility for HCBS programs that serve individuals with nursing facility level of care needs. 6

NF Level of Care Criteria Current criteria is found in DHS Form 3361. Remains effective for individuals under age 21 until October 1, 2019. New criteria is described in Mn Statute, 144.0724, subdivision 11 7

NF LOC This change in criteria only affects nursing facility level of care. Does not affect hospital level of care (CAC), neurobehavioral hospital level of care (BI-NB), or ICF/DD level of care (ICF/DD facility services and DD waiver). 8

LOC Changes Do Not Affect Residents admitted to a nursing facility prior to October 1, 2014 Other payers coverage criteria, such as Medicare Long term care insurance Other long term care benefits coverage such as nursing facility services provided by the Veteran s Administration 9

Who Will the Change Affect? New applicants for HCBS programs and new NF admissions The revised LOC criteria will be applied: At assessment occurring on or after January 1, 2015 for new HCBS applicants. At preadmission screening for new NF admissions occurring on or after January 1, 2015. 10

Potential Impact on Current HCBS Participants For individuals in Elderly Waiver, Alternative Care, Community Alternatives for Disabled Individuals, Brain Injury-NF on January 1, 2015: The revised LOC criteria will be applied at their NEXT reassessment occurring on or after January 1, 2015. 11

Potential Impact on Current NF Residents Individuals admitted before October 1, 2014 No impact. Individuals admitted to a nursing facility between October 1, 2014 and December 31, 2014 and on MA Revised criteria applied to establish qualifying 90-day stay on or after January 1, 2015 for continuing MA payment of NF Individuals admitted on or after October 1, 2014 who spend down to MA after January 1, 2015 Revised criteria applied to establish qualifying 90-day stay on or after January 1, 2015. 12

Who Determines LOC? Lead agencies authorized in MN Statute, section 256B.0911 who perform Long Term Care Consultation or MnCHOICES assessments Preadmission screening: Senior LinkAge Line staff, with referrals as needed Nursing facility staff to establish qualifying 90-day stay using the online PAS tools for some individuals 13

HCBS Programs Eligibility Always requires a face-to-face assessment by a lead agency to determine eligibility. Level of care determination is part of the process. Always requires at least annual reassessment for continuation of eligibility, including level of care determination. 14

Level of Care Determination for NF Services At preadmission screening completed as required prior to admission to a certified NF. This has always been part of the requirement for MA payment of NF services. FW rely on DHS Form 1503 for verification that LOC is met. To establish the qualifying 90 day stay for continuing MA payment. An individual must be reassessed after admission, and may no longer meet LOC. 15

Preadmission Screening Is required for ALL admissions to a MA-certified facility, certified boarding care or swing bed, regardless of payor. Establishes LOC for MA payment for nursing facilities Federal requirement identifying those with MI or DD entering a nursing facility SLL process implemented November, 2013. Most facilities are now familiar with the online tool and communication processes related to PAS. Most importantly, can use this online tool to reestablish LOC to meet qualifying 90-day stay. 16

When PAS Process Cannot Determine LOC - The online PAS process also yields a referral for face-toface LTCC, when this type of assessment is needed to finally determine LOC for initial PAS or to establish 90 day qualifying stay. A face-to-face LTCC (MnCHOICES) assessment must be used to make a final determination that an individual does not meet any criteria for NF LOC. It cannot be concluded that individual does not meet any NF LOC criteria until an LTCC assessment has been completed. 17

Determining LOC for NF Residents Lead agencies will complete face-to-face assessments for NF residents when online PAS cannot determine NF LOC at admission. Lead agencies will complete face-to-face assessments for NF residents when other methods cannot determine NF LOC to satisfy the 90 day qualifying stay. 18

Qualifying 90-Day Stay A qualifying 90-day stay is one of the NF LOC criteria in statute related to nursing facilities. Once the qualifying 90-day stay is established, the individual is considered to meet LOC criteria throughout the person s continuing stay for that admission, including transfers. Most common method used to establish qualifying 90-day stay: MDS assessment 19

Continuous Stay For purposes of implementing the changes in NF LOC criteria, a continued nursing facility stay is defined as a stay beginning from the admission date to a MA-certified nursing facility in Minnesota, and ending with the date of formal discharge from a MA-certified nursing facility services back to the community. 20

Continuous Stay Includes Transfers The continued nursing facility stay for an individual includes transfers from the MAcertified admitting facility in Minnesota to another MA-certified nursing facility in Minnesota. The continued nursing facility stay for an individual includes transfers from a MA-certified NF in Minnesota to an acute hospital back to the same or different MA-certified NF in Minnesota. 21

Where LOC is Documented In MMIS using data entered from a face-to-face assessment or PAS Relies on rules built into the system to establish LOC Edits make sure the data is complete, accurate All tools have same assessment items and rules related to LOC. Individual items and relevant scores from DHS 3428 are found in the bulletins. 22

MMIS and MA Payment for LTC The LTC Screening Document allows service agreements to be entered with services authorized. The Screening Document is also used to pay NF claims under FFS. The LTC Screening document controls waiver spans; waiver spans control capitation for managed care for EW. 23

Revised LOC Criteria: 5 General Categories of Need 1. The person lives alone (or will live alone) or be homeless without their current housing type AND has had a fall resulting in a fracture within the last 12 months OR has a sensory impairment that substantially impacts functional ability and maintenance of a community residence OR is at risk of maltreatment or neglect by another or at risk of selfneglect 2. Significant difficulty with memory, using information, daily decision making, or behavioral needs that require intervention 24

LOC Criteria. OR 3. Need the assistance of another person or constant supervision to begin and complete toileting or transferring, or positioning and the assistance cannot be scheduled (1 critical ADL) OR 4. Has dependency in 4 or more activities of daily living (ADLs) OR 5. Needs formal clinical monitoring at least once every 24 hours as defined in DHS From 3428B. 25

At risk. The LOC criteria related to self-neglect or maltreatment by another can only be established through face-to-face assessment performed by a lead agency (county, or tribe or managed care organization). 26

Assessment Under LTCC The current assessment tool will be replaced with the on-line, web-based MnCHOICES assessment. The rules related to LOC criteria are in MnCHOICES as well as in MMIS. Items related to LOC decisions are the same in both tools. 27

LOC Assessment Items included in the assessment that establish NF LOC: Living arrangement PLUS Fall resulting in fracture within last 12 months or Vision or hearing limitations or Risk of self-neglect or maltreatment by another 28

Clarification of LOC Assessment Items included in the assessment that establish NF LOC: ADL (activity of daily living) items Clinical monitoring (vent dependent and tube feeding as well) Behavior Orientation Self-preservation Mental Status Exam (MSE) 29

Living Arrangement + Risk This category is 2 part: I must be living alone or homeless AND have another risk assessed. New valid value added to the Living Arrangement field in MMIS (who I live with): 06 Would live alone or be homeless without my current housing type Valid Living Arrangement values for NF LOC: 01, 05, 06 This additional choice was needed in order to avoid disrupting services for individuals at reassessment for folks who live in congregate settings. Can also be used at initial assessments. 30

Living arrangement plus Sensory impairment OR Score of 02 or greater in hearing or vision Fall resulting in a fracture OR New valid value 03: Fall resulting in a fracture in the last 12 months OR At risk of self-neglect OR At risk of maltreatment 31

Self-neglect, Maltreatment This last LOC criteria related to selfneglect or maltreatment by another can only be established through face-to-face assessment performed by a lead agency. Only applies to individuals who meet the definition of a vulnerable adult under MnStatute, section 626.5572, subd. 21. 32

Self-neglect or Maltreatment The level of need that can result in a determination of risk by the assessor is not identical to those circumstances encountered by an assessor that are required to be reported to the Common Entry Point. Risk is not required to be reported, but assessors may certainly discover circumstances that trigger a report under Adult Protection mandates. 33

Is this person at risk of self neglect? If yes, check all that apply Alcohol and/or other drug use leading to health or safety concerns Behaviors that pose a threat of harm to self or others Dehydration or malnutrition Hygiene that may compromise health Impairment of orientation, memory, reasoning and/or judgment Inability to manage funds that may result in negative consequences Inability to manage medications or to seek medical treatment that may threaten health or safety Unsafe/unhealthy living conditions Other, specify. 34

Self-Neglect in MMIS This basis of NF LOC is recorded on the LTC SD in the Professional Conclusions (section E of DHS-3427) using Yes (Y) for the statement: The person has not or may not ensure his/her own care, hygiene, nutrition or safety. 35

Is the person at risk of maltreatment by another? If yes, check all that apply: Financial exploitation Physical abuse Mental abuse Emotional abuse Sexual abuse Risk that a caregiver who has assumed responsibility for all or a portion of care cannot or will not provide food, shelter, clothing, health care or supervision necessary to maintain the person s physical or mental health. 36

Maltreatment in MMIS This basis of NF LOC is recorded on the LTC SD in the Professional Conclusions (section E of DHS-3427) using Yes (Y) for the statement: The person has been or may be neglected, abused, or exploited by another person. 37

NF LOC Based on Behavioral/Cognitive Needs An individual may meet NF LOC through any one of these assessed needs Self-preservation: Score of 02 or greater OR Orientation: Score of 02 or greater. OR Behavioral intervention: Score of 01 or greater OR Mental Status Exam: Score of 10 or greater 38

Self-preservation & Orientation Self-preservation- This assessment item is related to an individual s judgment and/or physical ability to recognize, cope, make appropriate decisions and take action in a changing environment or a potentially harmful situation. An individual will meet NF LOC if they are mentally or physically unable or both Orientation to person, place and time. An individual will meet NF LOC if they have partial or intermittent periods of disorientation 39

Behavioral Intervention & Memory Issues An individual who needs occasional staff intervention for behavioral/emotional needs meets NF LOC. Occasional is defined as less than four times per week. The Mental Status Exam is a screening tool indicating memory issues. A person who has a score of 10 or greater (which indicates the possible presence of dementia) and less than 29 (scores higher than 29 indicate not applicable or refused ) meets NF LOC. 40

Staff Intervention Intervention can be cues, redirection or behavior management/instruction Behavior management or instruction have practice meanings related to evaluation of the behavior/symptom, development of a plan, staff training, monitoring the effectiveness of a plan. 41

NF LOC Based on ADLS The NF LOC criteria related to ADL dependencies as defined are either: Dependencies in 4 ADLs OR A dependency in one critical ADL (toileting or positioning or transferring). Dependency scores are the same as those used for case mix classification except toileting. 42

Continence The current toileting item focuses on the on the type of incontinence. Incontinence managed independently is not a dependency, does not meet this criteria. The current item is frequently coded in error when an individual has continence needs and meets their own needs independently. 43

Continence Support A new item Does the person need constant supervision or assistance from another Y/N is currently in MMIS and must be completed. Y meets critical ADL criteria for NF LOC Referral for evaluation of incontinence is crucial. 44

NF LOC Based on Clinical Monitoring Must occur at least once every 24 hours to meet revised NF LOC criteria The need for clinical monitoring must be documented in a plan that reflects 6 formalized components related to clinical monitoring as defined in DHS-3428B, AC, BI, CADI, EW Case Mix Classification Worksheet. 45

Clinical Monitoring Is described in detail in DHS Form 3428B, Case Mix Classification Worksheet Is a formal monitoring plan with specific components The monitoring can be done by qualified people, including informal caregivers who have been trained There are documentation requirement, such as the monitoring activity and results, e.g. 46

Case Mix Classification in Minnesota s HCBS Programs Establishes budget caps for some HCBS programs Does not define NF level of care Is not an outcome of assessment except for budgeting purposes There is a new case mix V for EW for ventilator dependent individuals 47

However A short hand for LOC can be based on case mix, which is edited for in MMIS. For purposes of the revised LOC criteria, case mix B K, and V meet LOC. Additional assessment information is then evaluated in the rules to determine whether additional LOC criteria have been met. 48

Satisfying the Qualifying 90-Day Stay Criteria There are 3 ways to satisfy the qualifying 90-day stay criteria: MDS will be the primary method used to establish NF LOC for the qualifying 90-day stay. MDS establishes LOC for all RUGs classification except PA1 and PA2. For individuals with all other RUGs classifications, NO additional assessment activity or documentation is required 49

Minimum Data Set (MDS)and NF LOC The determination of NF LOC using the MDS assessment is possible because much of the information about needs that is used to establish NF LOC is also contained in the MDS assessment tool used by nursing facilities. The RUGs classifications created from MDS carry information that can be used as an equivalent to LOC, similar to case mix. 50

MDS Assessment Used For MA individuals, admitted on or after 10-1- 14, the qualifying 90-day stay is established using the first quarterly MDS assessment completed after admission. For other individuals admitted on or after 10-1- 14 who subsequently spend down to MA, their last MDS quarterly assessment completed before their MA eligibility start date is used to establish LOC. 51

Online Tool & Face-to-Face Assessment Nursing facilities will use the online PAS tool to re-establish NF LOC ONLY for PA1 and PA2 by entering assessment information into the tool. DHS will provide a crosswalk for completing the online tool based on MDS data. If NF LOC still cannot be established, the SLL will make the referral for the face-to-face assessment. A face-to-face assessment MUST be complete before a final LOC determination is made. 52

PA1 & PA2 Can Meet LOC Does the PA1 or PA2 classification mean the person does not meet NF LOC criteria? No. Many PA1 and PA2 individuals will meet NF LOC criteria. These RUGS classifications simply do not reveal enough information about needs to determine NF LOC based on ALL criteria. For example, need for assistance with toileting.. 53

Face-to-Face and NFs For face-to-face assessments performed, the Activity Date in MMIS will be the date the lead agencies receives the referral from SLL when NF LOC cannot be determined without a face-to-face assessment. 54

When LOC is Established Online In using the online tool, the NF will receive output documentation that is similar to what the NF receives at PAS. For the MA person, no additional activity is required by the facility No documentation is required to be entered into MMIS. Retain the output documentation in your file. Forward this documentation when transferring to another facility. 55

LOC is Established Face-to- Face for NF Residents Through LTCC or MnCHOICES assessment: No additional activity is required on the part of the facility. The person will receive a lead agency communication indicating the person meets NF LOC. The lead agency documents the assessment and LOC in MMIS. The lead agency will communicate with a financial worker if the person is an applying for MA that the person meets LOC. 56

When LOC is NOT Established Only a lead agency assessor can make the determination that a person does NOT meet any of the NF LOC criteria. This determination is communicated to the person, using DHS Form 2828, Notice of Action for fee-forservice individuals or MA applicants MCOs use DHS-approved templates for denial, termination or reductions (DTR) in services. This determination is also communicated to a financial worker using DHS Form 5181. 57

Bulletin 14-25-09 Focuses on NF services and NF LOC determination processes. Includes many examples re: qualifying 90 day stay with transfers, etc. 58

Notification of LOC Determination Whether HCBS applicant/participant or NF resident, the lead agency that completed the face-to-face NF LOC determination must provide the person (and their legal representive if any) information about the determination and the effect on eligibility. 59

Assessor Determination Mn Statute, section 256B.0911 governs LTCC/MnCHOICES, subd. 3a, paragraph (h), individuals assessed are to be given information, including the certified assessor's decision regarding the person's need for institutional level of care as determined under criteria established in subdivision 4e and the certified assessor's decision regarding eligibility for all services and programs as defined in subdivision 1a, paragraphs (a), clause (6), and (b) AND 60

Right to Appeal Determination the person's right to appeal the certified assessor's decision regarding eligibility for all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and (8), and (b), and incorporating the decision regarding the need for institutional level of care or the lead agency's final decisions regarding public programs eligibility according to section 256.045, subdivision 3. 61

LOC is Appealable Because LOC affects eligibility for services AND financial eligibility, this decision is specifically appealable under MN Statutes, section 256B.0911 governing LTCC. 62

2014 Legislative Changes Notice of Action Advance notice requirement for changes to LTC eligibility under MA due to changes in NF LOC criteria was extended to 30 days from the date notice send to person; continuing requirement. A notice is sent 1-20-15, the effective date (the date of the action) must be at least 30 days from 1-20-15. This notice will always be based on a face-to-face assessment, and will include the use of DHS Form 2828 (Notice of Action) or MCO DTR (Denial, Termination or Reduction). These notices always include appeal information. 63

2014 Legislative Changes Appeals Extension of the timeline for an individual to file an appeal that includes a request for continuation of services from 10 to 30 days, when the termination or reduction in services is related to the change in NF LOC criteria. Limited to appeals filed between January 1, 2015 and December 31, 2016. 64

Notifications About Eligibility and Services 2014 Changes 2014 legislation also specifies information that must be provided as part of the notification. The information must be included in Notice of Action and DTRs used for denial, termination or reduction of services. DHS will provide standardized information for lead agency inclusion. DHS Form 2828 will be revised as well. 65

Notifications About NF LOC Information has been developed for lead agency assessor use to communicate LOC determinations. Will include information about what this determination means, other service options, and appeal information. 66

Notifications About Eligibility Financial workers provide notification to individuals about financial eligibility, including financial eligibility for LTC, and changes to MHCP programs. Assessors provide notification to individuals about level of care determinations and program eligibility or changes to eligibility. All notices include appeal information. 67

Communication with Financial Workers There is a process in place used by financial workers that continues: They rely on the DHS Form 1503 from NF to verify LOC at preadmission screening. (MMIS claims edits look for the actual screening document). They rely on DHS Form 5181 from an assessor to verify NF LOC for HCBS. They will rely on DHS Form 5181 from an assessor to verify of NO level of care. 68

Financial Workers Complete financial eligibility determinations. Apply LTC (special) rules when notification is received from an assessor that an individual meets institutional level of care. When LOC changes, financial eligibility is redetermined: Unknown to LOC LOC to No LOC 69

HCBS Transition Population: People Who - Were in EW, CADI or BI-NF as of January 1, 2014, and remain in the program until their next reassessment occurring on or after January 1, 2014, and who do not meet LOC criteria at that next reassessment. Includes all ages, and includes individuals who may no longer be eligible for MA. Some individuals are only eligible for MA under special rules applied to individuals who meet LTC service eligibility, i.e. LOC 70

NF Transition Population: People Who - Were admitted to a NF between October 1, 2014 and December 31, 2014 and Who were or became eligible for MA within these same dates, and Who do not subsequently meet LOC criteria to establish qualifying 90-day stay on or after January 1, 2015. These folks can access ECS as well as MA state plan if eligible. 71

Reassessment For the person s next reassessment occurring 1-1-14 or later: Continues to meet NF LOC Continue on programs as is currently done in MMIS Does not meet NF LOC Exit from waiver/ac Notice of Action and appeals information Refer for PCA assessment Open to ECS for transition 72

Customized Living Provider Input to Assessment There is a requirement in statute (256B.0911) that CL providers be notified of an upcoming re/assessment for EW. 73

Provider Input to Assessment Disability Waivers For a person who is to be assessed for waiver services under section 256B.49 governing the CADI and BI-NF programs, with the permission of the person being assessed or the person's designated legal representative, the person's current provider of services may submit a written report outlining recommendations regarding the person's care needs prepared by a direct service employee with at least 20 hours of service to that client. The person conducting the assessment or reassessment must notify the provider of the date by which this information is to be submitted. 74

Financial Worker Actions There is a process in place used by financial workers that continues: They rely on the DHS Form 1503 from NF to verify LOC at preadmission screening. (MMIS claims edits look for the actual screening document). A FW will NOT revise LTC eligibility under MA UNLESS they receive DHS 5181 from an assessor to verify NO level of care. If this form is not received, the person is assumed to continue to meet LOC. 75

Assessor Communication with Financial Workers Given the changes in 2014 legislation, when an assessor communicates to a FW using DHS 5181 that an individual no longer meets NF LOC, the assessor will communicate to both the person and the financial worker a no sooner than date that meets the 30 day advance notice requirement. 76

Financial Worker Notices Current forms used by financial workers for NF residents will continue to be used. DHS Form 4915 (participant/applicant) DHS Form 3050 (NF provider) Updated forms, manuals and training for FW are available. 77

Notifications for NF Residents DHS Form 4915 This form will include information about the date when MA payment for NF will discontinue. This date will always be: Not sooner than 30 days from the date the assessor sent the person the notice Will always be the last date of a month Changes to financial eligibility that may result are also communicated by the FW, follows notice and effective dates for MA eligibility changes. 78

Provider Responsibilities Nursing facility residents that do not meet level of care retain all applicable transfer and discharge rights pursuant to 42 C.F.R. 483.12. Discharge and planning requirements are in both state and federal law. 79

Provider Notices, Tenants Rights Providers have requirements related to notices to discontinue services, discharge. The change in NF LOC does not change these requirements. Individuals with leases retain tenants rights as well. 80

Support Options for All Nursing Facility Residents Relocation assistance from a variety of sources: Discharge planning carried out by the NF Contact SLL for assistance in connecting residents to support provided through: Return to Community Initiative Relocation Services Coordination/Care Coordination for people on MA If eligible, through Moving Home Minnesota (Money Follows the Person) initiative 81

Transition Supports Essential Community Supports: Both a new program for seniors and a transition strategy for individuals affected by changes to NF LOC. Implementation also delayed. State plan home care services Relocation assistance strategies Community supports through Title 3 Housing supports 82

Essential Community Supports (ECS) A set of services identified as those most frequently used in the sample analysis of individuals participating in HCBS who, based on their most recent assessment information in MMIS, would likely not meet the new LOC criteria. Individuals in the transition population may be eligible for ECS. State-funded program. 83

ECS Services Homemaker Personal emergency response Chore Caregiver education/training Home delivered meals Service coordination (case management) Community living assistance (under design) Adult day service added 2014 legislative session 84

ECS Settings Are not available to individuals in foster care, board and lodge or non-certified boarding care settings. Are available to individuals in Housing with Services settings that are apartments. 85

ECS Provider Requirements Are the same as those in the EW waiver. Uses the state rates for these services. Can find provider requirements at http://www.dhs.state.mn.us/main/id_000094# 86

Eligibility for ECS Must be established based on a face-toface Long Term Care Consultation (MnCHOICES) assessment. Individuals who are eligible for PCA services under MA cannot access ECS. ECS is available to people of all ages in the transition population. Must have a need for an ECS service. 87

ECS Program Details $400 monthly maximum budget Required service coordination, limited to $600 annually (an additional $600 for service coordination to assist in transition planning is available one time). ECS will be authorized by a LTCC/certified assessor, using MMIS service agreements, for needed services. 88

ECS Program Ongoing monitoring is required, as applicable. Individuals of all ages in the transition population who no longer meet MA financial eligibility requirements can access ECS if they meet AC financial eligibility requirements. Managed care enrollees: the MCO will manage these services but services will be authorized using a service agreement, providers bill DHS, not the MCO. 89

ECS for Seniors In addition to the transition population, ECS will remain an option for people age 65 and older who are: Not eligible for MA Do not meet LOC but have some emerging needs Meet AC financial eligibility criteria Assessed to need ECS service(s) More information in upcoming bulletin 90

Support Options Persons who are 60 and older are also eligible for Federal Older Americans Act Title III services. Contact Senior LinkAge Line at 1-800-333-2433 Housing: GRH, MSA-Shelter Needy These programs are not dependent on HCBS or other program eligibility. 91

Communication with Consumers For HCBS, a notice has been developed and will be mailed to ALL folks currently enrolled in October, November, December in EW, AC, CADI, BI-NF. This notice will let people know about the change, and that they may be offered alternative services at their next reassessment. Copy of the letter will be sent to lead agencies prior to mailing to participants. Participants will be instructed to contact their case manager or care coordinator if they have questions. 92

Communication with Lead Agencies Lead agencies will receive info about folks who might not meet LOC at their next reassessment. This will be sent to the LTCC Administrative Contact at each lead agency quarterly. First report Week of December 16 th Folks whose waiver span ends in Jan, Feb, March By lead agency on last assessment in MMIS 93

Applying Implementation Dates Lead agencies (counties, managed care organizations and tribes) that perform LOC assessments must not apply the revised criteria prior to the implementation dates for HCBS programs or NF admissions. The current criteria remain in effect for individuals under age 21 until October, 2019 for both NF and HCBS services. 94

Training Training November 20, 2014: Focus on HCBS and ECS December 11, 2014: Focus on operations for lead agencies MMIS coding Decision modeling for transition population Review of forms changes Presentations to be scheduled Bulletins 14-25-09 and 14-25-10, 2 additional on HCBS and ECS 95

NF LOC Project Information The NF LOC initiative has a web site where additional materials can be found at www.dhs.state.mn.us/nfloc Information about additional training opportunities Stakeholder materials Bulletins Mailbox dhs.nfloc@state.mn.us 96

Other Resources All DHS forms and bulletins can be found at http://www.dhs.state.mn.us/main/id_000100 All statutes can be found at https://www.revisor.mn.gov/statutes Information about PAS, Return to Community, and First Contact can be found at www.mnaging.net NF LOC Initiative Email dhs.nfloc@state.mn.us Current NF LOC criteria is found in DHS Form 3361 This criteria will remain effective for individuals under age 21 until October 1, 2019. New criteria is described in Mn Statute, 144.0724, subdivision 11 97

Adult Protection Resource The Vulnerable Adults Mandated Reporting course is designed to introduce you to: The Vulnerable Adults Act Definition of maltreatment and vulnerable adult Who are the mandated reporters The Common Entry Point (CEP) 98

Adult Protection Found on the DHS website, Adult Protection page http://www.dhs.state.mn.us/dsdtraining/w ebmanrpt/default.htm Email address DHS.AdultProtection@state.mn.us (651) 431-2609 99

Questions? And thanks for joining us! 100