Frequently asked questions about the LTSS Improvement Tool

The 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 service providers. 

DHS uses data gathered from assessments, eligibility, service authorizations, health-care claims, etc., for program monitoring, state and 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:

1. Person’s evaluation of his/her coordinated service and support plan (CSSP)
2. Case manager’s evaluation of the person’s CSSP. We expect to incorporate these questions in 2019.
3. Person’s evaluation of his/her service provider
4. Case manager’s evaluation of the person’s service provider. We expect to incorporate these questions in 2019.
5. Person’s evaluation of his or her case manager. We expect to incorporate these questions with the launch of MnCHOICES Assessment 2.0.

DHS will implement the LTSS Improvement Tool in three phases to allow lead agencies time to adjust their workflows and incorporate these questions into the person’s visit.

DHS implemented Phase I in October 2017. This included two sets of questions:

• Person’s evaluation of his/her coordinated service and support plan (CSSP)
• Person’s evaluation of his/her service provider

Note: Based on feedback from the county-state work group and other stakeholders, DHS decided to target the Phase I questions for people who receive waiver services. For people who receive non-waiver services (e.g., only state plan), these questions are optional at this time. See the Eligible populations section below for more information.

DHS expects to implement Phase II in 2019. 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 part of a visit with the person. The case manager will respond to these questions on his/her own time.

• Case manager’s evaluation of the person’s coordinated service and support plan (CSSP)
• Case manager’s evaluation of the person’s service provider

DHS plans 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 will continue to be responsible for completing Phase I and II questions).

Waiver case managers have an ongoing responsibility to monitor the service plans of waiver participants and should incorporate the LTSS Improvement Tool into their regular monitoring activities. For disability waiver programs, the case manager will complete the LTSS Improvement Tool at a semi-annual or mid-year visit with the person. For AC and fee-for-service EW, the case manager will complete the LTSS Improvement Tool during a monitoring visit with the person, whether in-person or via phone. For non-waiver programs (e.g., state plan PCA only), this tool is not required at this time. See the State plan services section below for more information.

The waiver case manager will complete this tool for people who receive waiver services. This includes contracted case managers. Contracted case managers have access to the MnCHOICES Support Plan application and the LTSS Improvement Tool. 

If a person has both a waiver case manager and a Rule 185 case manager, the waiver case manager will complete the tool. See the Eligible populations section below for more information. 

For BI, CAC, CADI, and DD waiver participants, in cases where the county of residence differs from county of financial responsibility, the county of financial responsibility is responsible for providing case-management services and should complete the tool. 

For AC and EW FFS, the county of residence is always the lead agency and responsible for providing case management services and should complete the tool. When a tribal nation is the lead agency, the waiver or AC tribal case manager should complete the tool. 

This tool is not required at this time for people who receive only non-waiver services (e.g., state plan services such as PCA only or home care nursing). See the State plan services section below for more information.

Case managers should try to schedule mid-year visits when the provider is not present. If this is not possible, case managers may ask the provider to leave the room for part of the meeting so the case manager can ask the evaluation questions.

Yes. If a person finds a question within the LTSS Improvement Tool uncomfortable or difficult to answer, the person may make an informed choice not to answer. However, DHS encourages the case manager 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, the case manager should select “Chose not to answer” as the response. We encourage the case manager to add a comment in the narrative text box at the end of the visit indicating why the person chose not to answer specific questions.

No. The case manager must ask every question in the LTSS Improvement Tool. The person should decide whether or not to answer the question.

In Phase I, there are two sets of questions.

• In the “Person’s Evaluation of his/her CSSP” section, there are 18 questions.
• In the “Person’s Evaluation of his/her Service Provider” section, there are nine general questions about the selected service provider. If a person only receives non-waiver services or CDCS, then only the nine general questions will display. Additional questions may display based on the program setting:
  • Adult day services, day training & habilitation, prevocational services or structured day program require four additional service-specific questions (13 questions total).
  • Adult or child foster care or customized living require 12 additional service-specific questions (21 questions total).

The LTSS Improvement Tool uses scaled, multiple-choice options to capture the person’s responses to the items. The scale terminology is not meant to be exact, but rather one’s perception of the frequency that it occurs or is experienced. The scale runs from most to least. As a rule of thumb, you could think of the scale as running from 100 percent of the time through 0 percent of the time, where the terms roughly divide up the percentages. But, neither you nor the person is being asked to name a precise percentage, hence the broader terminology:

• Almost always = 100 percent 
• Most of the time 
• Some of the time 
• Rarely = 0 percent

Yes. Only people who use the MnCHOICES Support Plan application will have access to the LTSS Improvement Tool. If lead agencies still use the MnCHOICES Community Support Plan with Coordinated Services and Supports Plan form, DHS-6791B (PDF), then lead agencies will not have access to the LTSS Improvement Tool. If a person does not have a CSP/CSSP in the MnCHOICES Support Plan application, lead agencies will not be able to complete the LTSS Improvement Tool. See the Eligible populations section below for more information.

The link to create an “LTSS Evaluation” will appear when the case manager closes a CSSP in the MnCHOICES Support Plan application. A case manager may click this link to generate the Phase I questions of the LTSS Improvement Tool. For details, see the MnCHOICES Support Plan User Manual.

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 needs to complete the LTSS Improvement Tool only once per year for every person who has a CSSP in MnCHOICES. If the case manager completes the LTSS Improvement Tool before updating the person’s CSSP, a new LTSS Improvement Tool does not need to be completed until the following year.

If a change in provider is recorded in the CSSP after the case manager has submitted the LTSS Improvement Tool, there is no need to complete a new LTSS Improvement Tool. Only one LTSS Improvement Tool evaluation needs to be completed per year. 

If there was a change in provider made in the CSSP before the LTSS Improvement Tool was submitted, then DHS recommends that the case manager determine an appropriate time to gather the person’s feedback if the new provider is selected. The case manager may schedule a later mid-year visit to ensure that the person has interacted with the provider enough to give feedback on services received.

The tool selects services from the person’s last closed CSSP. If a person has a residential or day service in the CSSP, the system is more likely to select that service for evaluation than other home and community-based services (e.g., chore services or homemaker). 

Most services provided under HCBS waiver programs are eligible for evaluation. If a person does not have service(s) that are eligible for evaluation, the system will display a message, “The services which this person has selected do not require an evaluation to be completed.”)

For a person who receives multiple services, the system will randomly select one service and an associated provider from the person’s last closed CSSP. 

If lead agencies are only using the rate tool in MnCHOICES and the person does not have an electronic support plan, the LTSS Improvement Tool does not need to be completed.

If the person has more than one provider for a service, the system randomly selects one provider associated with that service from the person’s last closed CSSP.

If a person receives 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 the case manager has internet connection in the field, he/she will collect the responses and save or submit using 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: 

• The LTSS Improvement Tool has a print feature built into the MnCHOICES Support Plan application. If the case manager prints and completes questions on paper, the case manager should manually enter these responses in the support plan application when he/she has internet connection.
• DHS has an eDocs series (DHS-7611) available so the case manager may download it to a desktop ahead of time. In the eDocs versions, the case manager can save responses electronically and manually enter them in the Support Plan application when he/she has an internet connection.

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).

The time required to complete the LTSS Improvement Tool is a reimbursable activity under waiver case management. If a case manager chooses to use the eDoc version of the LTSS Improvement Tool, it can be given to a case management aide to enter this data in the MnCHOICES Support Plan application. This is considered a reimbursable activity.

Case managers may use the My Plans tab in the support plan application and select LTSS Evaluations under Document Type. This allows the user to track his or her cases by open or closed status of the LTSS Improvement Tool questions. The system will display a list for each status that is selected. (For details, see the My Plans section in the MnCHOICES Support Plan User Manual.)

No, the LTSS Improvement Tool does not apply to EW participants who are enrolled in managed care. Counties and tribal nations should only ask the LTSS Improvement Tool questions when an EW participant receives services through fee-for-service and is not enrolled in managed care. See the Health plans/managed-care organizations section below for more information.

No, the LTSS Improvement Tool does not apply to the Essential Community Supports program.

No, the LTSS Improvement Tool does not apply to the Consumer Support Grant program.

No, the LTSS Improvement Tool does not apply to the Family Support Grant.

No, the LTSS Improvement Tool does not apply at this time for a person who receives services in an ICF setting.

No, the LTSS Improvement Tool does not apply at this time for a person who receives SILS. If the person uses home and community-based waiver services, he/she is not eligible for SILS.

Yes. Questions in the LTSS Improvement Tool apply to people who self-direct their services through the CDCS service option. Although the CSSP will list a designated fiscal entity instead of a service provider, the person’s responses about satisfaction with services are still relevant. The case manager should ask the person for feedback about how his/her services are working (even though the system does not select a single service and a service provider).

No, 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 in Phase III. 

For a person who receives Rule 185 case management and waiver services, the LTSS Improvement Tool does apply and focuses on the person’s feedback on the waiver services. The waiver case manager will ask these questions during the mid-year visit.

No, MCOs do not use the LTSS Improvement Tool. 

As part of the HCBS settings rule transition plan, MCOs are gathering feedback from EW participants on their experience with a service provider using the Person’s Evaluation of Foster Care, Customized Living, or Adult Day Service, DHS-3428Q. DHS provided instruction to managed care organizations about gathering this feedback in Bulletin #18-25-04C.

No, the case manager does not need to complete the LTSS Improvement Tool for any people who receive Elderly Waiver services under managed care. Counties acting as a delegate for a health plan and that use the MnCHOICES Support Plan application under their MCO delegation agreement may complete the evaluation questions, but DHS does not require it.

If person has a guardian, the case manager should still ask the person the questions. The case manager should indicate in the tool if the guardian answered the question as well.

DHS does not require the guardian to be present or to 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 delivery of services.

While completing the LTSS Improvement Tool, the case manager will be asked “who is responding to these questions?” The case manager will then be directed to “check all that apply.” If a guardian is present, the case manager should select both the person and guardian. A text box will display allowing the case manager to provide additional information, if needed.

DHS values feedback from all people who receive services, regardless of situation; therefore, 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 what’s important to and important for the person.

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:

• HCBS settings rule
• Olmstead Plan
• Lead agency review
• Centers for Medicare & Medicaid Services (CMS) requirements

DHS will use this data, integrated with assessment and use data, to:

• Create performance measures
• Improve service responsiveness
• Inform stakeholders on trends in HCBS quality and outcomes

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.).

Not at present. We aren’t collecting people’s feedback about their case managers now. But in the future, we do plan to collect that feedback.

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.

While completing the LTSS Improvement Tool, a person may request a change in services. The goal of these evaluations is to gather a person’s feedback on services and service providers by providing structure to the conversations already occurring. Case managers should follow standard protocol for making changes to the person’s CSSP, as they would do any time a person requests a change in their services or CSSP.