HCBS Reports

Round 4: Mid-Round Report

Report from lead agency visits conducted between April 2019 - June 2021.  Mid-round case file review report (PDF)   

Case file review results from lead agency visits conducted between April 2019 - August 2022. Mid-round compliance dashboard (PDF)

---

Round 4: Mid-Round Findings

The following findings are taken from the HCBS Lead Agency Review Summary Report for lead agencies reviewed between April 2019 and June 2021. Quantitative and qualitative information was gathered during these reviews via a number of data collection methods, including a review of a sampling of over 3,000 case files, surveys completed by more than 1,100 case managers and assessors and numerous on-site meetings and focus groups with lead agency staff. 

Round 4 Themes

Along with review of technical compliance, the Lead Agency Review also looks at trends and themes that may impact services and services delivery. For Round 4, the areas of emphasis are: equity, community integration and program sustainability. 

Equity:

Emphasis is placed on how lead agencies are engaging with underserved and emerging communities, preparing for their aging population and taking steps to ensure equitable access to services. As seen in Figure 1, HCBS participation is becoming more diverse across the state. 

Figure 1: Changes in HCBS participation by race in Minnesota, 2015 to 2019

Community Integration:

Emphasis is place on how lead agencies are supporting individuals to live in their preferred setting and navigate community access and resources. As seen in Figure 2, more individuals are living in their own home, across all waiver programs.

Figure 2: Percentage of individuals living at home in Minnesota, FY2015 to FY2019

Program Sustainability:

Emphasis is placed on how service utilization and cost impacts an individual's choice in employment, housing and participation in their community. As seen in Figure 3, all employment measures reviewed in Round 4 have increased compliance, when compared to Round 3.

Figure 3: Comparison of employment measures reviewed from Round 3 to Round 4

Technical Compliance

A core component of the Lead Agency Review process is case file review. A number of measures are reviewed to determine the lead agencies overall compliance with both federal and state requirements. 

Person-centered planning:

A new element of the Round 3 review was the monitoring of person-centered practices implemented by each lead agency. These elements continue to be reviewed in Round 4 and case file review has shown increased compliance across every measure.

Figure 4: Development of a plan using person-centered planning elements: Round 3 to Round 4

Timeliness:

A measure that was refined for review in Round 4 is timeliness of the support plan. To be compliant, support plans must be developed and sent to the individual or their legal guardian within 60 days of the individual's assessment visit.  

Figure 5: Timeliness of plan sent to individual, by program in Round 4

Best practices

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 during Round 4.

Case management and assessment

• Utilize case aides to assist with tasks, such as: intake, tracking eligibility determination and MMIS entry;
• Use supervisors and leads to complete administrative tasks that cannot be billed under waiver programs, such as: appeals, obtaining technical assistance and coordinating staff trainings;
• Use contracted case management for individuals living in another county and/or when the lead agency is unable to hire additional staff;
• Separate role of case manager and assessor.

Housing

• Increase use of CDCS to assist with staffing options for individuals living in their own home;
• Working with the local Housing and Redevelopment Authority.

Employment

• 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.