Minnesota Department of Human Services

Question
Home and Community Based Services (HCBS), funded through the U.S. Department of Health and Human Services, Center for Medicaid Services, are intended to help adults remain in their community as they get older or if they have disabilities. Minnesota wanted to review the HCBS programs as implemented by counties and health plans to ensure they meet federal and state requirements and identify successful practices that improve the quality of service to HCBS participants.

Process
The Improve Group is implementing a mixed-method review process that relies on several sources of information: staff administering the programs, case file review, document review including contracts and policies, and analysis of financial and other systems data. Much of the data is collected during a multi-day site visit to the county or entity administering the program in which we learn about local challenges and successes. Each review results in a report that identifies promising practices as well as recommendations and corrective action requirements; these are supported by detailed data analysis. Both DHS and the local agency use the report to improve services, administration and supports.

Outcome
To date, over 40 counties have been reviewed with the remaining anticipated over the next three years. DHS has learned that local agencies need supports in order to serve HCBS participants; in particular, updated contracting practices and methods of gathering participant outcomes and satisfaction. As a result, DHS has begun developing new training and preparing its staff to meet with local agencies. We have also found a number of promising practices in each community, and have developed ways for local agencies to share ideas with each other and teach their peers through cross-site forums.