Community First Choice information as of December 1, 2014 Subject to Change

Who is eligible? A child or adult who is: 1) Eligible for Medicaid 2) Requires an institutional level of care, e.g.: -nursing facility -ICF-IID -institution of mental disease

Home and Community-based Settings Where? Statewide Home and Community-based Settings Not: Nursing facility Hospital providing long-term services Institution for mental disease ICF-IID Other institution-like settings

What are CFC Services? 1) CFC Personal Attendant Services (PAS) -assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) 2) CFC Habilitation Services (Hab) -acquisition, maintenance, and enhancement of skills necessary for the person to accomplish ADLS, IADLS, and health-related tasks 3) Backup systems and supports 4) Support consultation

1) CFC PAS ADLs and IADLs defined Activities of daily living (ADLs): basic personal everyday activities including, but not limited to, tasks such as eating, toileting, grooming, dressing, bathing, and transferring. Instrumental activities of daily living (IADLs): activities related to living independently in the community, including but not limited to, meal planning and preparation, managing finances, shopping for food, clothing, and other essential items, performing essential household chores, communicating by phone or other media, and traveling around and participating in the community.

Assistance with ADLS and IADLs Hands-on assistance, supervision, and/or cueing Non-skilled assistance with performance of ADLs and IADLs Household chores Escort services (“accompanying but not transporting […] to access […] activities in the community” Assistance with health related tasks (delegated by an RN, health maintenance activities, extension of therapy)

2) CFC Hab Includes hab training in: Self-care Personal hygiene Household tasks Mobility Money management Community integration Use of adaptive equipment Personal decision making Interpersonal communication Reduction of challenging behaviors Socialization and the development of relationships Participating in leisure and recreation activities Use of natural supports and typical community services available to the public Self-administration of medication Strategies to restore or compensate for reduced cognitive skills

3) Backup systems and supports Backup systems and supports: electronic devices used to ensure continuity of services and supports. These items may include an array of available technology, personal emergency response systems, and other mobile communication devices. Persons identified by an individual can also be included as backup supports. Emergency response services are available for people who live alone, or are alone for significant parts of the day, or have no regular caregiver for extended periods of time, and would otherwise require extensive routine supervision.

4) Support Consultation Voluntary training on how to select, manage, and dismiss attendants Available to people using the consumer directed services option.

How will people be assessed? 2 parts: 1) Assessed for institutional level of care (LOC) 2) Assessed for functional need

1) LOC → Assessment Nursing facility LOC → Medical Necessity / Level of Care (MN/LOC) ICF-IID LOC → Intellectual Disability/Related Condition Assessment (ID/RC) Psychiatric inpatient LOC → Child and Adolescent Needs and Strengths assessment (CANS) or Adult Needs and Strengths Assessment (ANSA)

2) Functional Needs Assessment Who? “Assessments for CFC services will be conducted by existing assessors who are determined to be qualified by the State in a state plan or LTSS program already approved by CMS.” How? 2060-like

What is the role of the Local Authority? Contract with DADS and a separate agreement with MCOs Responsible for determining LOC and for CFC assessment for adults with intellectual disabilities in STAR+PLUS Ongoing targeted case management for individuals with IDD in STAR+PLUS Responsible for determining LOC for children in STAR+PLUS Cannot be a CFC provider in managed care

How will the Local Authority conduct CFC assessments? LA Obligations Related to CFC: Initial Assessment (tentative) For STAR+PLUS Members Not Receiving any LTSS on an IDD Interest List AND for STAR+PLUS Members Not on an IDD Interest List and Not in a Waiver Trigger: MCO sends referral to LA Conduct a Determination of Intellectual Disability (DID) after receiving referral from MCO If DID denies eligibility: Send denial notice to member and copy to MCO and DADS If member appeals denial à Notify MCO and DADS of appeal and fair hearing decision If DID approves eligibility: Send DID and ID/RC to DADS Trigger: DADS Notifies LA of decision about member approval for CFC If member is approved: Send recommended service plan to MCO If member is not approved: No further action required LA Obligations Related to CFC Reassessment (tentative) For STAR+PLUS Members with IDD Trigger: MCO notifies LA 90 days prior to end date of LOC to conduct ID/RC and develop recommended service plan Conduct ID/RC assessment and submit to DADS Trigger: DADS notifies LA of decision about member approval for CFC services If member is approved: LA submits recommended service plan to MCO 45 days prior to end date of LOC If member is not approved: no further action required

Who can provide CFC services? LTSS providers determined qualified by the state in an LTSS program already approved by CMS Home and community support services agencies (HCSSAs) Certified HCS providers Certified TxHmL providers Licensed Personal Emergency Response agencies Qualified support advisors Providers hired by people using the CDS option who meet qualifications