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

2. 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

3. 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

4. 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

5. 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.

6. 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)

7. 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

8. 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.

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

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

11. 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)

12. 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

13. 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

14. 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

15. 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