The purpose of this information letter (IL) is to inform Deaf Blind with Multiple Disabilities (DBMD) program providers, Community Living Assistance and Support Services (CLASS) Direct Service Agencies (DSAs) and Case Management Agencies (CMAs) about the implementation of the Community First Choice (CFC) benefit for individuals in the CLASS Program, effective June 1, 2015. This letter does not address CFC services through the consumer directed services (CDS) option or through Medicaid managed care. Requirements regarding CFC services delivered through the CDS option are addressed in IL15-31.
For your convenience, a table of contents for this letter is set forth below:
Table of Contents
Introduction 1 Important Things to Know about CFC 2 Services Offered Under the CFC Option 2 Impact of CFC in the CLASS and DBMD Waiver Programs 4 DBMD Program Provider and CLASS CMA and DSA Responsibilities Related to Implementation of CFC 4 Service Provider Requirements 6 Compliance Requirements 7 Billing and Rates 8 Eligibility Requirements/Fair Hearings 9 DSA Staff and Case Manager Requirements 10 CLASS and DBMD Form Revisions 11 Information Letters and Rule Changes 12
Introduction
CFC is a state plan option governed by Code of Federal Regulations (CFR), Title 42, Chapter IV, Subchapter C, Part 441, Subpart K, regarding Home and Community-Based Attendant Services and Supports State Plan Option (Community First Choice) that provides certain services and supports to individuals living in the community, including individuals in the CLASS and DBMD programs. CFC services are Medicaid state plan services, not waiver services.
Important Things to Know about CFC
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The CFC option offers CFC personal assistance services (PAS), CFC Habilitation (HAB), CFC emergency response services (ERS), and CFC support management services.
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For CLASS and DBMD, the CFC services of PAS and HAB are combined into one CFC service — CFC PAS/HAB, which is considered the same service as habilitation in CLASS and residential habilitation in DBMD.
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All of the tasks and activities delivered through CLASS habilitation or DBMD residential habilitation will be delivered through CFC PAS/HAB.
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ERS will be provided through CFC ERS, not as an adaptive aid.
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The reimbursement rate for CFC PAS/HAB will be the same as the current CLASS habilitation
and DBMD residential habilitation reimbursement rates.
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Individuals receiving licensed assisted living or licensed home health assisted living in the
DBMD Program or support family services or continued family services in the CLASS
Program will not receive CFC services.
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CFC PAS/HAB and CFC ERS will not be included in the calculation of the individual plan of
care (IPC) annual cost for the CLASS and DBMD Programs services. However, the CFC
service cost will be included separately on the IPC.
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Electronic visit verification (EVV) will not apply to DBMD program providers delivering
services to individuals enrolled in the DBMD Program. CLASS DSAs that use EVV for
habilitation must use it for CFC PAS/HAB.
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Individuals in the CLASS and DBMD Programs may no longer receive personal assistance
services through the HHSC Medicaid benefit of Personal Care Services (PCS). Services currently provided to individuals through PCS will be transitioned over to CFC PAS/HAB. The individual’s CLASS or DBMD provider will be responsible to provide for all of the individual’s personal attendant service and habilitation needs. More information about the transition of PCS to CFC PAS/HAB will be provided at a later date.
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Individuals must be given the opportunity to participate in person-centered planning process. The person-centered planning process is led by the individual where possible.
Services Offered Under the CFC Benefit
In accordance with the state plan amendment approved by the Centers for Medicare & Medicaid Services (CMS) and rules of the Health and Human Services Commission (HHSC) at
1 Texas Administrative Code (TAC) Chapter 354, Subchapter A, Division 27 (relating to Community First Choice), CFC offers the following services:
1. CFC personal assistance services (PAS) – Services that provide assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), as defined in 42 CFR §441.505, through hands-on assistance, supervision, and/or cueing. Such assistance is
provided to an individual in performing ADLs and IADLs based on the individual’s person- centered service plan. CFC personal assistance services include:
A. non-skilled assistance with the performance of the ADLs and IADLs;
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household chores necessary to maintain the home in a clean, sanitary, and safe
environment;
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escort services, which consist of accompanying, but not transporting, and assisting an
individual to access personal assistance services or activities in the community; and
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assistance with health- related tasks as defined in 42 CFR §441.505 in accordance with
state laws.
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CFC habilitation (HAB) – Acquisition, maintenance, and enhancement of skills necessary for an individual to accomplish ADLs, IADLs, and health-related tasks. CFC habilitation is provided to allow an individual to reside successfully in a community setting by assisting the individual to acquire, retain, and improve self-help, socialization, and daily living skills or assisting with and training the individual on ADLs and IADLs. Personal assistance may be a component of CFC habilitation for some individuals’ ADLs. CFC habilitation includes habilitation training, which is interacting face-to-face with an individual, to train the individual in activities such as:
A. self-care;
B. personalhygiene;
C. household tasks;
D. mobility;
E. money management;
F. community integration including how to get around in the community;
G. use of adaptive equipment;
H. personal decision making;
I. reduction of challenging behaviors to allow individuals to accomplish ADLs and IADLsand health-related tasks; and
J. self-administration of medication. -
CFC emergency response services (ERS) – Electronic devices to ensure continuity of services and supports. These services are available for individuals who live alone, who are alone for significant parts of the day, or have no regular caregiver for extended periods of time, and who would otherwise require extensive routine supervision.
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CFC support management services – Voluntary training on how to select, manage, and dismiss attendants.
Health-related tasks, in accordance with state law, include tasks delegated by a registered nurse, health maintenance activities, and extension of therapy. An extension of therapy is an activity that a speech therapist, physical therapist or occupational therapist, instructs the individual to do as follow-up to therapy sessions. If appropriate, the individual’s attendant can assist the individual in accomplishing such activities with supervision, cueing and hands-on assistance.
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