Funding Tennessee’s Community Living Services
CFC would allow Tennessee to draw down an additional federal
funds that could be up to $60 million annually in Medicaid resources to sustain
the shifts in the long term services and supports system.
OVERVIEW
The Community First Choice Option is a community-based
Medicaid state plan service which includes hands on assistance, safety
monitoring, and cueing for assistance with activities of daily living,
instrumental activities of daily living and health related functions for
individuals based on functional need, not diagnosis or age.
THE BASICS
The Affordable Care Act, Section 2401, added 1915(k) to the
Social Security Act under Medicaid. Final rules available at 42 CFR 441 Part K
or in the Federal Register at Vol. 77, No. 88 (77 FR 26828).
·
Supports choice, independence, and integration
in accordance with the Olmstead
decision
·
Person-centered and consumer-directed
·
Services must be provided in a home and
community-based setting and CANNOT be provided in a nursing facility,
institution for mental diseases (IMD), or intermediate care facility for people
with development disabilities (ICF-MR)
·
Must be provided on a statewide basis
·
Eliminates HCBS waiting lists
·
States that implement CFC will receive an
additional 6% in federal matching funds, with no sunset
·
States that are pursuing CFC (to date): AR, CA,
CO, LA, MD, MN, NY, RI, WA
ELIGIBILITY
Must be Medicaid eligible
Must require an institutional level of care (hospital,
nursing facility, ICF-MR, or IMD)
REQUIRED SERVICES
States must provide the following services.
·
Attendant services and supports to assist in
accomplishing: activities of daily living (ADL), instrumental activities of
daily living (IADL), and health-related tasks
·
Attendant services and supports include:
hands-on assistance, safety monitoring, and cueing
·
Assistance with the learning skills necessary to
accomplish ADL, IADL, and health-related tasks
·
Allows for the purchase of back-up systems (such
as beepers or other electronic devices) to ensure continuity of services and
supports.
·
The State must develop and offer a voluntary
training to individuals on how to select, manage and dismiss attendants.
PERMISSIBLE SERVICES and SUPPORTS
States can choose to provide the following services.
·
Transition costs, such as security deposits for
rent or utilities, purchasing basic kitchen supplies, etc.
·
Services that increase independence or
substitute for human assistance, such as assistance with learning how to use
public transportation, for example.
EXCLUDED SERVICES
CFC funding cannot be used to pay for the following services
because either the service cannot be paid for by Medicaid or the service is
available through alternative mechanisms, such as HCBS waivers. However, similar services may be permissible
under the context of “Expenditures relating to a need identified in an
individual’s person-centered service plan that increases an individual’s
independence or substitutes for human assistance.”
·
Room and board
·
Special education and related services provided
under IDEA and vocational rehab
·
Assistive technologies (other than those used as
back-up systems)
·
Medical supplies and equipment
·
Home modifications
MODELS FOR SERVICE DELIVERY
States can select one or more model for the delivery of CFC.
Ideally, states will provide consumers with a robust system in order to increase
choice. Services must be provided under a person-centered plan.
“Agency Provider
Model” includes a range of approaches, with the individual having the
ability to select, train, and dismiss their attendant, including:
Traditional agency
managed services
Agency-with-Choice
model where the agency operates solely as a fiscal intermediary
“Self-Directed Model
with service budget” including:
·
Vouchers
·
Direct Cash Payments
·
Fiscal Agent
CONSUMER RIGHTS
Emphasis on a person directed plan and planning process,
which includes individuals chosen by the consumer
Consumers can select family members (except spouse or legal
guardian) or any other individuals to provide services and supports
·
Consumers can train workers in specific areas of
care needed by the individual and to perform the needed assistance in a manner
that is consistent with the individual’s personal, cultural, and religious
preferences
·
Consumers can establish additional staff
qualifications based on their specific needs and preferences
SO, WHAT WILL CFC LOOK LIKE IN TENNESSEE?
Many decisions still have to be made. CFC sets the framework
for a fully integrated, non-diagnosis-specific, community-based service system
that provides individuals the civil right to live independently in the community
and out of an institution. CFC is structured to allow states to work within
their unique Medicaid system of state plan services, waivers, and managed care
services.
The decisions for structure, implementation, and monitoring
are the responsibility of the State’s CFC Development and Implementation
Council, which must be comprised of mostly people disabilities, seniors, and
their representatives – as required by CFC.
It is imperative that Tennessee establish its Development
and Implementation Council NOW! Every day delayed is money left on the table,
and people’s rights ignored.
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