Local Authority Questions related to Community First Choice (CFC)
Contents
I. CFC in General
II. Level of Care Determinations
III. Referrals
IV. Service Coordination
V. CFC in IDD Waivers
VI. CFC in STAR+PLUS and STAR Health
VII. CFC and General Revenue Services
I. CFC in General
1) What are CFC services?
CFC contains four services:
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;
B. household chores necessary to maintain the home in a clean, sanitary, and safe environment;
C. escort services, which consist of accompanying, but not transporting, and assisting an individual to access personal assistance services or activities in the community; and
D. assistance with health-related tasks, defined as “specific tasks related to the needs of an individual, which can be delegated or assigned by licensed health-care professionals under State law to be performed by an attendant.”
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. personal hygiene;
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, IADLs, and 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.
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.
2)Will a person lose CFC services if the person loses Medicaid eligibility during the plan year? Is there a timeframe for the SC to assist the individual to get their Medicaid reinstated without a loss of services?
A person must be Medicaid eligible to qualify for CFC services. A protocol to address temporary loss of Medicaid eligibility during the plan year will be created.
3)Will a person who loses Medicaid be placed in a “hold” status or discharged? Will the LIDDA have to do a reassessment if the person is reinstated?
A person must be Medicaid eligible to qualify for CFC services. A protocol to address temporary loss of Medicaid eligibility during the plan year will be created.
4)Will CFC be rolled out to mental health population as well or is it specific to only IDD?
Yes. CFC will be available to people age 21 and under and age 65 and over who meet an Institution of Mental Disease (IMD) level of care. CFC will also be available to people of all ages who meet a medical necessity level of care (MN-LOC).
Local Mental Health Authorities will be responsible for conducting a CANS or ANSA for adults and children potentially eligible for CFC on the basis of an IMD level of care. See [IMD flowchart].
LAs and LMHAs are not responsible for administering any CFC activities for people eligible for CFC on the basis of MN-LOC.
5)Will other services ever be added to CFC, such as Day Habilitation?
Day habilitation is not likely to be added to CFC in the near to intermediate future. Rider language currently under consideration at the Legislature would, if passed, add non-medical transportation and respite to CFC services available in STAR+PLUS.
6)What forms will be used to develop Person Directed Plans for people receiving CFC services in the IDD waivers and through managed care?
See below.
PDP Form 8665
- Required for all HCS and TxHmL PDPs
- May be used for general revenue funded services, but only if the individual is not also receiving CFC services through a Medicaid MCO. Note that DADS will eventually require use of PDP Form 8665 for this population.
CFC Functional Assessment Form H6516
- Required for all individuals with an ICF Level of Care receiving CFC services through a Medicaid MCO
- Required for general revenue funded services if the individual is also receiving CFC services through a Medicaid MCO. (The same form is used for both general revenue funded services and CFC services.)
7)When will the Explanation of IDD Services be updated to include the CFC program?
DADS Form 2121 (Longterm Services and Support, People with Medical/Physical Disabilities)has been updated to include CFC. DADS anticipates the revised Explanation of IDD Services document to be updated by end of June 2015.
8)Is there a DADS list of names of DADS regional staff people the LIDDA SCs should contact in order to get DADS to terminate a person’s Primary Home Care (PHC)?
Yes. DADS has begun to send LIDDAs lists of TxHmL recipients whose PHC and ERS services will transition to CFC services. These lists include contact information for the DADS regional staff that the LIDDA will call to get the name of the DADS case manager assigned to each person.
More information on this process can be found in DADS IL XX-2015, available online here [post hyperlink once final draft is available]
Draft:
9)If a consumer requests their staff to attend trainings sponsored by DADS, HHSC, etc., where do the funds come from for the staff to attend?
DADS IL 2015-28 indicates: “[a]n HCS or TxHmL Program provider must, if requested by an individual: […] ensure a CFC PAS/HAB service provider attends training provided by or through HHSC or DADS so that the service provider can meet any additional qualifications desired by the individual.”
This training would be paid for the same way providers pay for other training today.
10)Has a list of billable services, billing codes and payment rates been published?
Rules related to the CFC programs and rates were adopted May 21, 2015, effective June 1, 2015. These rulesestablish CFC rates using pre-existing attendant and habilitation, consumer directed services, support consultation, financial management services agency and emergency response services rates.
To read the rules:
Program rules
Reimbursement rates
An HCS or TxHmL Program provider must comply with the CFC Billing Guidelines for HCS and TxHmL Program providers. The reimbursement rate for CFC PAS/HAB will be the same as the current HCS SHL and TxHmL CS reimbursement rates. The ERS rate is a cost ceiling and is currently $29.76 (once per month). Therefore, HCS and TxHmL Program providers must bill the actual amount paid for CFC ERS, which may be no more than $29.76. If the program provider contracts for the provision of CFC ERS, the actual monthly cost is the amount the program provider paid the contractor for CFC ERS. The current rates, as established by HHSC, can be found on HHSC’s website under Rate Analysis for Long-Term Services and Supports.
The service codes associated with the new CFC services for use in CARE are:
• CFPH - CFC PAS/HAB
• CFPHV - CFC CDS PAS/HAB
• CFERS - CFC ERS
• CFFMS - CFC Financial Management Service
• CFSCV - CFC Support Consultation
The updated bill code crosswalk can be found at:
11)Will there be CFC handouts, showing the services offered and eligibility requirements?
No, individuals and families will learn about CFC through targeted outreach. LIDDA service coordinators are required to provide a letter and an oral explanation to people currently served in IDD waivers whose services will transition to CFC reimbursed services. The deadline to provide this letter and oral explanation is July 1, 2015. HHSC may outreach to individuals not enrolled in an IDD waiver or on an IDD waiver interest list.
12)Will there be CFC Rights Booklets?
LA and waiver rights booklets will be revised to include CFC language and MCOs will be responsible for explaining rights for non-waiver persons receiving CFC.
13)Will there be an acknowledgement form showing that consumers were notified of CFC services available to them?
The DADS Information Letters directed initial and annual notification. Acknowledgement forms regarding receipt of rights/complaint processes should be revised at the local level to include CFC.
14)Will the Identification of Preference form and the Verification of Freedom of Choice form be updated to reflect CFC?
There are no plans to update these forms at this time.
15)Will a PDP be required for CFC recipients?
Yes. A PDP is built into the H6516 form (CFC functional assessment) for CFC recipients receiving CFC through STAR+PLUS. For CFC recipients receiving CFC through the waiver, existing/updated PDP forms will be used. For children being assessed for CFC, the appropriate PCAF form with CFC addendum is used.
16)Are there any special reports the LIDDA will need access to for CFC? If yes, what steps are required to ensure staff have appropriate access?
Questions about CARE reports related to CFC should be directed to Ms. Rhonda Ritchie at DADS at .
17)Will more training be available on H6516, the CFC functional assessment?
At this time, DADS does not have plans to offer additional training on H6516. Some Local Authorities are working with their local MCOs to offer regional trainings. In some instances, the trainings are reciprocal: MCO staff train LIDDA staff on the H6516 and LIDDA staff train MCO staff on person-directed planning.
18)When is a person, who meets CFC provider qualifications and lives in the home of an adult individual, not eligible to be the CFC provider?
The requirements differ depending on whether the person is using the Consumer Directed Services (CDS) option or the agency model (non-CDS). In all instances below, the service provider must meet all relevant qualifications established by law/rule and qualifications requested by the individual and/or the individual's LAR based on the individual's needs and preferences.
Under the CDS option, the LAR cannot be the provider (employee) because the LARis required to be the employer and the same person must not be the employer and employee. Similarly, the LAR’s spouse, designated representative, or designated representative’s spouse cannot be the provider.
Under the agency model, the parent of an adult may be the service provider.
Under both CDS and the agency model, the service provider may not be the person's parent if the person is a minor or the person's spouse, both considered legally liable adults.
19)What impact would a person’s refusal of CFC services have on future eligibility for CFC services?
Because CFC is an entitlement benefit, refusal of services at one point in time would not affect the person’s eligibility for CFC services at a later point. The person would not lose eligibility or move to the bottom of an interest list.
20)Are there forms or processes for someone that does not want CFC services or who is not eligible?
TBD.
21)What is the process when someone ages out of Superior?
TBD.
22)What is the transfer process to another LIDDA? Will it resemble the LIDDA Reassignment?
TBD.
23)When a referral is received for an individual who no longer resides in the local service area, is there a defined process to follow?
TBD.
24)What is the process for eligibility determination when the designated LIDDA is determined by the residence of the LAR, and the individual resides in a county outside the designated LIDDA?
TBD.
II. Level of Care Determinations
25)Will Managed Care Organizations (MCOs) be responsible for conducting Determinations of Intellectual Disability (DIDs) for children?
No. Local Authorities are responsible for conducting DIDs for children and adults potentially eligible for CFC on the basis of an Intermediate Care Facility for Individuals with Intellectual Disabilities or Related Conditions (ICF-IID) level of care.
26)Will MCOs approve Medicaid reimbursement for Determinations of Intellectual Disability (DIDs)? Will there be any stipulations or restrictions around reimbursements?
Yes, the MCOs will reimburse for the psychological testing component of a DID, if the testing meets all of the relevant criteria of a Medicaid covered benefit. This criteria includes: testing is performed by a licensed PhD psychologist who is also a Medicaid provider and testing does not exceed 4 hours in a day and 8 hours in a year.
For more information related to psychological testing as a Medicaid acute care benefit, see: Texas Medicaid Provider Procedures Manual.
Psychological testing falls under procedure code 96101.
The protocol for billing for psychological testing is being discussed at the state level. More information will be forthcoming.
27)Can a Local Authority bill for more than one DID per person if needed in the future?
It depends. A Local Authority can bill for the psychological testing component of a DID if the testing meets all relevant criteria found in theTexas Medicaid Provider Procedures Manual.Some of these criteria include that the testing not exceed four hours in a single day and eight hours in a single year.
28)The CFC Intellectual Disability/Related Condition (ID/RC-CFC) assessment is submitted to DADS via CARE screen K23. How do we submit the required documentation to DADS (as stated in the flowchart)?
Download and use Form 2007 – CFC LOC Determination Review Cover Sheet from DADS forms ( Form 2007 lists the required documents and instructs LIDDAs to fax the documentation to 512-438-5693.
29)Will the CARE screen K23 be available prior to June 1, 2015?
Yes. DADShosted a webinar on Tuesday, May 26, 2015 with detailed information about CFC processes in CARE. The webinar was broadcasted to LIDDAs and presentation materials can be found at: .
30)Who is responsible for determining the Level of Care (LOC) for an individual with IDD potentially eligible for CFC: the Local Authority Service Coordinator (SC)or DADS?
The LIDDA is responsible for determining the LOC and entering the determination into CARE. DADS is then responsible for approving or denying the LOC.
If LIDDA staff determine the person does not meet LOC, LIDDA staff should submit LOC 0 into CARE.
31)With regard to conducting and billing for DIDs, please explain the distinction between a licensed PhD Psychologist and a Licensed Psychological Associate (LPA) who is DADS certified to conduct DIDs.
While both licensed PhD psychologists and Licensed Psychological Associates are qualified to perform DIDs pursuant to relevant rules in the Texas Administrative Code, only the psychological testing component performed: a) by a licensed PhD psychologist and b) in compliance with all other relevant Medicaid billing guidelines, will be reimbursable by the MCO.
The protocol for billing MCOs for psychological testing, when all relevant criteria are met, is still under discussion. Further guidance will be forthcoming.
32)Who is qualified to complete the ABL assessment?
Each ABL assessment has different specifications related to qualifications of the person completing the assessment. Please review the ABL assessment manual to determine who is qualified to conduct that specific ABL assessment.
33)A DID older than five years for an adult will have an ABL determination of over five years, too. In this situation, would only an ABL update be required?
It depends. DADS memorandum “Requirements for Completing a Determination of Intellectual Disability (DID) for Community First Choice (CFC) Applicants/Participants,” dated January 20, 2015, provides guidance on when a new DID or a DID Review and Endorsement must be completed for non-waiver individuals who are referred for CFC:
“At the time an individual is being assessed for eligibility for services, best practice is for a psychologist [authorized provider] to conduct new intellectual functioning and ABL assessments, or to review the individual’s most recent DID assessment and use their professional judgment to decide whether a new DID is indicated. If the ABL is not included in the individual’s most recent DID assessment, the LA is required to conduct an ABL assessment and include the ABL in the packet submitted to DADS.