Oregon is the first state to implement a Community First Choice (CFC) Option program. Initially, there was confusion about guardians serving as paid caregivers under the K Plan. State officials are working with the Centers for Medicare and Medicaid Services (CMS) to develop a process to allow guardians, frequently family members, to continue as paid caregivers. The regulations governing CFC include strong conflict of interest provisions. Without a process to allow guardians to be paid caregivers, individuals with intellectual and developmental disabilities and their advocates in Oregon feared that some individuals would be forced into institutional placements.
Oregon’s K Plan is the second Community First Choice Option plan to win approval from the Centers for Medicare and Medicaid Services (CMS). Under the K Plan, Oregon will provide home and community-based services and supports under its state plan in exchange for a 6% increase in its federal Medicaid match for those services. Services not provided under the K Plan that people with intellectual and developmental disabilities (I/DD) might need will continue to be available through waivers, including supported employment/pre-vocational services, family training, and waiver case management.
California is the first state to win approval from the Centers for Medicare and Medicaid Services to adopt the Community First Choice Option provision of the Affordable Care Act. The state will make home and community-based attendant services and supports and assistance with health-related tasks, including hands-on assistance, cuing, and supervision available to low-income people with disabilities who otherwise would have to receive care in a nursing facility or intermediate care facility for individuals with intellectual/developmental disabilities. The state will receive a 6% increase in federal matching funds for the new community-based services and supports.
California will be the first State to receive new federal Medicaid funding from the Community First Choice (CFC) Option in the Affordable Care Act, according to an announcement made today by the Centers for Medicare & Medicaid Services (CMS) Acting Administrator Marilyn Tavenner. The CFC Option is a new Medicaid State plan option which allows States to provide broadly-defined home and community-based attendant services to certain Medicaid beneficiaries who would otherwise need nursing facility or other institutional services. States choosing to participate receive a 6 percentage point increase in their federal medical assistance percentage (FMAP) for services provided under this option. California will receive an estimated $258 million dollars for the first year of implementation, and $315 million for the second year. The increased funding is available as long as the option is included as a benefit in the State’s Medicaid program.
The Arc submitted comments to the Centers for Medicare and Medicaid Services (CMS) concerning the proposed rule regarding the Medicaid Program State Plan Home and Community-Based Services and Setting Requirements for Community First Choice. In general, The Arc supports the efforts of CMS to incorporate the values of inclusion, independence, and autonomy into home and community-based services. The Arc offered suggestions to CMS that could further clarify and strengthen the proposed rule.
The Centers for Medicare and Medicaid Services (CMS) issued two rules concerning community-based services for people with disabilities – one final rule and one proposed rule.
The final rule implements the Community First Choice (CFC) Option, a provision of the Affordable Care Act that provides an incentive to states to expand community-based attendant services and supports to people with disabilities who are eligible for institutional level of care. States that choose the CFC option will receive a 6% increase in their federal Medicaid share (FMAP) for those services. The rule requires states to provide CFC services only in a “home and community” setting. Unfortunately, the rule does not include the definition of a home and community setting. The definition in the proposed rule generated so many comments that CMS decided to revise the definition and seek public input again. The revised definition will appear in the proposed rules implementing the Home and Community Based State Plan option described below. Once a definition is finalized it will apply across all of the home and community programs – 1915(c) waiver programs, the 1915(i) State Plan option, and the 1915(k) CFC Option. The CFC final rule should appear in the Federal Register on May 7.
CMS also announced the proposed State Plan Home and Community-Based Services (HCBS) rule which includes the revised definition of “home and community” setting. The State Plan HCBS proposed rule gives states guidance about how to amend their state Medicaid plans to make home and community-based services available without having to design waivers. State plan home and community-based services will be available to individuals with significant needs who will not have to meet institutional level of care. If a state chooses the option, services must be available to anyone who meets eligibility standards; waiting lists are not permitted.
CMS’s proposed definition of home and community setting lists qualities that settings should have, such as:
“The setting is integrated in, and facilitates the individual’s full access to, the greater community including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, like individuals without disabilities. . . “
The proposed rule lists specific facilities that would not be considered home and community-based settings, such as intermediate care facilities for individuals with intellectual and developmental disabilities.
CMS will rely on the proposed setting definition as it reviews new 1915(k) CFC options and will expect states to comply with the setting requirements. If there are changes to the definition when the rule is finalized, CMS will give states a transition period, at a minimum of one year, to make any needed changes.
The Arc will review the revised definition of home and community setting and make comments if necessary. It is anticipated that the proposed rule will appear in the Federal Register on May 3. The comment period will close 30 days later.
On Friday, Feb. 25, the Centers for Medicare and Medicaid Services (CMS) published a notice of proposed rulemaking (NPRM) in the Federal Register regarding the Community First Choice (CFC) Option. The CFC Option is a new Medicaid provision, added by the Affordable Care Act, to allow states to provide a comprehensive community-based service to people who would otherwise need a nursing home or institutional level of care. The CFC Option will provide states with an additional 6 percent federal matching rate in reimbursement for services provided to eligible people under the option. The DPC will be analyzing the proposed regulations for the CFC Option over the next several weeks and provide that analysis and suggested comments to chapters and affiliates prior to the due date for comments. Public comments must be received by CMS no later than 5:00 pm on April 26. View the NPRM at http://www.gpo.gov/fdsys/pkg/FR-2011-02-25/pdf/2011-3946.pdf
States will see significant new federal support in their efforts to help move Medicaid beneficiaries out of institutions and into their own homes or other community settings, Health and Human Services (HHS) Secretary Kathleen Sebelius announced yesterday. The Affordable Care Act provides additional funding for two programs supporting that goal:
Money Follows the Person (MFP): The Affordable Care Act (ACA) extended the MFP demonstration program (which was set to expire in fiscal year 2011) for an additional five years. The 13 States receiving awards today (CO, FL, ID, ME, MA, MN, MS, NV, NM, RI, TN, VT, and WV) join the 29 States and the District of Columbia already operating MFP programs. Together, these States will receive more than $45 million in the first year of the awards, and more than $621 million through 2016. The MFP program provides individuals living in a nursing home or other institution new opportunities to live in the community with the services and supports they need.
Community First Choice (CFC) Option: The ACA created the CFC Option, which will give States additional resources to make community living a first choice, and leave nursing homes and institutions as a fall back option. Starting in October, this option will allow States to receive a six percent increase in federal matching funds for providing community-based attendant services and supports to people with Medicaid. Over the next three years—through 2014—States could see a total of $3.7 billion in new funds to provide these services. The CFC proposed rule, posted today, describes the details of this program and solicits public comment. See the HHS press release at http://www.hhs.gov/news/press/2011pres/02/20110222b.html