From AAPD (4.28.11):
Medicaid Community First Choice Option: Rules Pending
By David Heymsfeld, Policy Advisor, AAPD
On Tuesday April 26, 2011 AAPD joined with many other disability organizations in the Consortium for Citizens with Disabilities (CCD) to file comments to the Centers for Medicaid & Medicare Services (CMS) on the proposed rule to implement the new Medicaid Program, the Community First Choice Option (CFCO). As you may recall, this new Medicaid state plan option was established by the Affordable Care Act of 2010 – also known as health care reform -- with the strong support of people with disabilities.
About CFCO
The new Medicaid option provides incentive payments for states to establish programs to allow people with disabilities to receive services in a setting most integrated with the community, including giving people with disabilities the ability to manage their own assistance, if they wish to do so. CFCO will give people with disabilities a full range of options for receiving home and community based services as an alternative to institutional care. The CFCO program begins October 1, 2011. States with an approved program will receive an additional 6% in federal funding for services provided under the approved program. The services which a program must fund include assistance with Activities of Daily Living, with Instrumental Activities of Daily Living, and with health related tasks. There must also be back-up systems (such as beepers) and mechanisms to ensure continuity of service, and voluntary training on how to select, manage and dismiss attendant care workers.
In developing their CFCO plans, states must collaborate with a Development and Implementation Council that “includes a majority of members with disabilities, elderly individuals, and their representatives.” The plan must include a quality assurance system to allow appeals from denials of proposed individual plans, and to receive feedback, and maximize consumer independence and control.
Disability Comments on the Proposed Rules
The disability groups’ comments commended CMS for underscoring throughout the proposed regulations the principles of consumer control articulated in the Community First Choice Options law. That is, for person-centered planning processes, choice in hiring, directing and firing workers, options for self-directed service budgets, and a robust implementation council as the central decision-maker in a long term services and supports system.
However, among several suggestions for modifying the language in the proposed rules, CCD was concerned that the statute and regulation may have been interpreted to extend program eligibility to lower income individuals who do not have an institutional level of care need, and that this does not reflect Congressional intent. CCD recommended that CMS final rule for the state’s CFC option must first address all individuals who have an institutional level of care need before a state opts to serve lower income persons who do not have an institutional level of care need. CCD also recommended that states may establish medical eligibility criteria that would limit eligibility for the program to individuals who have an institutional level of care need, regardless of their income.
Note that the proposed rule and the comments to CMS are the first stage in implementation of CFCO. A final rule from CMS should come out over the summer and before the October start date for this new Medicaid program that could go a long way to reduce trapping people with disabilities in institutional settings.
Advocacy Steps:
- Find out whether your state is planning to apply for these extra funds for CFCO.
- See if your state has appointed a Community First Choice Options Development and Implementation Council by contacting your state’s Medicaid program or Governor’s Council on Disability or similar state entity. If not, urge your state to do so. Councils are a prerequisite of the program.
- Consider recommending yourself as a participant on this Council.
- Ensure your state develops a CFCO plan with all the necessary elements and receives the funds intended.
- Monitor your state’s progress with its CFCO plan.
For a copy of the CCD comments in full, please write to [email protected] and put “Community First Choice Option” or “CFCO” in the subject line.
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