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Michael Petruzzelli

, National Council for Mental Wellbeing

CMS Issues Guidance on Community First Choice for HCBS Services in Medicaid

January 12, 2017 | Medicaid | Comments
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The Centers for Medicare and Medicaid Services (CMS) recently issued a letter to State Medicaid Directors providing guidance on the implementation of the Community First Choice (CFC) State Plan Option, a home and community-based benefit package available to states to promote community stability and integration.

Authorized under the Affordable Care Act, the CFC Option allows states flexibility to provide additional services that are not typically covered by Medicaid if those services will help an individual remain in the community rather than be placed in a nursing home. Additionally, it provides a six percentage point increase in federal matching payments to states for service expenditures related to the option.

Currently, five states have successfully exercised this option, including: California, Maryland, Montana, Oregon and Texas. To view summaries of the approved waivers, and for more information on the underlying regulations creating the CFC option, see here.

For states looking to implement the CFC option, the new CMS guidance details the following:

  • The enhanced Federal Medicaid Assistance Percentage (FMAP);
  • Program eligibility, including financial eligibility and the level of care requirement;
  • CFC required services;
  • Three available service models;
  • Person-centered planning process and service plan;
  • Home and community-based settings;
  • Requirement for a quality assurance system;
  • Maintenance of existing expenditures;
  • Concurrent use of other Medicaid authorities, including managed care, 1915(b) waivers, and Section 1115 demonstrations;
  • State flexibility in developing approaches to benefits and service delivery;
  • Comprehensiveness of reimbursement methodologies; and
  • Incorporating the CFC benefit into a state’s current long-term services and supports system.