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Center for Medicare and Medicaid Services (CMS) Releases Guidance on the Community First Choice State Plan Option

February 27, 2017

On December 30, 2016, CMS released guidance to state Medicaid directors on Section 1915(k) of the Social Security Act, also known as the “Community First Choice” state plan option. Section 1915(k) allows a state to amend their state plan so they can provide personal attendant services (PAS) and related support services in their home or community. The guidance describes each of the provisions of the new Community First Choice (CFC) option and explains what the state will need to do to comply with each one.

CMS states that one of their major goals in encouraging the use of Section 1915(k) as an option has to do with streamlining funding for PAS across different populations that are normally covered by different service models and that use different eligibility criteria and assessment tools. PAS are services are useful across all conditions and disabilities. Funding all PAS through the Community First Choice option allows people with disabilities to gain access to these services faster.

The guidance goes into detail on the type of PAS provided under the Community First Choice State Plan option. It funds all services needed to provide help with activities of daily living and instrumental activities of daily living, all health related tasks, and all tasks necessary to improve the ability of an individual with a disability to do any of these tasks independently. Although the guidance does not specifically mention support so that people can be employed, PAS support can, for example, enable a person to prepare for their work day in the community and assist people who may work from home. States can also elect to cover tasks necessary to help the individual transition into the community and technology that substitutes for human assistance.

An example of the latter is an electric seat lift that would help a person with a disability get out of or onto a chair without human assistance, which also might be useful in a workplace. The guidance also describes certain regulatory requirements of home and community-based services (the HCBS Settings Rule and Person-Centered Planning), and the oversight mechanisms for CFC services.

For more information, read the guidance.