DOH Issues FAQ Regarding Community First Choice Option

The Department of Health (DOH) has issued a Frequently Asked Questions (FAQ) document on contracting and credentialing of plans and providers related to the Community First Choice Option (CFCO). The enacted 2019-20 State Budget delayed implementation of several CFCO services from July 1, 2019 to Jan. 1, 2020, but all waiver enrollees can access those CFCO-covered services through the current waiver programs. The outstanding services include Assistive Technology, Community Transitional Services, Environmental Modification, Home Delivered Meals, Moving Assistance, Skill Acquisition Maintenance and Enhancement / Community Habilitation, and Vehicle Modification.

CFCO is an optional set of services under Medicaid, authorized in the Affordable Care Act (ACA), that allows long-term services and supports (LTSS) that were previously only available through a waiver to be Medicaid State Plan Services. CFCO provides home and community-based services (HCBS) and supports to individuals in need of long term care, including help with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The remaining seven CFCO services will be carved into the following Managed Long Term Care (MLTC) products: Partial Capitation, Programs of All-Inclusive Care for the Elderly (PACE), Fully Integrated Duals Advantage for individuals with Intellectual and Developmental Disabilities (FIDA-IDD), Medicaid Advantage, and Medicaid Advantage Plus (MAP). They will also be carved into Mainstream Medicaid Managed Care (MMC), Health and Recovery Plans (HARPs), and Special Needs Plans (SNPs).

The FAQ provides clarification on the following topics:

• general timeline;
• draft rates and billing codes;
• contracting, including clinical assessments, clarification regarding provider contracts, administrative agreements, and business associate agreements;
• credentialing of providers;
• provider listing; and
• network adequacy standards, including single case agreements and Provider Network Data System (PNDS) requirements.

For an overview of the program, various guidance and templates, draft rates and billing codes, training webinars, and more, go to DOH’s CFCO webpage.

Please email cfco@health.ny.gov if you have any questions or concerns.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871