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CFCO Update

The Department of Health (DOH) convened the Community First Choice Option (CFCO) Steering Committee to discuss the timeline for incorporating the CFCO benefit into Medicaid managed care, including Managed Long Term Care (MLTC). Beginning in July 2018, the Medicaid managed care benefit package will include Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) skill acquisition, maintenance, and enhancement services for CFCO-eligible members. Additional CFCO services will be added to the benefit package starting in January 2019.

Plans should have received a communication from DOH on Feb. 5th indicating that they will need to identify members who are eligible for CFCO services and notify Maximus of the appropriate Restriction/Exception (RRE) code by April 1st. For all MLTC plans other than FIDA-IDD, the RRE code will be CF. Plans should have received additional information from Maximus on Feb. 6th regarding RRE file submission as well as instructions on submitting five test records to Maximus by March 16th  (available here).

To be eligible for CFCO services, plan members need to meet three criteria: be eligible for Medicaid, have a Universal Assessment System (UAS) score of 5 or higher, and live in their own residence or in the residence of a family member. After plans submit an initial list of current members who meet these criteria to Maximus, subsequent submissions will need to identify just those newly eligible for CFCO. We have asked whether there is a way for the State to query the UAS system to avoid plans having to go record by record to identify eligible members. Staff indicated that plans participating in the data exchange system should be able to generate bulk reports from their UAS information and that DOH would send out info on the data exchange to all plans.

DOH indicated that they are developing and will share detailed guidance regarding the settings that meet the definition of "own residence." The Department also clarified that the benefits entering the benefit package in July are directly comparable to the personal care benefit currently in the benefit package. Cueing and safety monitoring are not stand-alone services but rather are provided during the process of assisting a member to perform ADLs or IADLs. DOH indicated that they would include this information in educational activities for those involved in the fair hearing process.

Additional CFCO workgroup meetings will be scheduled to address implementation details. The presentation slides are available here.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841