Community First Choice Option (CFCO)

DRAFT

GUIDELINES FOR AUTHORIZING COMMUNITY TRANSITIONAL AND MOVING ASSISTANCE SERVICES

12/19/2018

Community First Choice Option (CFCO) services and supports must be provided in home and community–based settings in compliance with the setting requirements outlined in 42 CFR §441.530 and the Medicaid State Plan. However, if a CFCO–eligible member/recipient is currently in an institutional setting (nursing home, Intermediate Care Facility, etc.) and would like to reside in a private home in the community, s/he may be eligible for CFCO transitional and/or moving services. These services help finance the transition to an appropriate community–based setting to receive long term services and supports (LTSS), including those provided through CFCO. CFCO will not fund transitions from one community–based setting to another.

Community Transitional Services (CTS)– Individually designed services intended to assist a member/recipient to transition from an institutional setting to an appropriate home and community–based setting. For the purposes of these guidelines, institutional settings include:

  • Nursing Facility;
  • Institution for Mental Disease; and
  • Intermediate Care Facility for Individuals with Intellectual Disabilities (ICFs/IID).

CTS must be based on the assessed needs of the member/recipient and support his/her desires and goals as outlined in the Person–Centered Plan of Care (POC).

CTS expenditures covered under CFCO include:

  • First and last month´s rent;
  • Utility and rental deposits;
  • Cleaning and security deposits;
  • Payment for background/credit checks (related to housing);
  • Initial deposits for heating, lighting and phone; payment of previous utility bills that may prevent the member/recipient from receiving utility services; and
  • Basic household furnishings necessary to establish a household such as furniture, linens and kitchen supplies.

Costs are limited to a one–time expense of up to $5,000

CTS providers are service coordination agencies (for 1915(c) waiver participants) or Independent Living Centers (for Managed Care members) assisting individuals through the Open Doors* program and/or the Olmstead Housing Subsidy (OHS) program**.

Open Doors Transition Specialists and OHS Housing Specialists are familiar with the services available in the local community. They will meet with individuals residing in an institutional setting and/or their family members, facility discharge planners/social workers, and Care/Case Managers to assist with the identification of what is needed for the member/recipient to return to the community, access community resources, including CTS, and expedite the claiming process.

Moving Assistance– Individually designed service intended to transport the possessions and furnishings of a CFCO–eligible member/recipient who is moving from an institutional setting into a community–based setting.

Moving Assistance is limited to a one–time expenditure of $5,000.

Moving Assistance is provided by moving companies appropriately licensed/certified by the New York State Department of Transportation (DOT). For a list of providers, please visit: here.

Procedure for Approving Community Transitional Services (CTS) and/or Moving Assistance:

  • The care/case manager will work with the discharge planner at the institutional setting to make a referral to the Open Doors Transition Specialist for members/recipients expressing interest in transitioning to the community. The Open Doors Transition Specialist will provide information regarding options for living in the community, and will collaborate with family members, facility discharge planners/social workers, and Care/Case Managers to begin transition planning.
  • A functional needs assessment is completed and indicates that the member/recipient desires to live in a community based setting and his/her needs can be met is such a setting.
  • The care/case manager will work with the discharge planner at the institutional setting and the Open Doors Transition Specialist to identify needed resources and facilitate the process of transitioning from an institution to the community, including assisting with housing options. A referral will be made to the OHS Housing Specialist for assistance with navigating the process of finding housing options if the member/recipient does not have a setting available.
  • The care/case manager, with the member/recipient and any other individuals participating in the development of the POC, will determine if CTS and/or Moving Assistance is appropriate and necessary to assist the member/recipient to successfully transition back to the community.
  • The care/case manager and the member/recipient will explore potential payment sources for the identified CTS and/or Moving Assistance including private insurance, community resources, and other State/federal programs before a request for payment under CFCO will be considered.
  • The care/case manager must confirm that a setting is available for the member/recipient to transition to, and the setting meets the requirements outlined in 42 CFR §441.530 and the Medicaid State Plan.
  • The care/case manager must complete the Community Transitional Services and Moving Assistance Description and Cost Projection Form (available on the Department´s CFCO website) and submit it along with a copy of the POC to the Local Department of Social Services (LDSS), Managed Care Organization (MCO), or Developmental Disabilities Regional Office (DDRO) for review and authorization. Please note that for Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) waiver recipients, the care/case manager must complete either the Community Transitional Services Description and Cost Projection Form or the Moving Assistance Description and Cost Projection Form depending on the requested service and submit it along with a copy of the POC to the Regional Resource Development Center (RRDC).
  • If Moving Assistance is requested, the care/case manager or designee must obtain a signed contract from a New York State Department of Transportation licensed/certified moving company and submit the contract to the LDSS, MCO, RRDC or DDRO. The contract must outline the specific information of the move (for example; to/from location, mileage/gas costs, items to be moved, assembly/disassembly to be completed, etc.). A moving contract may not exceed $5,000 and any changes in the proposed cost must receive prior approval from the LDSS, MCO, RRDC or DDRO.
  • The LDSS, MCO, RRDC or DDRO will then review the Community Transitional Services and Moving Assistance Description and Cost Projection Form along with the POC and make a determination for the service authorization. The LDSS, MCO, RRDC or DDRO must notify the care/case manager of the service authorization.
  • The care/case manager will inform the member/recipient and providers of the approved service authorization and that the service(s) can be initiated.
  • The care/case manager will notify the CTS provider that will assist with the CTS and/or Moving Assistance of the authorization. The CTS provider will be responsible for coordination of the transition, including completion of any/all transitional and/or moving services outlined in the POC (i.e. purchasing of furnishings, communication with landlords and payment of initial rent/securities, communication with and payment of utilities, etc.).
  • Upon completion of the CTS and/or Moving Assistance services, a summary of all the services with the actual costs must be submitted to the LDSS, MCO or DDRO on the Uniform Community First Choice

Option (CFCO) Final Cost Form. For NHTD/TBI waiver recipients, the care/case manager will submit a Waiver Services Final Cost and RRDS Approval of Final Cost Form to the RRDC along with a summary of all the services with the actual costs.

  • The LDSS, MCO, RRDC or DDRO will review the Uniform Community First Choice Option (CFCO) Final Cost Form and notify the care/case manager that the CTS provider may submit a claim for reimbursement. The RRDC will review the Waiver Services Final Cost and RRDS Approval of Final Cost Form and notify the care/case manager that the CTS provider may submit a claim for reimbursement.
  • The care/case manager will notify the CTS provider and/or Moving Assistance provider of this determination and instruct the provider to submit a claim to the LDSS, MCO, RRDC or DDRO for the reimbursement for expenditures identified in the Community Transitional Services and Moving Assistance Description and Cost Projection Form and Uniform Community First Choice Option (CFCO) Final Cost Form. For NHTD/TBI waiver recipients, the care/case manager will notify the CTS provider and/or Moving Assistance provider of this determination and instruct the provider to submit a claim to eMedNY via ePaces for the reimbursement for expenditures identified in the Community Transitional Services and Moving Assistance Description and Cost Projection Form.

*The Open Doors Transition Center Project is part of the State's Money Follows the Person (MFP) program. Open Doors is currently administered by the New York Association for Independent Living. Open Doors has Transition Specialists at Independent Living Centers (ILCs) across the state to assist people in nursing homes by providing education about options and resources available in the community, identifying services that individuals need to return to the community, and facilitating these transitions. This process leverages the local knowledge and experience (provided at no cost to the MCO, LDSS, RRDC, DDRO or member/recipient) of the Transition Specialists. More information can be found at https://ilny.us/programs/mfp.

**The Olmstead Housing Subsidy (OHS) program provides a rental subsidy for high–cost, high–need Medicaid recipients to help New York´s seniors (aged 55 and over) and other individuals living with chronic disabilities (aged 18 and over) afford and locate accessible, affordable, safe, and sustainable housing. The program is designed for those members/recipients who are living in a Skilled Nursing Facility and are looking to transition back into the community. The OHS program is administered by NYAIL. For more information on OHS, referrals, and eligibility criteria, please visit: https://ilny.us/programs/ohs.