To be eligible for CFC, an individual must:

• Be a child or an adult who is eligible for Medicaid.
• Meet an institutional level of care, including:

     i. hospital,
     ii. a nursing facility,
     iii. an intermediate care facility for individuals with an intellectual or developmental disability,
     iv. an institution providing psychiatric services for individuals under age 21, or
     v. an institution for mental diseases for individuals age 65 or over.
• Need help with activities and instrumental activities of daily living (ADLs and IADLs), such as dressing, bathing and eating.

No, there is not an interest list for CFC. CFC is a Medicaid State Plan entitlement service and must be provided to those individuals that meet the eligibility criteria.

Yes. Individuals with IDD that meet the coverage criteria and are being served in a home or community setting will have access to CFC. CFC is available to individuals that reside in their own home, or the home of a family member (own home, family home setting).

Answer: Yes, individuals who are eligible for “full” Medicaid state plan benefits and meet the other eligibility criteria for CFC will be able to receive CFC services. Full dual-eligible means an individual who is enrolled in Medicare and Medicaid and is eligible to receive full Medicaid state plan benefits, and is not limited to payment of Medicare premiums and cost-sharing.

Answer: All individuals who meet the eligibility criteria for CFC are eligible to receive habilitation if the individual has an identified unmet need for the service as determined by the individual and the service planning team using a person-centered planning process.

No. Currently, children who meet the requirements may access CFC through the Fee-For- Service (FFS) model if they are enrolled in FFS or STAR, or managed care if they are enrolled in STAR+PLUS or STAR Health.

• PAS: assistance with ADLs and IADLs through hands-on assistance, supervision, and/or cueing.
• Habilitation (HAB): acquisition, maintenance, and enhancement of skills necessary for the individual to accomplish ADLs, IADLs, and health-related tasks
• Emergency response services (ERS): backup systems and supports to ensure continuity of services and supports. Backup systems and supports include electronic devices to ensure continuity of services and supports and are available for individuals who live alone, who are alone for
significant parts of the day, or have no regular caregiver for extended periods of time, and who would otherwise require extensive routine supervision.
• Support Management: voluntary training on how to select, manage, and dismiss attendants. This is a voluntary service that offers practical skills training and assistance related to recruiting, screening, hiring, managing, and dismissing attendants.
• Support Consultation: An optional service for those who use the CDS option that is provided by a support advisor and provides a level of assistance and training beyond that provided by the Financial Management Services Agency (FMSA) through Financial Management Services (FMS). Support consultation helps an employer to meet the required employer responsibilities of the CDS option and to successfully
deliver program services.
• PAS and HAB will be available through the CDS option.

CFC services are not time or age limited. Eligible individuals will be able to access CFC services as long as needs are present.

Answer: There is not a defined annual cost limit for CFC. However, the amount of CFC services an individual receives is based on an assessment of an individual’s need for the service as developed by the service planning team, using a person centered planning process.

•  ADLs means basic personal everyday activities including, but not limited to, tasks such as eating, toileting, grooming, dressing, bathing, and transferring.
•  IADLs means activities related to living independently in the community, including but not limited to, meal planning and preparation, managing finances, shopping for food, clothing, and other essential items, performing essential household chores, communicating by phone or other media, and traveling around and participating in the community.

Support management is voluntary training on how to select, manage, and dismiss attendants. If an individual requests this service, the CFC provider will be expected to provide the individual with information about support management through a toolkit which will soon be available on the DADS and HHSC websites. There is not a separate rate for support management.

PAS and PCS provide personal assistance services in completing tasks related to ADLs/IADLs. CFC will provide personal assistance services and habilitation. Habilitation includes acquisition, maintenance, and enhancement of skills necessary for the individual to accomplish ADLs, IADLs, and health-related tasks. In addition, individuals receiving CFC must meet institutional level of care requirements.

There is not a defined annual cost limit for CFC. However, the amount of CFC services an individual receives is based on an assessment of an individual’s need for the service and consideration of unmet needs as developed by the service planning team, using a person-centered planning process.

No. CFC does not replace respite. Respite will remain a service in the waiver programs. Respite is not changing as part of this initiative. Respite cannot be provided at the same time as CFC PAS/HAB.

No. CFC ERS will be available only to individuals who reside in their own home or family home setting.

A documented service planning process that includes people chosen by the individual, is directed by the individual to the maximum extent possible, enables the individual to make informed choices and decisions, is timely and occurs at times and locations convenient to the individual, reflects cultural considerations of the individual, includes strategies for solving conflict or disagreement within the process, offers choices to the

There are three levels of care determinations which include: nursing facility/hospital, ICF/IID, and IMD (for individuals under 21 and over 64). Different entities are responsible for completion and approval of the LOC depending on the program through which CFC is being delivered. For individuals in STAR+PLUS, who meet medical necessity, the MCO will be responsible for assessing and authorizing CFC services. Individuals with IDD will be assessed by the Local Intellectual and Developmental Disability Authorities (LIDDA). See the attached CFC Provider Summary Tool for more information on parties responsible for CFC activities.

MCO stands for Managed Care Organization. There are five MCOs that will be contracting with providers for CFC: Amerigroup, Molina, Cigna HealthSpring, Superior, and United Healthcare.

An individual can be enrolled in STAR+PLUS waiver and receive CFC services as long as the individual has a need for at least one waiver service. While it is true both STAR+PLUS waiver and CFC include PAS, STAR+PLUS waiver PAS includes protective supervision, while CFC PAS does not. However, an individual can receive Protective Supervision through the STAR+PLUS waiver and continue to receive CFC PAS.