CFSS delay is raising many questions

by Jane McClure

A delay in implementation of the Community First Services and Supports (CFSS) program is raising red flags for Minnesotans with disabilities. The earliest possible implementation date has now been pushed back to June 1, 2022.

While it’s not the first time that implementation of CFSS has faced a delay, the latest action frustrates many people with disabilities and their advocates. The Minnesotan Consortium for Citizens With Disabilities (MNCCD) hosted a meeting in September to discuss the challenges of another delay. Representatives of the Minnesota Disability Law Center were on hand to explain the delay and what it means.

The Minnesota Department of Human Services (DHS) is emphasizing that the delay in implementing CFSS won’t affect anyone’s ability to continue receiving services, or to access assessments needed to start services. But there are worries that the delay will affect long-sought assistance such as a 2021 state law change that provides flexibility for people with disabilities who need to be driven to destinations by a personal care attendant.

About 45,000 Minnesotans are current in the Personal Care Assistance (PCA) Program, which would be replaced by CFSS. The delay is due to DHS’ need for additional time to receive approvals on waiver and state plan amendments from the federal Centers for Medicare & Medicaid Services (CMS). The COVID-19 pandemic has increased the demand on state and federal staff to prepare, review and authorize peacetime emergency amendments. This has limited their capacity for CFSS and other important, non-peacetime-emergency amendments, according to DHS.

Natasha Merz, director of disability services for DHS, said state officials are committed to making the long-awaited transition. “CFSS offers benefits that the current PCA program doesn’t offer,” Merz said. Those include more flexibility in paying providers and in purchases of goods and services.

One challenge in making the transition is that Minnesota has such a large PCA Program. Other states making the transition to CFSS have had far fewer people to deal with. “Most states make the transition with a smaller group,” Merz said, “We have broad eligibly for the PCA Program.”

Then there is the ongoing COVID-19 pandemic and how it has affected workload at the state and federal levels. The change from PCA to CFSS needs multiple federal approvals. That’s because CFSS involves a number of program.

Because CMS has been dealing with many issues tied to the ongoing pandemic and the federal American Rescue Plan Act funding and programs, that has delayed action on matters such as Minnesota’s request to make the program transition to CFSS.

Merz said there is federal backlog of requests from states for CMS action. Workers at the state level has also been tied up with other work related to the pandemic.

The PCA driving issue was discussed at the MNCCD meeting. The ability to have staff drive clients to appointments, shopping and on other needed trips was seen as a huge gain.

Many people on the PCA program have been told in recent years that state law prevents staff from driving them anyway. The law change passed this year spelled out that “traveling” can include driving and accompanying a person to medical appointments and other locations.

During hearings during the 2021 session, people with disabilities and advocates emphasized the importance of the change,. It would be a “very small change … that has a big impact for people,” said Vicki Gerrits, executive director of Minnesota First Community Solutions on behalf of the PCA Reform Coalition.

PCAs currently can go to the store and shop for their clients with a shopping list. But the clients they’re shopping for cannot accompany them. PCAs can’t drive their clients to medical appointments. They can accompany them using state-reimbursed, nonemergency medical transportation services.

If a PCA does drive a client to a destination, the staffer must clock out for the time spent in transit, and clock back in once arriving at the destination. To avoid Department of Labor violations, PCA agencies are required to pay the employee for that entire time – as it was all spent working – but can’t bill for it.

The change would not increase the number of billable hours allotted for PCAs to provide services – those hours are based on “essential” activities like dressing and bathing, not “instrumental” activities like shopping for food or helping with laundry – it would simply allow the available hours to be used for driving needs.

As for CFSS itself, delays have been an issue since 2014.CFSS has been on the drawing boards for several years. It was brought forward as a way to replace Minnesota’s longtime Personal Care Assistance (PCA) program. The PCA program has served Minnesotans with disabilities for almost 50 years.

CFSS was presented as having varying impacts on the lives of people with disabilities. A 2015 overview by DHS staff indicated that the new program would mean little change in the daily lives on some people with disabilities. For others, it will offer opportunities for greater choice, flexibility and independence.

“CFSS comes in response to what we have heard from Minnesotans with disabilities about how they would like long-term services and supports in our state to evolve. People told us that they want to continue receiving help with activities of daily living but also want more opportunity to do as much as they can for themselves, be as independent as possible and have flexibility to make choices …” DHS staff wrote in a guest editorial in 2015.

“First and foremost, we expect all people receiving PCA services today to be eligible for CFSS. Like PCA services, CFSS can get help with activities of daily living, instrumental activities of daily living and health-related tasks. CFSS also brings significant enhancements to PCA services being offered today. In addition to traditional PCA services, CFSS workers can assist in enhancing or maintaining skills that can increase independence. Improvements of CFSS include greater flexibility and funding for technology and home and vehicle modifications that help to increase independence,” Colman and Bartolic wrote. “With CFSS, people will be able to choose between using a more traditional agency model to provide their services or to directly manage their staff by using a budget model. Service amounts will be based on each person’s needs for assistance with activities of daily living and/or behavioral interventions using the current home care rating scale. People receiving services will develop their own service delivery plan with help of a new consultation service. The Consultation Service will assist individuals to make informed choices about their options and responsibilities within CFSS.”