Program changes debated

As the start date for the new Community First Services and Supports (CFSS) Program draws near, members of Minnesota’s disability community are unsure as to whether or not it will improve the quality of life for people with disabilities. Dozens of people weighed in on CFSS prior to the February 12 comment deadline. The program is planned to start April 1, or when it obtains federal approval. The change could affect as many as 25,000 Minnesotans.

The Minnesota Department of Human Services (DHS) hopes to make the change to CFSS as soon as possible. But with state-specific waiver request going to the federal Center for Medicare and Medicaid Services (CMS), as well as many questions about CFSS implementation here, some disability community leaders doubt the changes could be made by April 1. Some asked whether it will have to be postponed.

Start date was one of the concerns raised repeatedly in January at a session organized by the Minnesota Consortium for Citizens with Disabilities (MN-CCD). The group discussed a number of technical issues tied to CFSS, as well as inconsistencies in state and federal program language and definitions that need to be addressed as the program goes forward. Other disability community advocates say it’s likely that during 2014 legislative session, bills will be introduced to address some of these issues with CFSS.

CFSS is meant to allow people more say in hiring and directing their own staff, and more responsibility and control over there outlined supports and services. The program is for people who are recipients of Medical Assistance (MA); alternative care programs or traditional MA waiver recipients. It also is for people who have medical services identified in an individualized education program and is eligible for MA special education services.

Many people believe it will improve delivery of services and supports, that it will provide participants more choices, more control over the services and who will provide those services.

Yet others worry that the program hasn’t been completely worked through and that there will be unintended consequences because of the unresolved and unexpected questions. One need raised is for more detailed information to consumers, including more detailed information about choices for service. Another is that of monitoring of those who will provide services.

Anne Henry, an attorney with the Minnesota Disability Law center outlined the pros and cons of CFSS during the Minnesota State Council on Disability legislative review discussion January 27 in St. Paul. “The change could unlock opportunities for some people,” she said. “People could hire assistance but could also tap into training and assistance and substitute that for the paid help. There’s a wonderful opportunity for people to use their personal care assistants to provide personal development and personal improvement help and training. Another plus is for parents and spouses to be paid for assistance. The caveat to that is that the program is the lowest paid system in Medicaid.” she said.

But one concern is that the change could affect people who are eligible for nursing home care, but could not get less expensive community services. Henry called that possibility “flat-out wrong” and a violation of the state’s Olmstead Plan. She also said it could result in more being spent on nursing home care, rather than a more economical community-based setting.

Cuts made to the PCA program in 2009 and enacted in 2011 could also have major implications for CFSS, in terms of funding and programmatic restrictions.

Those cuts were made by the type of disability a person has and knocked some people with brain injuries, mental health issues and developmental disabilities out of the PCA program. Some advocates are asking that people with those disabilities get help under CFSS.

Some at the meeting said, processes and even word definitions needs to be spelled out more clearly for some aspects of the program. Other questions were raised about how people will qualify for services and how “dependency” and “needs” for service are assessed. Another concern is that not all of Minnesota’s 87 counties will have the administrative staff and other related CFSS programs in place by the time the program is slated to begin.

CFSS will be a federal-state funded service, with 56 percent paid with federal MA funds and 44 percent paid with state MA funds. The program is for people living independently in the community. It’s meant to be more accessible and flexible than the PCA program, and to make it easier for people to transition out of institutional care back into the community. Other goals of CFSS include more support of community living, more self-directed services and for children, testing of innovative models of coordinating services across home, school, and community.

Those eligible for CFSS must be determined dependent in one activity of daily living or behavioral needs based on an assessment; not receive family support grants and live in one’s own home or apartment, not a hospital or institutional setting.

CFSS services are to include assistance with daily living task including; eating, toileting, grooming, dressing, bathing, mobility, positioning, and transferring. The services also include assistance with many other activities related to daily living, ranging from meal planning and preparation, help with travel in the community. Other services include assistance to acquire, maintain, or enhance the skills necessary for the participant to accomplish daily living tasks and health-related procedures that can be delegated or assigned by a state-licensed health care or mental health professional and performed by a support worker.

It covers, in terms of material things, expenditures including services, supports, or environmental modifications, or goods, including assistive technology. It does include funding for mechanism such as use of Communication technology and other electronic devices, to ensure continuity of services and supports for participants. Funding is also covered for transition costs for participants moving out of an institution and into the community.

CFSS services will be provided by support specialists and support workers who will be employed by agency providers or the participant. Support workers must enroll with DHS, complete a background study, and meet a number of other requirements. Agency providers must be MA-enrolled health care program providers and meet all applicable provider standards and requirements, including compliance with background study requirements, and reporting maltreatment of minors and vulnerable adults. Agencies must also provide participants with information on service-related rights.

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