Editor’s note: This month, Tim’s Desk gives readers a look back at the community First Service and Support program. The program, which retired Executive Director/Editor Tim Benjamin wrote about extensively over the years, has met a delay.

Benjamin’s past writings give our readers a historical perspective on CFSS and how long it can take to get a program implemented through state and federal processes. Talk of CFSS and a related program, or PEO, began several years ago.

Read more about the delay elsewhere in this issue.

We also note that As of this issue, Tim’s Desk will move to a less frequent publication cycle. Enjoy the autumn weather.

From April 2014:

Community First Supports and Services is another piece of our future that we have to be involved in. This program could be good for many of us, bad for others; but if we don’t make our voices heard about the problems we see it will be bad for all of us. There are a lot of people at the Department of Human Services who want this to work for us—people who are very compassionate and committed to preserving all the independence the disability community wants. The federal government still has to okay the program plans—even though the state legislature has already assumed in the budget that the federal government will increase its reimbursement rate by six percent. So there is real pressure to get CFSS going and the stat receiving the money it’s already budgeted.

From April 2015:

he Community First Service and Support is a new program that DHS has been waiting to enact. CFSS incorporates the (Personal Care Attendant) PCA program and the Consumer Support grant, and requires state and federal approval to begin. We’ve been waiting for the federal government’s okay on the CFSS changes for well over a year. Instead of continuing to wait for approval, DHS has decided to enact PEO (personal Employment Options) as a similar program to prepare us for CFSS when the federal okay is given. DHS believes that both new programs, PEO and CFSS, will offer recipients more control, flexibility and responsibility.

The major changes coming with PEO include: 1) a financial management structure that is similar to CFSS’s financial structure; 2) An agency management structure; and 3) a budget management structure. AMS and BMS are also the names DHS has given the new programs. It appears that the AMS is similar to the traditional PCA program, and the BMS is similar to PCA Choice. The major differences between PCA Choice and the traditional PCA program were the number of options and the amount of work being done by the recipient. With BMS, the recipient will eventually have a budget and a financial stipend rather than allocated service units for each activity of daily living.

The recipient will also have more options for finding, hiring, training, scheduling and firing PCAs, as well as responsibilities for providing their own backup for their staff and creating their own care plan. The PEO that is replacing the PCA Choice program will eliminate the qualified professional role.

Within the traditional PCA program, the provider agency has been responsible for finding, hiring and training and for most all of the items listed above for which BMS recipients will be responsible.

In my personal opinion, the control and flexibility are advantages that will not outweigh the challenges and added responsibility in the new programs. The state’s programs have given us incentives to become self-sufficient and to pay taxes by working with the assistance of PCAs, but running your own PEO, and eventually CFSS, program will require considerable work hours. A person will not be able to do both jobs well. I already know too much about what it’s like to have to forgo time at work when I have PCA staffing problems. If I have to run my own agency as well, I’m really worried about my ability to work this full-time job.

I would rather see the government encouraging and incentivizing more job opportunities rather than creating new barriers to independent living. There needs to be a happy medium somewhere between the extremes of the two different management-structured programs. And while those get fixed, another major problem that needs fixing is low rates of reimbursement to providers.

DHS is hoping to enact its new PEO this summer, but is awaiting state legislation giving DHS the options to restructure the PCA program plans. It’s also still awaiting the federal government review and approval of the CFSS plan. Major pieces that are holding up the federal government’s okay on CFSS and the state’s next steps on the PEO plan are reporting and monitoring requirements and assurances on how to evaluate whether a person is safe and receiving the services due. Those aren’t easy measures to set up. We’ll see how quickly any of these changes are introduced—and implemented.