| (a) Subject to the specifications, conditions, requirements,
and limitations established by HHSC, Community First Choice (CFC)
services are provided subject to provisions in 42 CFR §§441.500
- 441.590. Services include:
(1) CFC personal assistance services. CFC personal
assistance services include:
(A) non skilled assistance with the performance of
the ADLs and IADLs through hands-on assistance, supervision, and/or
cueing;
(B) household chores necessary to maintain the home
in a clean, sanitary, and safe environment;
(C) escort services, which consist of accompanying,
but not transporting, and assisting an individual to access personal
assistance services or activities in the community; and
(D) assistance with health-related tasks.
(2) CFC habilitation. CFC habilitation is provided
to allow an individual to reside successfully in a community setting
by assisting the individual to acquire, retain, and improve self-help,
socialization, and daily living skills or assisting with and training
the individual on ADLs and IADLs. Personal assistance may be a component
of CFC habilitation for some individuals. CFC habilitation services
include habilitation training, which is interacting face-to-face with
an individual, to train the individual in activities such as:
(A) self-care;
(B) personal hygiene;
(C) household tasks;
(D) mobility;
(E) money management;
(F) community integration, including how to get around
in the community;
(G) use of adaptive equipment;
(H) self-advocacy;
(I) personal decision making;
(J) interpersonal communication;
(K) reduction of challenging behaviors;
(L) socialization and the development of relationships;
(M) participating in leisure and recreational activities;
(N) use of natural supports and typical community services
available to the public; and
(O) self-administration of medication and other health-maintenance
activities.
(3) CFC emergency response services. CFC emergency
response services 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.
(4) CFC support management. The CFC support management
benefit is available to individuals receiving CFC personal attendant
services or CFC habilitation services regardless of service delivery
option.
(b) CFC services can only be delivered in a home and
community-based setting. These settings do not include:
(1) a hospital providing long-term services;
(2) a nursing facility;
(3) an institution for mental disease;
(4) an intermediate care facility for individuals with
an intellectual disability or related conditions; or
(5) a setting with the characteristics of an institution
as described in 42 CFR §441.530(a)(2)(v).
(c) Individuals receiving services through CFC are
not precluded from receiving other home and community-based long-term
services and supports through other Medicaid state plan, waiver, grant,
or demonstration authorities.
(d) Services are limited by functional need as determined
by the assessment described in §354.1363(b) of this division
(relating to Assessment).
(e) MCOs are required to offer all CFC services to
those MCO members who are eligible and are determined to need the
services based on an assessment conducted in accordance with §354.1363
of this division.
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