Mont. Admin. R. 37.40.1002 - AGENCY-BASED AND SELF-DIRECTED COMMUNITY FIRST CHOICE SERVICES: ELIGIBILITY, SERVICES PROVIDED, AND LIMITATIONS
(1) To qualify for
Community First Choice Services (CFCS), a person must:
(a) be Medicaid eligible;
(b) meet the level of care criteria found at
ARM 37.40.205(1);
and
(c) demonstrate a medical and
functional need for assistance with activities of daily living.
(2) CFCS includes assistance with
the following activities:
(a) activities of
daily living;
(b) instrumental
activities of daily living;
(c)
medical escort services;
(d) skill
acquisition, maintenance, and enhancement; and
(e) personal emergency response
systems.
(3)
Instrumental activities of daily living are only authorized when the member
demonstrates a medical and functional need to receive assistance with
activities of daily living. Instrumental activities of daily living may not
account for more than one-third of the total time allocated per two-week period
for CFCS or a maximum of ten hours per two-week time period, whichever is
less.
(4) Medical escort services
are only authorized when the member has demonstrated a medical and functional
need for CFCS. Medical escort services must be directly related to a member's
medical and functional need for assistance en route to, or at the Medicaid
reimbursable medical service, and are available when a family member or
caregiver is unable to accompany the member.
(5) Skill acquisition, maintenance, and
enhancement services are only authorized when the member demonstrates a medical
and functional need to receive assistance with activities of daily living. The
service may be authorized if a member is expected to achieve full independence
in skill acquisition within a 90-day time period. A skill acquisition letter of
endorsement signed by a skill acquisition advocate is required prior to
authorization of the service.
(6)
Personal emergency response system services (PERS) are only authorized when the
member demonstrates a medical and functional need to receive assistance with
activities of daily living.
(7)
CFCS, except for medical escort services, shopping, laundry, and community
integration, will be provided in the member's home.
(8) CFCS may not typically be provided in
group home settings unless prior authorized by the department. Group home
settings include licensed youth foster homes, mental health group homes, and
adult intensive community home services. CFCS may be authorized when the
person's medical needs are beyond the scope of services normally provided by
programs funding services in the group setting. For example, a person requiring
additional assistance because of an acute medical episode or
post-hospitalization period may receive CFCS in a youth foster home
setting.
(9) CFCS is not available
to the following:
(a) persons who reside in a
hospital, hospitals providing long-term care, or a long-term care facility as
defined in
50-5-101,
MCA, and licensed under
50-5-201,
MCA;
(b) persons who reside in
assisted living or adult foster homes, as defined in
50-5-225,
MCA, and licensed under
50-5-227,
MCA;
(c) persons who live in homes
which are not safely accessible by normal modes of transportation.
(10) CFCS may not include any
skilled services that require professional medical training unless otherwise
permitted under
37-8-103,
MCA, or ARM
24.159.1616.
(11) CFCS do not include services which
maintain an entire household. CFCS do not include:
(a) cleaning floors and furniture in areas
that members do not use or occupy;
(b) laundering clothing or bedding that
members do not use;
(c)
supervision, respite care, babysitting, or visiting;
(d) maintenance of animals unless the animal
is a certified service animal specifically trained to meet the health and
safety needs of the member;
(e)
home and outside maintenance; and
(f) meal preparation for other family
members.
(12) CFCS
provided by a member of the member's immediate family is not CFCS for the
purposes of the Medicaid program, and is not eligible for reimbursement.
Immediate family member includes the following:
(a) a spouse; and
(b) a natural, adoptive, or foster parent of
a minor child.
(13) CFCS
must be delivered by a CFCS personal care attendant employed by an enrolled
Medicaid provider that has met the criteria established by the department for
the delivery of CFCS as referenced in ARM 37.40.1017 and 37.40.1018.
(14) CFCS may not be provided to relieve a
parent of child-caring or other legal responsibilities. CFCS for children with
disabilities may be appropriate when the parent is unqualified or otherwise
unable to provide services and the child is at risk of institutionalization
unless the services are provided.
Notes
53-2-201, MCA IMP: 53-2-201, 53-6-113, MCA;
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