Fact Sheets

COMMUNITY FIRST CHOICE OPTION SECTION 1915(K)

Today, the Centers for Medicare & Medicaid Services (CMS) is releasing two rules that support State efforts to expand access to home and community based services (HCBS) for people with disabilities. 

This fact sheet describes the final rule entitled “Community First Choice Option.”

This final rule implements the Community First Choice State plan option, which was authorized by the Affordable Care Act and provides an incentive for States to expand their Medicaid coverage for person-centered home and community-based attendant services and supports.  States that elect the Community First Choice option are eligible for a 6 percentage point increase in their federal medical assistance percentage. Individuals who require an institutional level of care are eligible for the services, which will be offered in community-based settings.

States electing the Community First Choice option will make available home and community-based attendant services and supports to assist beneficiaries in accomplishing activities of daily living, instrumental activities of daily living, and health-related tasks. Beneficiaries may “self-direct” services, which affords individuals maximum choice and control over the services they receive. States may choose to also provide coverage for transition costs to assist Medicaid beneficiaries who are leaving institutions in transitioning to the community. States may also choose to provide for the provision of services that increase independence or substitute for human assistance, such as non-medical transportation services.

In order to qualify for the enhanced match, States must meet several specific requirements,   such as developing their Community First Choice benefit with the input of with a stakeholder council that includes a majority of members with disabilities, elderly individuals, and their representatives; establishing and maintaining a comprehensive continuous quality assurance system specifically for this Community First Choice benefit; and collecting and reporting information for Federal oversight and the completion of a Federal evaluation of the program.  Additionally, for the first 12 month period in which the Community First Choice benefit is implemented, the State must maintain or exceed the level of expenditures for home and community-based attendant services provided under the State plan, waivers or demonstrations for the preceding 12 month period. 

The Affordable Care Act directs that the Community First Choice benefit may only be available in a “home or community” setting, and this rule does not finalize language regarding the definition for such settings.  CMS articulated standards for settings in Community First Choice’s proposed rule, but based on the comments the agency received, CMS decided to revise the standard and seek public comment again.  The revised standard is in the Home and Community-Based Services State plan option (“1915(i)”) proposed regulation that CMS released today. While the setting requirements are proposed, the Community First Choice option is in full effect, and CMS will rely upon these proposed provisions as we review new State plan amendments to implement the Community First Choice option.    To the extent there are changes when the settings standard is finalized, we are committed to offering States  a reasonable transition period (of not less than one year) to make any needed changes to come into compliance with the final rule so as to minimize any disruption to State systems that were established in compliance with the proposed regulations. 

The statute requires CMS to conduct an evaluation by December 31, 2015 in order to determine the effectiveness of the Community First Choice option in allowing individuals to lead an independent life, the impact on the physical and emotional health of individuals receiving these services, and a comparative analysis of the costs of services provided under Community First Choice and those provided in an institution.  An interim report of this evaluation is due to Congress by December 31, 2013.

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