Yesterday, the Centers for Medicare and Medicaid Services (CMS) released the final rule on the Medicaid program’s Community First Choice (CFC) option as mandated under the Affordable Care Act (ACA) establishing a new option for states to provide home and community-based attendant services and supports for beneficiaries.

With the additional flexibility to finance home and community-based services and support, the provision is expected to increase state and local accessibility to services that augment the quality of life for beneficiaries through a person-centered plan of service and various quality assurances—at a potentially lower per capita cost relative to institutional care settings.

According to the rule, states that elect this option must make available home and community-based attendant services and supports to assist in accomplishing activities of daily living, instrumental activities of daily living, and health-related tasks through hands-on assistance, supervision, and/or cueing. Additionally, the following services may be provided at the state’s discretion—transition costs, such as rent and utility deposits; first month's rent and utilities; purchasing bedding, basic kitchen supplies, and other necessities required for transition from an institutional setting; and the provision of services that increase independence or substitute for human assistance to the extent that expenditures would have been made for the human assistance, such as nonmedical transportation services or purchasing a microwave.

The final rule sets forth the requirements for CFC, however, requirements pertaining to "setting," under §441.530, will be addressed in future rulemaking.