CFC for Fee for Service Medicaid Clients Texas Department of State Health Services

Intake & Enrollment Process DSHS is responsible for all CFC assessments and authorizations for Fee For Service clients under 21. Children referred by DSHS or children without an MCO will be case managed by DSHS; including completing the CFC assessment.  (Children NOT on an MCO should NOT be referred or told they must get on an MCO in order to get CFC. They can remain in Fee For Service Medicaid) DSHS regional case managers are identifying current PCS clients or new clients who meet referral criteria for potential LOC. DSHS is referring clients to their LIDDA who meet referral criteria for potential LOC. Interim process includes a monthly manual spreadsheet referral process. Beginning 11/1/15, this process will use the CFCFFS FTP site similar to FTP MCO site. The LIDDA then prioritizes the DSHS referrals and completes necessary LOC assessments.

Intake & Enrollment Process cont. The LIDDA will follow the Fee For Service process to retrieve and upload information to the CFCFFS FTP site to DSHS after the assessment is completed or a determination made. DSHS will complete the CFC functional assessment and authorize services via TMHP and provide case management services. DSHS will refer client’s back to their LIDDA yearly for LOC reassessment via FTP site.

CFC Self-Referral to LIDDA or Non Self-Referral needing Attendant/Habilitation  LIDDA Staff will: 1.  Confirm family interest & refer the child to the TMHP Client Line at the number 1-888-276-0702.  2.  Identify their agency name and that they are with the LIDDA, in order for the TMHP call center to document the referral source information.  3.  Identify whether the client has a current DID, under the criteria established in DADS memorandum “Requirements for Completing a Determination of Intellectual Disability for Community First Choice Applicants/Participants,” dated January 20, 2015 TMHP Referral staff will: 1.  Document the LIDDA (by name) as the referral source on the PCS/CFC referral. 2.  Forward the PCS/CFC referral to the appropriate local DSHS office. 

CFC Self-Referral to LIDDA cont. The DSHS case worker will: 1.      Utilize the CFC/LOC referral form to determine if a client is a potential candidate for CFC and where the client should be referred for a LOC assessment. This referral form has been updated to capture whether the individual was referred by a LIDDA. 2.      When sending the LIDDA the spreadsheet of referrals, via the CFC FTP site, on the 7th of the following month, the spreadsheet will indicate that the individual was referred by a LIDDA.  Upon receipt of the monthly referral spreadsheet, via the CFC FTP site, from DSHS, the LIDDA will determine the order in which to assess all children referred from DSHS, by following the priority order established by HHSC in the document “Final Interest List CFC Assessment Guidance:”

For Questions Email ASKPCS@dshs.state.tx.us Coming Soon: DSHS/LIDDA - CFC Department of State Health Services and Local Intellectual and Developmental Disability Authority Procedures for Community First Choice (Fee-For-Service Clients under age 21 with ICF/IID LOC Determination)