CFSS 101: The Need-to-Knows on a New Program – Podcast

Reflecting on 2023 and Introducing CFSS

David Hancox

Well, hello, Jason, and listeners, and welcome to another episode of the Champions of Homecare podcast. This is our first episode in 2024, Jason, and lately, we’ve been looking back at everything we discussed on the podcast in 2023. Let’s see, we explored multiple homecare service programs offered at Accra, including 245D Waivered services, FMS, or Financial Management Services, Mental Health Services and Private Pay. And we talked to some fantastic community partners who have helped to share resources for individuals with autism, and to lay out all the needs-to-knows about upcoming caregiver wage increases and bonuses.

Jason Dorow
Yeah, and I was even thinking back to last summer, David, when some of our guests helped a client of Accra get ready for back to school and prepared listeners with accessibility information for the State Fair. So we’re going to keep looking for timely opportunities like that to share pertinent information. But if you’re new to the Champions of Homecare podcast, we encourage you to go through the podcast archive, because you may find one of those conversations beneficial whether you’re a client, a caregiver, a responsible party, or even a case manager. So go on and dip through those podcasts from 2023 and see if you find something that might be helpful. But for now, let’s get on with today’s show. Today we are talking about a new service program. It’s called CFSS, or Community First Services and Supports.
And we have two experts here to break it down for us too. Joining the podcast is Rochelle Wodarz, Accra’s Senior Program Director for PCA choice and CFSS, as well as compliance, which is no small piece as well. And Rochelle, how are you doing today?

Rochelle Wodarz
I’m doing great. Thanks so much for having me.

Understanding the CFSS Service Models

David Hancox
Wonderful. We’re so glad you could be here. And alongside Rochelle is Amanda Whitmore, Accra’s CFSS Consultation Services Director. And Amanda, thanks for joining us today and how are you?

Amanda Whitmore
I’m doing great. Thanks for having me.

David Hancox
Great. It’s so nice to have both of you here. We appreciate you taking time to join to talk about this, we hope, upcoming program transition. It’s been promised for many, many, many years in the state of Minnesota, as we all know, and we seem to be getting closer all the time. But, for starters, let’s talk about what is CFSS? And what kind of services does it include? And what program is it replacing? Amanda? Would you like to start out?

Amanda Whitmore
Yeah, that’s a great question. So CFSS stands for Community First Services and Supports. And it’s really a new self-directed program that offers similar options to what’s available under PCA choice and CSG, to meet individuals needs, while giving them some more choices that are currently available, while still having some control and flexibility within their services and supports. What kind of services does it include? The service model under CFSS program is going to include a few different options. So it really is going to start with a program called consultation services. And that’s where you’re going to meet, that’s a really new program where everybody is going to get the assistance, kind of learning what these services are. So for those that are really unfamiliar and haven’t heard a lot about the program, this service is really going to help you. So that service is going to help you determine really what model of services are going to be best for your needs. So our models are the Agency Model and the Budget Model. Within these service models, the individuals will receive support from the consultation service provider to help determine the best supports to write into their service delivery plan. So what needs they’re going to have throughout the year. Under the Agency Model, and the Budget Model individuals can receive a variety of supports ranging from ADL support to a variety of goods and services that can help aid in their independence. Which is a little bit different than what they can get now. So that’s an added bonus in this new programming. And then what’s the program going to be replacing? So it’s essentially going to be replacing what we currently see as our PCA Choice and traditional models of care. And that’s going to be our Agency Model of services. And then the Budget Model is really essentially replacing our CSG services as we see them now. And then like I said, our consultation services are brand new, so they’re really not replacing anything just kind of helping people learn what those services are.

David Hancox
Amanda in your comment you use the phrase that it’s a little bit different than what is available now. So can you talk for just a minute about how CFSS is different from the existing PCA Choice Program? And what stays the same? Or what is going to change? And what clients who use PCA services, especially the choice model program, what they might be doing to kind of get ready for this transition? If anything at this point?

Amanda Whitmore
I think that’s a great question. So a lot of the services that you get now are remaining the same. So the way that you utilize your PCA Choice services and your CSG services, a lot of that is remaining the same, the way that the services run, you still will have a lot of freedom and choice on the caregivers that you can use and your basic ADL support that they would help you with throughout the day. All of the basic principles of that service are staying the same for the basic supports in your home. A lot of the things that are going to be new, especially under the Agency Model, something that wasn’t available to a lot of individuals under a PCA Choice model, or traditional model of services are the addition of some goods and services that if you have some informal supports in your home, that could help you with, say, bathing, and you don’t have a PCA that’s going to help you with your bathing tasks, you could essentially use those budgeted hours that you would have a caregiver, a paid caregiver helping you with, you could say, well, I want to use that 30 minutes a day, whatever that budgeted amount would be, to pay for a microwave that would reduce my dependence on a caregiver to help provide a meal for me. Because that would be dollars that I would have to then not pay a caregiver to provide a meal. So there is a variety of options that would be beneficial to people under a PCA Choice and traditional model that really aren’t there now that are going to be there under CFSS. So in that aspect it’s going to be really beneficial.

Benefits of CFSS

David Hancox
Okay. And you’ve mentioned a couple of times that there are two different CFSS delivery models. Could you just review real quickly what those two models are and how they’re different. And again, you know, how this is gonna be really, really new for clients. And I think one of the things that, as a provider we want to do is anytime there’s a change like this to a program model, it can produce a little bit of anxiety with clients. So maybe to reduce some of that, as you know, listeners are listening to this podcast, to reduce some of that anxiety, what do clients need to know about how to choose the model that’s best for them?

Amanda Whitmore
Yeah, I think reducing that anxiety, that consultation provider is really going to help you with that. So you’re really going to be able to lean on that consultation provider to help you walk through that process. So you’re really not going to be alone in that first year of services. And even going forward, it’s going to be a required part of CFSS to have a consultation services provider. So you really will have someone walking you through that process. And they’ll be with you throughout the entire year of your services there. They’re not just there to help you set it up there. They’re there to walk with you through all of the entire year of your service. So if you’re having problems throughout any of your service, you can always go back to your consultation provider. So really know that that’s someone you can lean on as well as your agency providers. So you really will have more supports within this program than you do currently, because you’ll have that additional service provider. So the two models really are Agency and Budget Model. Agency is really essentially replacing that that PCA Choice and traditional model. And then the Budget Model is really replacing the CSG model. For Agency Model, really a lot stayiig the same, freedom within that caregiver. Same concept with ADLs, all of that. A little more variety with goods and services. Like I said, you’ll have some more options with that. There’s more options with employer running the service. So it’s not, it’s kind of taking that traditional model of service a little bit more where the agency is taking on a little bit more of that and helping with the staffing and some of that aspect. So it’s not going to be as heavy on that client and caregiver relationship to do a lot of that. And then the Budget Model really is you get your budget for the year, you set it up with your consultation provider on this is what I want to use all these dollars for, this is what I would pay this person, that person, where I would spend these dollars for this goods and this service. So really running a lot of the same way as what your CSG model runs now. That model changes the least really.

David Hancox
Well, it’s very reassuring to know that there’s a safety net available for clients as they go through this process, transitional process, to this new model. And hopefully, as you said, that will help reduce some of that anxiety that people might be feeling in anticipating these upcoming changes. Jason?

Navigating the Transition to CFSS

Jason Dorow
I was going to ask, David, since we have, Amanda, now these two different models and you mentioned the consultation services provider, will Accra serve as a consultation service provider? And will Accra be able to work with clients no matter which model they choose? Just wondering for Accra clients right now wondering if they’re going to have to find a different provider, something’s going to change. Can they keep working with Accra when CFSS is implemented?

Amanda Whitmore
That’s a great question. So yes, Accra is going to be a consultation services provider. We are one of 22 throughout the state of Minnesota. Unfortunately, if you choose Accra for your consultation services provider, you’re not able to choose us for one of your other service providers. So you do have to know that going in. And that is something we’ll definitely explain to clients when they call if they want to choose us as their consultation service provider, and they’re already an Accra client, that is definitely a conversation we would have, just so that they’re aware, because we don’t want somebody that’s an existing Accra client for PA Choice, or CSG, to want to use us for consultation and then realize, oh, I can’t make that transition, and keep, you know, the employment with my current staff. So that is an unfortunate transition going into this programming, but a small, small mishap to have a lot of benefits.

Jason Dorow
Yeah, the work undertaken to make this transition will pay off in the long run for sure. Thinking of the long run, I know, you all have been waiting for this transition to eventually happen. Do you have an idea of what the timeframe is like for when the transition to CFSS will happen? And how long it will take?

Rochelle Wodarz
Sure, I can take that one. We’ve been waiting a long time. Lots of people have been waiting a long time. Currently, there is not a date for implementation at this point. But I can give a little bit of where we’re at. So DHS did submit amendments for CFSS to add to the federal level, which is CMS. And that was done on November 30 of last year. CMS has 90 days to respond. So we were in a few meetings last week and DHS has not heard anything, since they’ve submitted, which they do take as a good sign. So the deadline for the 90 day deadline is coming up pretty quickly. I believe they said the 28th of February, I had it in my head the 29th, but I think it’s the 28th technically. So once they hear back from CMS, we’re going to know a lot more. And DHS has assured providers that they will give no less than 90 days for providers to implement CFSS. So we don’t necessarily know a date. We can all speculate. But we’ve done that before. So I think we’re just all just kind of anxiously anticipating. And I think we’ll hear something in the next couple of weeks and give us a little bit more of an idea of where we’re at and where we’re going.

Client Preparation and Resources

Jason Dorow
Yeah, Accra is standing at the ready for when the go-ahead comes. I’m sure there are a lot of clients out there right now thinking okay, so we don’t know when it is, but oh gee, what do I need to do? How can I get ready for this? Or is there anything I need to do right now? Are there actions that clients should be taking right now? Is there anything they should be looking out for? I assume Accra will be providing them with information when that time does come?

Rochelle Wodarz
Yes. So one thing that I would recommend for clients to get ready and just to become a little bit more educated about all of the components and and what’s coming and we’re all going to be learning to some degree at the same time. So we’re all in it together. And we’ll all get through it together. But I would recommend going on the DHS CFSS website. There are several training videos, and they’re very well done. And they’re broken up into different areas. And they’re short and sweet. So if you wanted to just watch one or two at a time, or you wanted to watch all of them at once, if you wanted to, I think that would be really helpful for clients and responsible parties to start to just become a little bit more familiar with what’s coming. And what are the different components, and what does it mean to me. And really just start to be able to think ahead about maybe what model might work best for me, the consultation services providers are going to be helping them through that. But I know for some of us, and I know for myself, the more I hear something, the easier it is for me to, you know, just take it in, it can feel like a lot at once. You know, if we go in, and we haven’t heard anything about it before, this might help reduce a little bit of anxiety, just being informed about all the different components. And then once sitting down with the consultation services provider, you know, having heard it a little bit before and having thought through, well, I think this might work best for me, or gosh, I would really love to be able to use some of my dollars for some training, you know, that I would like my workers to go through, there are all kinds of opportunities to be looking at things a little bit differently. And I think those training videos will help people kind of get prepared and get your juices flowing about all the different things they might want to ask their consultation services provider about when the time comes. And then we also do have some, we have some information on our website: accrahomecare.org, for CFSS, as well as I think we have some of the training on there as well. But really every component of the training is on that DHS CFSS website.

David Hancox
Well, Rochelle, let me ask a related question, if I can. You know, I appreciated Jason’s question about what clients need to do to switch their services. But how will clients know when it’s their turn to get in line for consultation services? I mean, is that going to be an act of outreach on the part of a provider like Accra? Will it come from the county case manager to tell the client Oh, it’s time for you to begin this transition process? How will they know when to start?

Assisting Clients Through Reassessment

Rochelle Wodarz
Sure. So once there is CMS federal approval, and there’s an implementation date for providers, then it’s really going to start implementing for each individual client at the time of their reassessment. So when they – that’s the trigger. Yep. So let’s say today is implementation day and my reassessment isn’t due until July. That is when I start having those conversations at the reassessment with the assessor that comes to the home and goes through everything that they do every single year. They are going to start talking about, you know, now is the time to transition into CFSS. And they’re going to be asking for them to identify which consultation services provider they would like to use. And then once they identify that consultation services provider, the assessor is going to then send the assessment or reassessment over to that consultation services provider. And they’ll review that and reach out to the client to schedule that initial consultation services session. And that’s when we start having, we dive a little deeper into Okay, so I’m looking at the reassessment and based on that, and how you’ve used your services in the past and what’s worked and what doesn’t. That’s how we help create service plans for the CFSS services, and diving into what model works best and really trying to help the client understand or the responsible party understand their options. The transition takes, it’s going to take a good 18 to 24 months, as people go through all of their reassessments.

David Hancox
And when you say 18 to 24 months, we don’t mean 18 to 24 months for each individual, but for the entire population of individuals who receive PCA services. But your description that you just provided, I mean, very informative. Thank you so much for that detail. It’s very, very informative. And I would imagine for our listeners, it will be very helpful. But it also describes something that’s incredibly multi layered. This is a process – it’s gonna be really wow. And to switch – and we have what 35,000 people using PCA services right now in the state of Minnesota?

Rochelle Wodarz
At least, at least, I think last I heard it was 40,000. It’s a lot. It’s a lot. So we’ll all be in it together. But you know, there’ll be steps. So we’ll, you know, so that it’s not too overwhelming, you know, helping everybody through each individual step, I think and the assessor will start that process and help, you know, okay, here’s the next step. And then the consultation services provider helps and identifies Okay, now, here’s where we’re at to help you get to that next step and identifying that Agency versus Budget and reaching out to help them identify those providers as well.

CFSS Implementation

David Hancox
Well, you know, and it prompts me to share something else. And this may sound like a little bit of bragging, but I want to make sure that listeners are aware of the fact that this anticipated process is something that Accra has been paying very, very close attention to, for the last several years. Rochelle, you and several other people within Accra have been very, very involved in attending regular meetings and conversations with the Department of Human Services, DHS, and other players around the state to make sure that we are number one, as well informed as we can possibly be about this transition to CFSS. And number two, that we are building the infrastructure internally within Accra, so that we can provide the best possible service to our clients as they anticipate this transition. So I want to make sure that listeners are aware of that as well that Accra has not been a passive participant in this whole process, we’ve been very deeply involved. And a lot of that is because of you know, Rochelle yourself, and Amanda and others that have been taking a very active role in this process.

Jason Dorow
Thank you for making that point, David. That’s important. And Rochelle, you had so many wonderful suggestions and tips for clients who are anticipating this. I just wanted to reiterate that if you go to accrahomecare.org, and then you click on Services in the navigation bar up at the top, you’ll see a drop down menu and then a link that says CFSS to replace PCA and CSG. And so if you click on that, then you’ll find a link to the DHS website, which has those training videos, and has basically all the information we just went through in the podcast, but in a written format. So you don’t have to listen and watch us over again. You can read through that page.

David Hancox
You may want to – but you may want to.

Jason Dorow
Who knows? The last question I’d like to just throw out there, David might have another one. But one thing we like to do here in the Champions of Homecare podcast is ask our expert guests for tips and tricks and you two have worked so many years in Accra, and shared tons of expertise with clients. Do you have any tips or tricks that you haven’t already tossed out there to listeners and viewers that you think would be helpful either for people preparing for CFSS or just in general for clients who work with Accra? Putting you on the spot I know.

Rochelle Wodarz
Yeah, I mean, my biggest tip is just to start doing what they can to learn about CFSS just, you know, we’re here to answer questions as well, they can certainly reach out to Accra, and those of us who have been very involved in the CFSS journey and going to different trainings with DHS and meetings. And we can certainly try to walk through different scenarios, but I think because we’re still waiting, we’re still waiting for finalized policies, processes, statutes, from DHS as well. And as well as a provider manual that will be will be finalized around the same time as implementation, probably a little bit before, to help us with that heads up and that implementation that we have of at least 90 days. So we’re still waiting a little bit you know, so we can answer to the best of our knowledge now. And knowing that, in the end, things may come out and be a little bit different and that’s okay, we’ll just adjust and we’ll all reeducate together. But I do think the biggest components of what we’ve talked about are pretty solid. As far as what CFSS is, and what stays the same, and all of the different things that it provides, the flexibility it provides more so than what is currently in place.

Jason Dorow
Fantastic. Do you have anything else, David, or should we wrap it up?

David Hancox
No, I don’t think so. But I do want to take a moment, you know, again, to reiterate something Rochelle just said, and that is, you know, for listeners, if you’re not familiar with what CFSS is, please visit our website, go to the DHS website. The more that you can do to educate yourself about CFSS as we’re anticipating its beginning, the better off, will help you to navigate through the process. So I would just reiterate, Rochelle’s suggestion to educate yourself as much as you can. Second, I just want to thank both Rochelle and Amanda, for joining us today. Tremendous amount of information and resource that you’ve shared, and it goes a long way, again, to educating our listeners who are going to be anticipating using CFSS services in the future. So thank you both so very, very much for taking time out of your incredibly busy schedules, I know they are, and to be here and spend a little time with us today and providing this valuable information.

Rochelle Wodarz
Yeah. Thanks so much for having us.

Amanda Whitmore
Thank you.

Jason Dorow
Thanks, Rochelle. Thanks, Amanda. Well, we’ve started 2024 with a bang, David.

David Hancox
We have, we have started with a bang. think that was a wonderful interview. And the information that Rochelle and Amanda shared is so valuable. One of the biggest concerns I’ve had, as we’ve been discussing CFSS and it’s anticipated implementation is that there’s every time I talk with clients, well, not every time but frequently, when I talk with clients, they’ll say, what’s this CFSS? I don’t know what that is, what are people talking about? And it concerns me, because once implementation begins, I want us to do everything that we can as advocates and allies to reduce that level of anxiety that’s going to accompany this. And so the information that Rochelle and Amanda shared today, I think will go to a great degree to help reduce that anxiety, which to me is so very, very important.

Jason Dorow
It’s good that you’re having those conversations and that we’re having today’s conversation and all the information on CFSS is available on the Accra website. Because otherwise, when it does get implemented, it would be a total surprise. And that would be a lot worse than you having those conversations right now with someone who’s looking into the future a little bit worried about it, and you’re able to provide at least some foundational information that they can get their head wrapped around and be mentally prepared for when it does come.

David Hancox
Well, and it’s that sense of surprise that you just mentioned, Jason, is what you know, oftentimes causes that anxiety. And, you know, when you’re talking with an individual who needs and uses PCA services, on a daily basis, for many folks there, that’s a lifeline for them. You know, it’s a lifeline type service. For them, it’s essential. So anything that they perceive that might threaten that service, or the availability of that service, can really produce that anxiety. So we want to do everything we can to reduce that and to let people know that their services are secured. They just have some decisions to make about how those services are going to continue to be delivered. So I think this was a really valuable podcast to have. And I hope that listeners enjoy listening to it. And if it prompts additional conversations, that’s fantastic. That’s what we want it to do. So, Jason, thank you so much for organizing this and all the behind the scenes work that you do to help prepare for these podcasts. It is absolutely invaluable. And it’s always a pleasure to be here with you doing the podcasts together as a team. So thank you.

Jason Dorow
Yeah, it was a pleasure. Thanks again to Rochelle and Amanda for joining us today and providing all the information on CFSS. I’ll see you later David, see on the next podcast!

David Hancox
Okay. Have a good one.

.