Community First Services and Supports

Community First Services and Supports (CFSS) is a new self-directed home and community-based service being developed by the Minnesota Department of Human Services. CFSS is a service for people living in the community who need help with day-to-day activities.

When CFSS is implemented, it will replace the personal care assistance service and the Consumer Support Grant. CFSS is similar to PCA in many ways, but it will offer participants more control, flexibility, responsibility, and choice in how they use the service. CFSS is a program under the Medical Assistance, waiver and Alternative Care programs.

State and federal approval are required. DHS has legislative approval to implement CFSS and has submitted a Medicaid state plan amendment to the federal Centers for Medicare and Medicaid Services (CMS) to obtain approval for CFSS.

DHS is in discussion with CMS about the amendment. These discussions are a common part of the approval process, which can take several months.

How is CFSS similar to PCA?
CFSS will have the same eligibility rules as PCA. A person must have an assessment to determine eligibility for CFSS. Minnesota is continuing its transition to the MnCHOICES assessment, which will replace the PCA assessment.

Depending on the person's assessed needs and plan, CFSS support workers, similar to personal care assistants, will be able to provide direct care to the person or cue or supervise them. They can help with:
- Activities of daily living, such as eating, bathing, grooming, and transferring
- Health-related tasks
- Instrumental activities of daily living, such as shopping, cooking, laundry, and assistance with medications
CFSS provider agencies must:
- Enroll as Medical Assistance providers
- Meet CFSS provider standards and
- Complete CFSS agency training.
CFSS support workers must complete background checks and online CFSS training.
How is CFSS different from PCA?
CFSS expands the role of the support worker. Depending on the participant's assessed needs and plan, the support worker may also help the participant learn new skills to complete an activity of daily living.

When a person is assessed and found eligible for CFSS, they are required to meet with a consultation services provider, a new feature of CFSS. The consultation services provider will help participants:
- Select a service delivery model
- Learn how to use CFSS and
- Develop a person-centered CFSS service delivery plan based on the person's assessment.
The consultation service provider will also provide ongoing support to participants to help them achieve personal outcomes.

Another new feature allows spouses of CFSS participants and parents of minor CFSS participants to be paid to provide services to their eligible family members. They may be paid to provide up to 40 hours per week depending on the participant's assessed needs and plan.

CFSS offers a worker training and development service, intended to strengthen the skills of support workers and target those skills to the specific, assessed needs of the participant. The specific worker training and development activities must be described in the participant's service delivery plan. This service is similar to the training and supervision that a qualified professional may perform in PCA.

Lastly, depending on their assessed needs and plan, CFSS participants will be able to purchase goods to reduce the need for human assistance, such as a microwave that permits a person to prepare a meal. CFSS will also permit participants to modify their vehicles or homes to reduce the need for human assistance.

Service delivery models

CFSS will have two service delivery models, the agency provider model and the budget model.

Agency provider model

In this model, agency providers are the employers of support workers. This means the agencies will recruit, hire, train, supervise and pay CFSS support workers. Participants may have a say in the selection and dismissal of their support workers, if they choose.

Providers deliver services according to the assessed needs and service delivery plans. The agency will keep records and bill DHS for services authorized and provided. Services are authorized in units.

Budget model

In this model, CFSS participants are the employers of their own support workers. They will have a budget rather than allocated service units. Participants will recruit, hire, train and supervise their support workers.

Services will be delivered according to the participant's assessed needs and service delivery plan. A financial management service will help participants comply with federal and state labor laws; pay payroll; collect and file payroll taxes, obtain liability and workers' compensation insurance; manage and pay expenses; account for all spending; and process CFSS claims and payments.
How do I transition from PCA or the Consumer Support Grant program to CFSS?
How is the public involved?

CFSS is being designed by staff at DHS with input and advice from an Implementation and Development Council. The members of this public stakeholder group were selected in an open application process to represent various perspectives, such as PCA participants, family members, PCA agencies, counties, managed care organizations, advocates and others. By law, the majority of council members must be people with disabilities or seniors or their family members or representatives. The council has been meeting since the fall of 2012. The council will also provide input to DHS on the implementation of CFSS.

The public is welcome to attend and observe Implementation Council meetings. To be informed of meeting dates, email your name, organization name, and email address to the email address below.
Whom do I contact for more information?
How can I learn more about CFSS?
DHS has prepared two trainings for people who want to learn more about CFSS.
- The first is a short video to introduce you to the topic.
- The second is an interactive training that gives you more information.