CHOICES/ECF CHOICES Community Living Supports: What level of support is needed?

Community Living Supports (CLS) is a residential service available in TennCare CHOICES and Employment and Community First CHOICES (ECF CHOICES). The service supports the person’s independence and integration into their community. The service should be individualized to meet the person’s needs and may include things like hands-on assistance with activities of daily living (ADLs) and instrumental activities of daily living (iADLs), supervision, transportation, and other day to day supports.

Having the right level of CLS service is important. We want to make sure we provide the level of support that the person needs to be safe and happy in their home, but we also want to make sure we are not trying to over support them. We have provided some definitions for each of the CLS levels below, along with considerations of how we would determine which level is needed.

CHOICES:

CLS providers are reimbursed for each CHOICES member receiving CLS services based upon their level of need, as follows:

CLS 1:

• This level of reimbursement is for CHOICES members who are primarily independent or who have family members and other (in other words, non-CHOICES) paid or unpaid supports, but need limited intermittent CLS supports to live safely in community housing.
• Generally, this need is less than 21 hours per week, and does not require overnight staff or direct support staff to live on-site for supervision purposes.
• A primary staff member or other support staff must be on call on a 24 hour per day basis, when assistance is needed.
• The CLS provider must post the on-call phone number is a location accessible to all members who reside in the home.

CLS 2:

• This level of reimbursement is for CHOICES members who require minimal to moderate support on an ongoing basis but can be left alone for several hours at a time.
  • They do not need overnight staff or direct support staff to live on -site for supervision purposes.
• A primary staff member or other support staff must be on call on a 24 hour per day basis, when assistance is needed.
• The CLS provider must post the on-call phone number is a location accessible to all members who reside in the home.

CLS 3:

• This level of reimbursement is for CLS services to CHOICES members with a higher acuity of need who are likely to require supports and or supervision 24 hours per day due to the following reasons:
  • Advanced dementia or significant cognitive disability that impacts the member’s ability to make decisions, perform activities of daily living or instrumental activities of daily living, including behaviors which places the member or others at risk.
  • Significant physical disabilities that require frequent intermittent hands-on assistance with activities of daily living including toileting, transfers, and mobility; complex health conditions and compromised health status requiring medication assistance and daily nurse oversight and monitoring and/or daily skilled nursing services as needed for routine, ongoing health care tasks, such as blood sugar monitoring and management, oral suctioning, tube feeding, bowel care, etc.
• Members approved for 24-hour support who are assessed to be capable of independent functioning may participate in activities of their choosing without the support of staff as specified in the PCSP, risk assessment, and risk agreement section of the PCSP.  

ECF CHOICES:

CLS 1a:

• This level of reimbursement is for CLS services to ECF CHOICES members who are primarily independent but need limited intermittent CLS supports to live safely.
• Generally, this need less than 16 hours per week and do not need overnight staff or direct support staff to live on-site for supervision purposes.
• A primary staff member or other support staff must be on-call on a 24-hour-per-day basis when assistance is needed. CLS provider to post an on-call number in a location accessible to all people residing in the home.

CLS 1b:

• This level of reimbursement is for CLS services to ECF CHOICES members who are primarily independent but need limited intermittent CLS supports to live safely.
• Generally, this need 16 to 40 hours a week and do not need overnight staff or direct support staff to live on-site for supervision purposes.
• A primary staff member or other support staff must be on-call on a 24-hour-per-day basis when assistance is needed. CLS provider to post an on-call number in a location accessible to all people residing in the home.

CLS 2:

• This level of reimbursement is for CLS services to ECF CHOICES members who require minimal to moderate support on an ongoing basis but can be left alone for several hours at a time.
• They do not need overnight staff or direct support staff to live onsite for supervision purposes.
• They need greater to or equal to a total 8 hours a day but less than or equal to 16 hours a day.
• A primary staff member or other support staff must be on-call on a 24-hours-per-day basis. CLS provider to post an on-call number in a location accessible to all people residing in the home.

CLS 3:

• This level of reimbursement is for CLS services to ECF CHOICES members with higher acuity of need.
• They require supports and or supervision more than 16 hours a day and up to 24 hours a day due to the following reasons:
  • Significant cognitive disability that impacts the person’s ability to make decisions, perform activities of daily living or instrumental activities of daily living, including behaviors which places the person or others at risk.
  • Significant physical disabilities that require frequent intermittent hands-on assistance with activities of daily living including toileting, transfers, and mobility.
• Those approved for 24-hour support who are assessed to be capable of independent functioning may participate in activities of their choosing without the support of staff as specified in the PCSP, risk assessment and risk agreement.

CLS 4 medical:

• This level of reimbursement is for CLS services to ECF CHOICES members with higher acuity of need.
• They require supports and or supervision for more than 16 hours a day and up to 24 hours a day due to the following reasons:
  • Exceptional medical needs as well as significant cognitive disability that impacts the person’s ability to make decisions, perform activities of daily living or instrumental activities of daily living.
  • Significant physical disabilities that require frequent intermittent hands-on assistance with activities of daily living including toileting, transfers, and mobility; complex health conditions and compromised health status requiring medication assistance and daily nurse oversight and monitoring and/or daily skilled nursing services as needed for routine, ongoing healthcare tasks, such as blood sugar monitoring and management, oral suctioning, tube feeding, bowel care, etc.
  • 24-hour on-call staff back up is required for this service.

CLS 4 behavioral:

• This level of reimbursement is for CLS services to ECF CHOICES members with higher acuity of need.
• They require supports and or supervision more than 16 hours a day and up to 24 hours a day due to the following reasons:
  • Exceptional behavioral needs as well as significant cognitive disability that impacts the person’s ability to make decisions, perform activities of daily living or instrumental activities of daily living, including behaviors which places the person or others at risk
  • 24-hour on-call staff back up is required for this service

CLS-Behavioral Health Community Stabilization and Transition (CLS-BHCST):

• This is to ensure that CLS and behavioral health (BH) services are integrated for those with co-occurring behavioral health conditions.
• In-house or consultative psychiatry is available.
• Supervision of staff is by master’s level clinician and disability support providers receiving training in providing BH supports for those with Intellectual or Developmental Disabilities (I/DD).
• It is expected that staff are present and awake 24 hours per day/7 days per week.
• This service is temporary with a maximum amount of 180 days used, based on assessed need.

CLS Community Stabilization and Transition (CLS-CST):

• The purpose of this service is to allow time for stabilization, assessment, and planning for transition to the appropriate ongoing level of CLS.
• These services are appropriate for people who have been in highly structured (or supports-intensive) settings but do not have co-occurring serious mental health conditions or challenging behaviors that will require the integration of BH treatment services into the person’s daily life.
• CLS-CST can be used for a maximum of 90 days, based on assessed need.

CLS Emergency Placement Community Stabilization and Transition (CLS-EPCST):

• The purpose of this service is to support people who are referred by Adult Protective Services and require immediate housing supports because their home is either uninhabitable or they have been subject to abuse and neglect to the degree that their immediate safety, health, and welfare is in jeopardy.
• CLS-EPCST services are authorized for 30 days, and in exceptional circumstances, the managed care organization (MCO)/TennCare may authorize an additional 30 days maximum.
• The rate for CLS-EPCST includes room and board for the person.

For more information about CLS services and how to become contracted to provide any of these services, please refer to the Community Living Supports Provider Manual Supplement.

We look forward to working together to achieve improved outcomes.