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Aged, Blind and Disabled Manual Section: CHOICES Policy Manual Number: 130.010 Chapter: Employment and Community First CHOICES Legal Authority: TennCare III Medicaid Section 1115 Demonstration; Tenn. Comp. R. & Regs. 1200- 13-20 1. Overview The Employment and Community First (ECF) CHOICES program was established in 2016 to provide managed long-term services and supports (LTSS) for individuals with intellectual or developmental disabilities (I/DD) in a home and community-based setting. This includes individuals with I/DD who were previously on the waiting list for Department of Disability and Aging (DDA) waivers, individuals with intellectual disabilities who were not receiving home and community-based services (HCBS), and individuals with developmental disabilities previously ineligible for DDA waivers. The managed LTSS individuals receive are integrated with the physical and behavioral health benefits coordinated by their Managed Care Organization (MCO). The purpose of the program is to promote and support integrated, competitive employment and independent community living as the first and preferred option for individuals with I/DD. 2. Target Populations ECF CHOICES provides HCBS to six target populations:

a. Children under age 21 with I/DD living at home with family and who meet nursing facility (NF) level of care (LOC); b. Children under age 21 with I/DD living at home with family and who do not meet NF LOC, but who, in the absence of HCBS, are at risk of NF placement; c. Adults age 21 and older with I/DD who meet NF LOC and need specialized services for I/DD; d. Adults age 21 and older with I/DD who do not meet NF LOC, but who, in the absence of HCBS, are at risk of NF placement; e. Children under age 21 with I/DD and severe co-occurring behavioral health and/or psychiatric conditions who are living at home with family or other permanent guardian(s) in a long-term family living arrangement and who meet NF LOC; and f. Adults age 21 and older with I/DD and severe co-occurring behavioral health and/or psychiatric conditions who are transitioning out of a highly structured and supervised environment, who meet NF LOC, and need specialized services for I/DD.