CBSM - Consumer directed community supports (CDCS)

Consumer directed community supports (CDCS)

Page posted: 10/01/04

Page reviewed:

Page updated: 7/16/14

Legal Authority

Federally approved CAC, CADI, DD and TBI Waiver plans, Minn. Stat. §256B.0915, subd. 8 (c), Minn. Stat. §256B.0916 Subd. 6 (a), (c) and Minn. Stat. §256B.49, subd. 16 (c), (e)

Definition

Consumer Directed Community Supports (CDCS): Service option available under the CAC, CADI, DD, EW and BI Waivers that gives persons more flexibility and responsibility for directing their services and supports, including hiring and managing direct care staff.

Service Criteria

CDCS may include services, support and/or items currently available through the MA waivers, as well as additional allowable services that provide needed support to persons.

There are specific requirements for all services, supports and/or items that are available through the MA waivers, including CDCS. In order for services, supports and/or items to be purchased under CDCS, they must:

• Be for the sole benefit of the person

• Be the least costly alternative that reasonably meets the person’s identified needs

• Collectively provide a feasible alternative to an institution

• Meet the identified needs and outcomes in the person’s community support plan and assure the health, safety and welfare of the person

If all the above criteria are met, services, supports and/or items are appropriate purchases when they are reasonably necessary to meet the following outcomes:

• Decrease dependency on formal support services

• Develop or maintain personal, social, physical, or work related skills

• Enhance community inclusion and family involvement

• Increase independence of the person

• Increase the ability of unpaid family members and friends to receive training and education needed to provide support

Eligibility

To be eligible for CDCS, a person must either already be receiving services on an MA waiver in Minnesota or must meet all eligibility criteria for an MA waiver and be authorized to receive waiver services by the county.

The following persons are not eligible for CDCS:

• CDCS recipients who have exited the waiver more than once during their service plan year (ineligible for CDCS for the remainder of that service plan year)

• Persons who have had their eligibility restricted at any time by the Primary Care Utilization Review (PCUR)*

• Persons whose authorized representative has had their eligibility restricted at any time by PCUR

• Waiver recipients living in residential settings licensed by the Department of Human Services (DHS) or licensed/registered with the Minnesota Department of Health (MDH)

* County workers should check the Recipient Primary Care Utilization Review (RPCR) screen in MMIS to determine whether the person has been involved with PCUR before discussing the CDCS option with the person.

CDCS budget

Disability Services Division and/or Aging and Adult Services Division as appropriate set individual CDCS budgets. The individual budget for a person using CDCS must include the costs of all waiver services and MA state plan home care services. MA state plan home care services may be authorized on a separate line item on the service agreement.

All services must be provided within this budget amount, with the exception of:

• Assistive technology and home or vehicle modifications over $5000 if approved by the county (see description under environmental modifications and provisions)

• Costs for criminal background checks, if requested by the person and not otherwise required through a specific waiver service

• Required county case management services

See DD Waiver Consumer-Directed Services Budget Methodology (PDF).

A person is required to have a fiscal support entity (FSE) in order to access CDCS. An FSE is an MA-enrolled provider for CDCS who reimburses service providers for authorized CDCS services, supports and/or items.

New exception process

During the 2014 legislative session, the Minnesota legislature made changes that affect Consumer Directed Community Supports funding for young adults who meet certain criteria. For more information, see:

• CDCS exception to CDCS Budget Methodology for disability waivers (PDF)

• Exception to CDCS Budget Methodology checklist- DHS-6633 (PDF)

Covered services

CDCS has a range of allowable services, supports and/or items that can be tailored to meet a person’s needs in addition to those currently available through MA waivers. A person can choose to receive traditional waiver services and/or design his or her own services using CDCS.

The flexibility built into CDCS allows persons to:

• Describe services and supports in ways that are meaningful to them

• Design services and supports that are unique to them and best meet their identified needs

Services, supports and/or items that augment state plan services or provide alternatives to waiver or state plan services are covered under CDCS and must fit into one of four service categories:

• Environmental Modifications and Provisions

• Personal Assistance

• Self-Direction Support Activities

• Treatment and Training

Non-covered services

Services, supports and items that cannot be purchased within the person’s CDCS budget are:

• All prescription and over-the-counter medications, compounds, solutions and related fees (including insurance premiums and drug co-payments)

• Animals and their related costs

• Costs related to Internet access

• Expenses for travel, lodging or meals related to training the person or his/her representative or paid or unpaid caregivers

• Experimental treatments (Minn. R. 9525.3015, subpart 16)

• Fees incurred by the person such as Minnesota Health Care Program (MHCP) fees and co-pays, attorney costs or costs related to advocate agencies, with the exception of services provided as support planner services

• Home modifications for a residence other than the primary residence of the person or, in the event of a minor with parents not living together, the primary residences of the parents

• Home modifications that add any square footage

• Insurance expenses except for insurance costs related to employee coverage

• Membership dues or costs unless related to a fitness or exercise program for adults when the service and appropriate to treat a physical condition or to improve or maintain the person’s physical condition (condition must be identified in the individual’s plan of care and monitored by a MHCP-enrolled physician)

• Room and board and personal items that are not related to the disability

• Services covered by the State plan, Medicare, or other liable third parties including education, home based schooling and vocational services

• Services provided to or by individuals, representatives, providers or caregivers that have at any time been assigned to the Primary Care Utilization and Review Program

• Services provided to persons living in settings licensed by DHS or MDH, or registered as a housing with services establishment

• Tickets and related costs to attend sporting or other recreational events

• Vacation expenses other than the cost of direct services

• Vehicle maintenance, does not include maintenance to modifications related to the disability

Provider standards and qualifications

Each person may want to consider their needs and requirements when deciding the qualifications they would like the provider/staff to have. For example, a person who has frequent seizures may want to hire somebody that has training in how to react when someone is having a seizure or experience working with people who have seizures.

Additional qualifications are to be documented in the Community Support Plan. The provider/staff must meet these in order to provide CDCS. The person and/or their authorized representative must maintain documentation indicating how the qualifications are met.

When choosing other formal waiver services, all provisions of the waiver service must be followed including the services description, provider qualifications and quality assurance mechanisms of the service.

Criminal background studies

Criminal background studies are not required under CDCS. A person can choose to request a criminal background study on any or all of their staff. If a criminal background study is completed, the person must abide by the results of the study.

If a criminal background study is requested by the person/authorized representative or when the person has chosen a waiver service that requires background studies, Minn. Stat, chapter 245C, Human Services Background Studies, applies to determine if the staff person is disqualified. An individual who is disqualified through this process may not be paid under CDCS.

The cost of criminal background studies is not deducted from the individual budget amount when the person uses a background study as a staff requirement for an individually designed service. The cost will be covered as a service expense through the counties’ waiver budget allocations.

If the person chooses to use an agency with choice as their fiscal support entity and that agency requires background checks, the cost of the criminal background study is included in the administrative rate for that agency.

If the person selects a waiver service in which a background study is a required provider qualification for that waiver service, the cost is included in the rate for that waiver service.

CDCS Background Check Payment Comparison Chart (PDF)

Case management

Under CDCS, case management supports are separated into:

• Required Case Management (for all who receive CDCS)

• Support Planner Services (optional for any who receive CDCS)

Secondary information

Involuntary Exit Procedure

Counties have the option to follow the CDCS Involuntary Exit to exit a person from CDCS.

Paying Parents of Minor Children and Spouses

One option under CDCS is the ability to pay parents of minor children or spouses to provide services.

Briefcase Resource Documents

Additional resources

CDCS case management functions - Attachment B (PDF)
CDCS criteria for allowable expenditures - Attachment C (PDF)
CDCS Lead Agency Operations Manual (PDF)
CDCS Service information on the DHS Public Web site
Consumer Directed Community Supports (CDCS) Consumer Handbook (PDF)
Consumer Directed Initiative on the DHS Public Web site
Consumer Directed Toolkit (PDF)

Process and procedures

1. Access
2. Assessment
3. Service Planning
4. Service Revisions and Plan Changes
5. Authorization
6. Termination
7. Billing


Page posted: 10/01/04		Page reviewed:	Page updated: 7/16/14
Legal Authority	Federally approved CAC, CADI, DD and TBI Waiver plans, Minn. Stat. §256B.0915, subd. 8 (c), Minn. Stat. §256B.0916 Subd. 6 (a), (c) and Minn. Stat. §256B.49, subd. 16 (c), (e)
Definition	Consumer Directed Community Supports (CDCS): Service option available under the CAC, CADI, DD, EW and BI Waivers that gives persons more flexibility and responsibility for directing their services and supports, including hiring and managing direct care staff.
Service Criteria	CDCS may include services, support and/or items currently available through the MA waivers, as well as additional allowable services that provide needed support to persons. There are specific requirements for all services, supports and/or items that are available through the MA waivers, including CDCS. In order for services, supports and/or items to be purchased under CDCS, they must: • Be for the sole benefit of the person • Be the least costly alternative that reasonably meets the person’s identified needs • Collectively provide a feasible alternative to an institution • Meet the identified needs and outcomes in the person’s community support plan and assure the health, safety and welfare of the person If all the above criteria are met, services, supports and/or items are appropriate purchases when they are reasonably necessary to meet the following outcomes: • Decrease dependency on formal support services • Develop or maintain personal, social, physical, or work related skills • Enhance community inclusion and family involvement • Increase independence of the person • Increase the ability of unpaid family members and friends to receive training and education needed to provide support
Eligibility	To be eligible for CDCS, a person must either already be receiving services on an MA waiver in Minnesota or must meet all eligibility criteria for an MA waiver and be authorized to receive waiver services by the county. The following persons are not eligible for CDCS: • CDCS recipients who have exited the waiver more than once during their service plan year (ineligible for CDCS for the remainder of that service plan year) • Persons who have had their eligibility restricted at any time by the Primary Care Utilization Review (PCUR)* • Persons whose authorized representative has had their eligibility restricted at any time by PCUR • Waiver recipients living in residential settings licensed by the Department of Human Services (DHS) or licensed/registered with the Minnesota Department of Health (MDH) * County workers should check the Recipient Primary Care Utilization Review (RPCR) screen in MMIS to determine whether the person has been involved with PCUR before discussing the CDCS option with the person.
CDCS budget	Disability Services Division and/or Aging and Adult Services Division as appropriate set individual CDCS budgets. The individual budget for a person using CDCS must include the costs of all waiver services and MA state plan home care services. MA state plan home care services may be authorized on a separate line item on the service agreement. All services must be provided within this budget amount, with the exception of: • Assistive technology and home or vehicle modifications over $5000 if approved by the county (see description under environmental modifications and provisions) • Costs for criminal background checks, if requested by the person and not otherwise required through a specific waiver service • Required county case management services See DD Waiver Consumer-Directed Services Budget Methodology (PDF). A person is required to have a fiscal support entity (FSE) in order to access CDCS. An FSE is an MA-enrolled provider for CDCS who reimburses service providers for authorized CDCS services, supports and/or items. New exception process During the 2014 legislative session, the Minnesota legislature made changes that affect Consumer Directed Community Supports funding for young adults who meet certain criteria. For more information, see: • CDCS exception to CDCS Budget Methodology for disability waivers (PDF) • Exception to CDCS Budget Methodology checklist- DHS-6633 (PDF)
Covered services	CDCS has a range of allowable services, supports and/or items that can be tailored to meet a person’s needs in addition to those currently available through MA waivers. A person can choose to receive traditional waiver services and/or design his or her own services using CDCS. The flexibility built into CDCS allows persons to: • Describe services and supports in ways that are meaningful to them • Design services and supports that are unique to them and best meet their identified needs Services, supports and/or items that augment state plan services or provide alternatives to waiver or state plan services are covered under CDCS and must fit into one of four service categories: • Environmental Modifications and Provisions • Personal Assistance • Self-Direction Support Activities • Treatment and Training
Non-covered services	Services, supports and items that cannot be purchased within the person’s CDCS budget are: • All prescription and over-the-counter medications, compounds, solutions and related fees (including insurance premiums and drug co-payments) • Animals and their related costs • Costs related to Internet access • Expenses for travel, lodging or meals related to training the person or his/her representative or paid or unpaid caregivers • Experimental treatments (Minn. R. 9525.3015, subpart 16) • Fees incurred by the person such as Minnesota Health Care Program (MHCP) fees and co-pays, attorney costs or costs related to advocate agencies, with the exception of services provided as support planner services • Home modifications for a residence other than the primary residence of the person or, in the event of a minor with parents not living together, the primary residences of the parents • Home modifications that add any square footage • Insurance expenses except for insurance costs related to employee coverage • Membership dues or costs unless related to a fitness or exercise program for adults when the service and appropriate to treat a physical condition or to improve or maintain the person’s physical condition (condition must be identified in the individual’s plan of care and monitored by a MHCP-enrolled physician) • Room and board and personal items that are not related to the disability • Services covered by the State plan, Medicare, or other liable third parties including education, home based schooling and vocational services • Services provided to or by individuals, representatives, providers or caregivers that have at any time been assigned to the Primary Care Utilization and Review Program • Services provided to persons living in settings licensed by DHS or MDH, or registered as a housing with services establishment • Tickets and related costs to attend sporting or other recreational events • Vacation expenses other than the cost of direct services • Vehicle maintenance, does not include maintenance to modifications related to the disability
Provider standards and qualifications	Each person may want to consider their needs and requirements when deciding the qualifications they would like the provider/staff to have. For example, a person who has frequent seizures may want to hire somebody that has training in how to react when someone is having a seizure or experience working with people who have seizures. Additional qualifications are to be documented in the Community Support Plan. The provider/staff must meet these in order to provide CDCS. The person and/or their authorized representative must maintain documentation indicating how the qualifications are met. When choosing other formal waiver services, all provisions of the waiver service must be followed including the services description, provider qualifications and quality assurance mechanisms of the service.
Criminal background studies	Criminal background studies are not required under CDCS. A person can choose to request a criminal background study on any or all of their staff. If a criminal background study is completed, the person must abide by the results of the study. If a criminal background study is requested by the person/authorized representative or when the person has chosen a waiver service that requires background studies, Minn. Stat, chapter 245C, Human Services Background Studies, applies to determine if the staff person is disqualified. An individual who is disqualified through this process may not be paid under CDCS. The cost of criminal background studies is not deducted from the individual budget amount when the person uses a background study as a staff requirement for an individually designed service. The cost will be covered as a service expense through the counties’ waiver budget allocations. If the person chooses to use an agency with choice as their fiscal support entity and that agency requires background checks, the cost of the criminal background study is included in the administrative rate for that agency. If the person selects a waiver service in which a background study is a required provider qualification for that waiver service, the cost is included in the rate for that waiver service. CDCS Background Check Payment Comparison Chart (PDF)
Case management	Under CDCS, case management supports are separated into: • Required Case Management (for all who receive CDCS) • Support Planner Services (optional for any who receive CDCS)
Secondary information	Involuntary Exit Procedure Counties have the option to follow the CDCS Involuntary Exit to exit a person from CDCS. Paying Parents of Minor Children and Spouses One option under CDCS is the ability to pay parents of minor children or spouses to provide services. Briefcase Resource Documents CDCS-Related Changes to the LTC Screening Document for CAC, CADI and TBI Waivers (PDF)
Additional resources	CDCS case management functions - Attachment B (PDF) CDCS criteria for allowable expenditures - Attachment C (PDF) CDCS Lead Agency Operations Manual (PDF) CDCS Service information on the DHS Public Web site Consumer Directed Community Supports (CDCS) Consumer Handbook (PDF) Consumer Directed Initiative on the DHS Public Web site Consumer Directed Toolkit (PDF)
Process and procedures	1. Access 2. Assessment 3. Service Planning 4. Service Revisions and Plan Changes 5. Authorization 6. Termination 7. Billing