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Consumer Directed Community Support (CDCS) Manual

Consumer Directed Community Support (CDCS) Manual


CDCS unbundled service category: Individual-directed goods and services

Page posted: 12/10/24

Page reviewed:

Page updated: 8/3/26

Legal authority

Federally approved Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD) and Elderly Waiver (EW) waiver plans, federally approved Alternative Care (AC) 1115 demonstration, Minn. Stat. §256B.0913

Unbundling project

This page includes CDCS unbundled service category policy. When a person transitions to the unbundled CDCS service categories, they will use the policy on this page.

For information about who must use this new policy, refer to the Dec. 10, 2024, eList announcement.

Definition

Individual-directed goods and services: A CDCS service category that includes services, equipment or supplies that address an assessed need and are not otherwise provided through a waiver/AC or the Medical Assistance (MA) state plan.

Criteria for covered goods and services

People using CDCS can request approval for individual-directed goods and services that meet all requirements on CDCS Manual – Allowable and unallowable goods and services under CDCS.

In addition, goods and services must meet at least one of the following requirements:

  • · Decrease the need for other MA services.
  • · Promote inclusion in the community.
  • · Increase the person’s safety in their home.

    • Additional guidance

    The lead agency may request input from a medical provider or specialist. However, the lead agency cannot approve goods and services solely based on a prescription or recommendation from a doctor, occupational therapist (OT), physical therapist (PT) or other therapist.

    Examples

    This section includes examples of goods and services the person could purchase if they meet requirements in the criteria for covered goods and services section.

    Additional or specialized foods for a prescribed special diet

    For information about specialized diets, refer to CDCS Manual – Guidelines for special diets (unbundled).

    Thickening agents

    CDCS funds can pay for thickening agents when the person’s medical provider determines the person has a medical need.

    Oral and enteral nutritional products

    For information about nutritional products, refer to CBSM – Waiver oral and enteral nutritional products.

    Adaptive clothing

    CDCS funds can pay for adaptive clothing that is specially designed to increase the person’s independence in dressing, grooming, toileting or bathing or is designed to endure abnormal movement patterns or acting out. Adaptative clothing could also include items prescribed by the person’s doctor that are not covered by the person’s health insurance.

    Supplies and equipment

    CDCS funds can pay for devices (including assistive technology; refer to note below), controls, medical appliances or supplies that allow the person to do one of the following:

  • · Perform activities of daily livings (ADLs).
  • · Perform instrumental activities of daily living (IADLs).
  • · Communicate with others.
  • · Perceive, control, communicate or interact with their environment.

    • Note: The payment for assistive technology assessments depends on the person’s program:

  • · AC and EW: Assistive technology assessments are paid through the person’s CDCS budget.
  • · BI, CAC, CADI and DD waivers: Assistive technology assessments are paid through the county/Tribal Nation waiver budget and must be included on separate service agreement line items.

    • Covered supplies and equipment could include, but are not limited to:

  • · Supplies and equipment not available under the MA state plan, including items that exceed the covered MA state plan service limits. This includes durable and non-durable medical supplies and equipment necessary to meet functional limitations.
  • · Add-ons to otherwise-approved MA state plan items determined necessary to meet the needs identified in the person’s CDCS community support plan.
  • · Standalone assistive technology, monitoring technology or equipment (e.g., shower chair, portable/travel ramp for use in the community) that is not part of a home or vehicle modification project.
  • · Electronic tablets, both as part of a system of environmental controls and as an augmentative communication device.
  • · Equipment repair and maintenance, unless covered by the manufacturer's warranty.
  • · Items necessary for life support and supplies necessary for the proper functioning of the life support items.
  • · Pre-moistened cleansing wipes to aid in continence care related to the person’s disability (all waivers and AC) and/or health condition (AC/EW only).
  • · Used equipment; refer to the next section.

    • Used equipment

    The lead agency may authorize funding for used equipment when one of the following professionals has evaluated the equipment:

  • · Specialized equipment and supplies provider.
  • · OT who specializes in selling, installing or assessing equipment.
  • · PT who specializes in selling, installing or assessing equipment.

    • The professional evaluating the equipment must ensure:

  • · The used equipment meets the person’s assessed needs.
  • · The used equipment has been determined to be in good, working order.
  • · Fair market value is established for the equipment.
  • · The used equipment is cost-effective compared to purchasing new equipment.

    • Worker recruitment

    CDCS funds can pay for costs related to advertisement and recruitment of direct support workers (including newspaper ads, online job postings, online matching services to connect job seekers and people who receive services, etc.) when the expense is on a monthly basis or per job post/ad (i.e., not an annual fee).

    Once the person recruits a direct support worker, they must hire the worker directly, with assistance from the financial management services (FMS) provider.

    Transportation

    CDCS funds can cover transportation costs when the need for the transportation service is due to the person’s functional limitation. Reimbursable transportation costs include the cost of the transport (e.g., mileage or fares) and the person providing the transportation (i.e., driver).

    Notes:

  • · If the person needs assistance while being transported, costs for directly hired workers accompanying and/or driving is covered under CDCS Manual – Unbundled service category: Personal assistance.
  • · For information about transportation that is not covered, refer to the non-covered goods and services section below.

    • Indoor and outdoor home maintenance

    CDCS funds can pay for indoor and outdoor home maintenance services (e.g., washing floors, snow removal, lawn mowing) if all the following are true:

  • · The service is an appropriate way to meet the person’s assessed needs, as identified in their MnCHOICES support plan.
  • · The supports are necessary to maintain a clean, sanitary and safe home environment.
  • · The person cannot perform these tasks due to a functional limitation.

    • Health clubs and fitness centers

    CDCS funds can pay for health clubs and fitness center memberships for adults when the service is necessary and appropriate to treat, improve or maintain the person’s physical condition. The condition must be both:

  • · Identified in the person’s CDCS community support plan.
  • · Monitored by a Minnesota Health Care Programs (MHCP) medical provider.

    • The payment structure must be cost-effective for the person’s actual and projected use of the health club or fitness center. The person must periodically provide verification to the lead agency that they are using the health club or fitness center.

    Home care nursing (HCN) services performed by independent contractors

    CDCS funds can pay for a licensed nurse who is an independent contractor. The person must include these nursing services in their CDCS community support plan under the individual-directed services category and include the costs in their CDCS budget. For specific instructions, refer to CDCS Manual – Independent nurse contractors in CDCS.

    Modifications to recreational activities

    CDCS funds can pay for additional costs of a camp, sports, leisure, hobby or craft class/session that has been modified, adapted or specialized (e.g., special instructor, additional staffing, smaller class size, adaptive equipment) to address the person’s disability (all waivers and AC) and/or condition (AC/EW).

    Because these activities are considered recreational in nature and normally paid for by the person or their parents/family, coverage is limited to any additional costs when they exceed the cost without modifications/adaptations.

    In addition, CDCS funds can be used to support the person to participate in these activities by paying a worker to:

  • · Transport the person to the activity (both the driver’s time and their mileage) when the person is unable to transport themselves.
  • · Accompany the person to the activity and support them with any assistance needed.

    • Note: When authorizing out-of-home respite services provided in a camp setting, refer to CDCS Manual – Purchasing traditional AC/waiver goods and services under CDCS (unbundled).

    Adaptive or one-on-one swimming lessons

    The lead agency may approve the entire cost of adaptive or one-to-one swimming lessons from a qualified instructor for a person whose disability puts them at a higher risk of drowning, as specified in the CDCS community support plan. The person must receive swimming lessons in the most integrated setting appropriate for the person and their needs.

    Non-covered goods and services

    CDCS funds cannot pay for the following goods or services:

  • · Unallowable expenditures listed on CDCS Manual – Allowable and unallowable goods and services under CDCS.
  • · Item expenses that exceed waiver/AC limits.
  • · Oral nutritional products and electrolyte products (BI, CAC, CADI and DD only).
  • · Items that do not provide direct medical or remedial benefit to the person.
  • · Utilities that operate the equipment or supplies.
  • · Items that restrain the person or restrict their rights.
  • · Costs for health clubs or fitness centers for people younger than age 18.
  • · Internet access.
  • · Transportation a parent of a minor or spouse would be expected to provide (e.g., transportation to an after-school activity, day care, shopping centers or recreational events).
  • · Transportation to medical appointments.
  • · Classes, courses or conferences for paid/unpaid caregivers or the person covered under CDCS Manual – Unbundled service category: Treatment and training.
  • · Services that function solely as a substitute for child care.
  • · Water therapy or access to swimming for recreational or diversionary purposes.

    • Remote support service delivery option

    CDCS individual-directed goods and services can be delivered through remote support. Services delivered through remote support must meet all the requirements listed on CBSM – Remote support.

    Purchasing traditional waiver/AC services

    The person can use their individual CDCS funds to purchase waiver/AC goods and services available to them under their program. The good or service approved in the person’s CDCS community support plan must be categorized under individual-directed goods and services. For more information, refer to:

  • · CDCS Manual – Purchasing traditional AC/waiver goods and services under CDCS (unbundled).
  • · CDCS Manual – Purchasing PCA/CFSS and home care services under CDCS.

    • Provider standards and qualifications

    Individuals and vendors providing individual-directed goods and services must:

  • · Have all necessary professional and/or commercial licenses required by federal, state and local statutes and regulations, if applicable (e.g., professional licenses, waiver/AC provider standards for that service and other certifications or registrations).
  • · Have a valid business license in good standing, if applicable.
  • · Bill through the FMS provider.
  • · Be able to demonstrate to the person receiving services that they have the capacity to perform the requested work and the ability to successfully communicate with the person.

    • Special standards and qualifications

    Transportation providers must meet the criteria described on CBSM – Transportation.

    Indoor and outdoor home maintenance vendors must meet the criteria described on CBSM – Chore services, as well as the person’s standards and expectations. For example, the person may purchase snow removal from someone who does snowplowing or heavy housecleaning from a cleaning service. The person can choose to require the vendor to be bonded or insured.

    Providers of adaptive or one-on-one swimming lessons must, at minimum, possess a swimming instructor certificate.

    Verification of provider standards and qualifications

    Lead agency’s responsibilities

    Before approving services, the lead agency case manager/care coordinator must verify the individuals/vendors have:

  • · All necessary professional and/or commercial licenses required by federal, state and local statutes and regulations, if applicable (e.g., professional licenses, waiver provider standards for that service and other certifications or registrations).
  • · A valid business license in good standing, if applicable.
  • · A copy of the swimming instructor’s certificate, if applicable.
    Note: The lead agency must keep a copy of the swimming instructor’s certificate in their files, if applicable.

    • Person’s responsibilities

    The person must ensure all individuals/vendors have:

  • · The capacity to perform the requested work.
  • · The ability to communicate successfully with the person.

    • Additional resources

    CDCS Manual – Independent nurse contractors in CDCS
    CDCS Manual – Purchasing traditional AC/waiver goods and services under CDCS (unbundled)
    CDCS Manual – Purchasing PCA/CFSS and home care services under CDCS
    CBSM – Chore services
    CBSM – Remote support
    CBSM – Transportation

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