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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: 4/14/25

Legal authority

Federally approved BI, CAC, CADI, DD and EW waiver plans, federally approved 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/Alternative Care (AC) or the Medical Assistance (MA) state plan.

Criteria for covered goods and services

People using CDCS may purchase individual-directed goods and services that meet all the following basic waiver/AC requirements:

  • · Necessary to meet a need identified in the person’s assessment.
  • · Related to the person’s disability and/or condition.
  • · For the direct benefit of the person receiving services.
  • · Included in the person’s CDCS community support plan (CSP).

    • 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. Requested items must meet all basic waiver/AC criteria for allowable expenditures on CDCS Manual – Allowable and unallowable goods and services under CDCS before approval. A recommendation does not determine who is responsible to pay for the good/service.

    Examples

    This section includes examples of goods and services a 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 a 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:

  • · Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Developmental Disabilities (DD) waivers: Assistive technology assessments are paid through the county/tribal nation waiver budget and must be included on separate service agreement line items.
  • · Alternative Care (AC) and Elderly Waiver (EW): Assistive technology assessments are paid through the person’s CDCS budget.

    • 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 CSP.
  • · Standalone 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 and/or health condition.
  • · Items and expenses necessary and reasonable for the person to transition from an eligible setting to their own home.
  • · 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.
  • · Occupational therapist who specializes in selling, installing or assessing equipment.
  • · Physical therapist 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).

    Note: 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.

    Housecleaning services and outdoor maintenance tasks

    CDCS funds can pay for housecleaning or outdoor maintenance services (e.g., snow removal, lawn mowing) if both of the following are true:

  • · 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 condition. The condition must be both:

  • · Identified in the person’s CDCS CSP.
  • · 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 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 CSP under the individual-directed services category and include the costs in their CDCS budget. For specific instructions, refer to DHS – CDCS and home care nursing frequently asked questions.

    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 to meet the person’s disability and/or condition-related needs (e.g., special instructor, additional staffing, smaller class size, adaptive equipment).

    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)

    Non-covered goods and services

    Non-covered goods

    CDCS funds cannot pay for the following goods:

  • · Any prescription and over-the-counter medications, compounds and solutions and related fees, including premiums and co-pays.
  • · Room and board.
  • · Personal items.
  • · Oral nutritional products and electrolyte products (BI, CAC, CADI and DD only).
  • · Items available through other funding services, including, but not limited to MA state plan, Medicare, education expenses and other liable third parties.
  • · 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.
  • · Tickets and related costs to attend sporting or other recreational events.
  • · Animals (including service animals) and their related costs.

    • Non-covered services

    CDCS cannot pay for the following services:

  • · Costs for health clubs or fitness centers for people younger than age 18.
  • · Experimental treatments.
  • · Internet access.
  • · Services that are recreational in nature.
  • · Any fees incurred by the person (e.g., MHCP fees and co-pays).
  • · Attorney costs or costs related to advocate agencies.
  • · Transportation that 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.

    • 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

    A person can use their individual CDCS funds to purchase any of the waiver/AC goods and services currently available under their program. The good or service approved in the person’s CDCS CSP 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 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.
  • · 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

    Private individuals may provide transportation when they meet the person’s needs and preferences in a cost-effective manner. They can substitute for common carriers (e.g., Metro Mobility, buses, taxis) if they are a cost-effective option. They must have a valid driver’s license and meet state requirements for insurance coverage.

    Housecleaning or outdoor maintenance vendors

    Housecleaning and outdoor maintenance vendors must meet the person’s standards and expectations. For example, the person may purchase snow removal from a person who does snowplowing or heavy housecleaning from a cleaning service. The person can choose to require the vendor to be bonded or insured.

    Nursing services performed by independent contractors

    Home care nursing is ongoing, physician-ordered, hourly nursing services provided by a registered nurse (RN) or licensed practical nurse (LPN). The nurse must:

  • · Receive orders and implement interventions delegated, ordered or prescribed by a licensed health care provider.
  • · Maintain signed physician’s orders for the person in their files.

    • An RN must supervise an LPN independent contractor.

    The person may negotiate payment rates for a nurse who is an independent contractor, but that rate cannot exceed any state-established service rates (including bonuses).

    Verification of provider standards and qualifications

    Lead agency’s responsibilities

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

  • · All necessary professional and/or commercial licenses required by federal, state and local statutes and regulations, if applicable.
  • · A valid business license in good standing, if applicable.

    • Person’s responsibilities

    The person must ensure the individuals/vendors have:

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

    • When using nursing services performed by independent contractors, the person must:

  • · Verify each independent nurse’s qualifications/license.
  • · Obtain copies of verification of each nurse’s license, liability coverage and any other requirements.
  • · Provide copies of this documentation to the FMS provider and lead agency case manager/care coordinator upon request.

    • FMS provider’s responsibilities

    For independent nurse contractors, the FMS provider must check the excluded provider list to ensure the nurse can be a paid provider.

    Although not required, the FMS provider can choose to conduct its own verification of independent contractor qualifications as part of its standard business practices.

    Additional resources

    CDCS Manual – Purchasing traditional AC/waiver goods and services under CDCS (unbundled)
    CDCS Manual – Purchasing home care services under CDCS
    CBSM – Remote support

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