Revision 16-1; Effective May 3,2016

 

 

8100 Overview

Revision 15-3; Effective March 11, 2015

 

The Consumer Directed Services (CDS) option was codified in Section 531.051 of the Government Code and expanded by the 79th Legislature to provide more options for individuals to direct their Long-term Services and Supports (LTSS). The rules for the CDS option are found in Texas Administrative Code Title 40, Chapter 41.

§41.107 — Overview of the CDS Option.

(a) An individual or LAR may elect the CDS option if:

(1) the individual's program offers the CDS option;

(2) one or more program services in the individual's authorized service plan are available for delivery through the CDS option;

(3) the individual or LAR agrees to perform, or to appoint a DR to perform, the employer responsibilities required for participation in the CDS option;

(4) the individual or LAR selects a CDSA to provide FMS; and

(5) the individual or LAR has developed and received approval from the service planning team for each required service back-up plan.

(b) If an individual or LAR elects to participate in the CDS option, the individual or LAR:

(1) selects a CDSA to provide FMS;

(2) with the assistance of the CDSA, budgets funds allocated in the individual's service plan for delivery through the CDS option; and

(3) recruits, screens, hires, trains, manages, and terminates service providers.

(c) An individual or LAR, as the employer, may appoint in writing a willing adult as the DR to assist in performing employer responsibilities.

CDS is a service delivery option in which an individual or legally authorized representative (LAR) employs and retains service providers and directs the delivery of Respite Services and Flexible Family Support Services.

An individual participating in the CDS option is required to use a Financial Management Services Agency (FMSA) chosen by the individual or LAR to provide financial management services (FMS). FMS is defined as services delivered by the FMSA to an employer such as an initial orientation, training, support, assistance with and approval of budgets, and processing payroll and payables on behalf of the employer.

 

8110 Definitions

Revision 15-3; Effective March 11, 2015

 

The following terms, when used in reference to the Consumer Directed Services (CDS) option, have the following meanings:

Budget — A written projection of expenditures for each program service delivered through the CDS option.

Designated Representative (DR) — A willing adult appointed by the employer of record to assist with or perform the employer's required responsibilities to the extent approved by the employer. The DR is not the employer of record. The DR is not paid.

Employee — A person employed by the individual or LAR through a service agreement to deliver program services, who is paid an hourly wage for those services.

Employer of Record — The individual or LAR who chooses to participate in the CDS option and, therefore, is responsible for hiring and retaining service providers to deliver program services.

Financial Management Services (FMS) — Financial management services delivered by the FMS agency (FMSA) to the individual or LAR such as orientation, training, support, assistance with and approval of budgets, and processing payroll and payables on behalf of the individual or LAR.

Legally authorized representative (LAR) — A person authorized by law to act on behalf of an individual with regard to matters described in the CDS option, including a parent, guardian, managing conservator of a minor, or the guardian of an adult.

Service Back-up Plan — A documented plan to ensure that critical services delivered through the CDS option are provided to an individual when normal service delivery is interrupted or there is an emergency.

 

8200 Individual Choice in the CDS Option

Revision 13-2; Effective May 1, 2013

 

All individuals will continue to be assessed for financial and functional eligibility under the guidelines currently in use.

There is no change in eligibility determination. Individuals have the option of using a personal attendant for flexible family support or respite services delivered through a contracted home health agency or using the Consumer Directed Services (CDS) option, in which they hire and manage their own personal attendant.

Individuals currently receiving MDCP services may call and request to change to the CDS option at any time during the individual plan of care year.

 

8210 Initial Presentation of the CDS Option

Revision 15-6; Effective May 20, 2015

 

Texas Administrative Code §41.109, Enrollment in the CDS Option.

The case manager is responsible for presenting the Consumer Directed Services (CDS) option to individuals applying for MDCP services and individuals already receiving MDCP services. The case manager will review the CDS option annually during the reassessment. Unless an individual selects a different option from the initial choice, a new Form 1584, Consumer Participation Choice, is not required. Refer to Section 2370, Explaining Electronic Visit Verification Requirements, for talking points on explaining Electronic Visit Verification requirements to the applicant or individual requesting the CDS option.

The individual's signature on Form 2417, Rights and Responsibilities of Families/Primary Caregivers/Independent Individual, is acknowledgement of the presentation of the CDS option information. The case manager is also responsible for discussing Form 1581, Consumer Directed Services Option Overview, with the individual. If the individual is not interested in the CDS option, the individual signs Form 1584 and the case manager:

  • gives a copy to the individual;
  • files the form in the individual's case file;
  • ensures the individual understands that the option is available; and
  • informs the individual that a request to change to the CDS option can be made at any time.

If the individual is interested in the CDS option, the case manager must present Form 1582, Consumer Directed Services Responsibilities, which includes the following information:

  • responsibilities of the case manager and the Financial Management Services Agency (FMSA);
  • risks versus advantages; and
  • individual self-assessment.

In completing the individual self-assessment portion of the form with the individual, the case manager:

  • assists the individual in determining if he needs additional support from a Designated Representative to use the CDS option and documents the Designated Representative decision on Form 1582;
  • has the individual sign Form 1584, indicating that he selects the CDS option or wishes to remain with the provider agency option; and
  • presents Form 1583, Employee Qualification Requirements. If the individual selects the CDS option, forms and documentation regarding the CDS option are completed, which include the following information:
    • forms and documentation responsibilities in CDS;
    • employee qualification requirements;
    • personal attendant provider qualifications; and
    • employee relationship to the CDS individual.

The case manager presents the list of contracted FMSAs to the individual to select an FMSA.

The case manager may also inform the individual that The Department of Aging and Disability Services (DADS) website provides a choice list of FMSAs for individuals using the CDS option. The list, which allows individuals to search for FMSAs by county, can be accessed at: hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/consumer-directed-services-cds.

Under the CDS menu, select CDS Agencies and a list of DADS programs will appear. When a program is selected, on the top of the page is a drop-down list of Texas counties. After selecting a county, click the button labeled “Search for FMSAs”. This will create a list of FMSAs serving the selected county.

Declining the CDS Option

If the individual or legally authorized representative (LAR) declines or is not ready to select the CDS option after Form 1582 is shared, the case manager:

  • obtains the applicant's/individual's or LAR's signature on Form 1584 indicating his selection of the HCSSA option; and
  • signs and dates Form 1584.

The case manager must ensure the individual understands the CDS option is always available, and that the individual may call the case manager to request a change to the CDS option at any time.

Form 1584 is signed by the individual when a different service delivery option is chosen. For exceptions, see Section 8600, Transfer Procedures.

 

8220 CDS Option for Ongoing Individuals

Revision 12-1; Effective May 1, 2012

 

After the initial presentation, the individual signs Form 1584, Consumer Participation Choice, and the case manager files it in the case file.

The case manager will review the CDS option annually during the reassessment. The information is presented on Form 2417, Rights and Responsibilities of Families/Primary Caregivers/Independent Individual. Unless an individual selects a different option from the initial choice, a new Form 1584 is not required.

 

8300 Developing the Individual Service Plan

Revision 13-2; Effective May 1, 2013

 

§41.111. Service Planning in the CDS Option

(a) Service planning for an individual who chooses to participate in the CDS option is completed in accordance with the rules and requirements of the individual's program in the same manner as if services are delivered through a program provider. Service planning includes:

(1) determining the individual's needs;

(2) determining service levels;

(3) justifying changes to the service plan;

(4) maintaining costs and cost ceilings;

(5) reviewing services; and

(6) obtaining approval for planned services.

(b) A case manager or service coordinator must adhere to rules and requirements of the individual's program and in Subchapter D of this chapter (relating to Enrollment, Transfer, Suspension, and Termination) if the individual's services or a request for services is recommended for:

(1) denial;

(2) reduction;

(3) suspension; or

(4) termination.

(c) A case manager or service coordinator must provide an oral explanation of an action recommended by a service planning team. The procedure for requesting a fair hearing must be provided orally and in accordance with the individual's program requirements.

Case managers continue to determine eligibility and develop a service plan using current policy. All financial and non-financial eligibility requirements apply. Consumer Directed Services (CDS) is not a different service; it is a service delivery option.

The individual using the CDS option must have a back-up system to assure the provision of authorized Respite and Flexible Family Support Services deemed critical to the health and welfare of the individual. The individual or legally authorized representative must develop and receive approval from the case manager for each required service back-up plan in order to participate in the CDS option. Refer to Section 8420, Service Back-up Plans.

 

8400 Initiation and Transition to the CDS Option

Revision 15-3; Effective March 11, 2015

 

§41.401. Enrollment Process

The enrollment process is conducted in accordance with §41.109 of this chapter (relating to Enrollment in the CDS Option). Within five working days after receipt of a completed Form 1584, Consumer Participation Choice, by an eligible individual or LAR, or upon receipt of Form 1584 and within five working days after eligibility determination for an applicant applying for program services, a case manager or service coordinator must provide the following documentation to the Financial Management Services Agency (FMSA):

(1) Form 1584;

(2) the individual's authorized service plan;

(3) the individual's plan of care; and

(4) if not provided in paragraph (1)-(3) of this section:

(A) the date the employer may begin incurring expenses to initiate start-up activities and to incur recruitment and hiring expenses;

(B) the date the employer may begin delivery of program services through the employer's service providers;

(C) the number of units, the approved rate, or the amount authorized in the individual's service plan for each service to be delivered through the CDS option;

(D) the total funds authorized for each program service to be delivered through the CDS option; and

(E) the authorized schedule of service delivery per day, week, month, or other time frame specific to the service.

Individuals choosing the Consumer Directed Services (CDS) option must be Medicaid eligible or will become Medicaid eligible by the individual plan of care (IPC) service initiation date.

Within five working days after the applicant has met all MDCP eligibility criteria and has requested enrollment into the CDS option via Form 1584, Consumer Participation Choice, case managers must send a referral to the applicant's chosen financial management service (FMS) provider.

The referral packet will include:

  • Form 1584, signed by the individual, parent or legally authorized representative (LAR), and case manager;
  • Form 1740, Service Backup Plan, for each service;
  • Form 2065-B, Notification of Waiver Services;
  • Form 2402, Consumer Directed Services Option — Services Authorization; and
  • Form 2410, Medical-Social Assessment and Individual Plan of Care.

The case manager must refer to Section 3130 and Section 7130, Individual Plan of Care Development, at initials and annual reassessments for rounding respite or flexible family support services units per week up to the next quarter-hour on the IPC. The case manager also sends Form 2067, Case Information, to the agency to advise that the individual has selected the CDS option and requests that training be delivered to the individual. The agency is required to respond to the case manager on Form 2067 within 30 days to advise that the training and transition planning has been completed and the individual is ready to negotiate a start date for CDS.

If the agency is unable to complete the training within the required time frames, an explanation must be provided on Form 2067. If the case manager has not heard from the individual and FMSA in 30 days, the case manager should contact the individual regarding the delay.

For MDCP Applicants using the Money Follows the Person (MFP) option whose Medicaid Eligibility will not be determined until 30 Days after the Nursing Facility (NF) Admission Date

Case managers must inform MFP applicants who are not yet Medicaid eligible when discharged from the NF that MDCP services must be delivered through the provider service delivery model until Medicaid eligibility is determined. Case managers follow current policy and enroll applicants using the provider service delivery model. Once applicants have been certified for Medicaid, case managers must add FMS as a change to the IPC and change the respite authorization to CDS.

For Individuals Choosing the CDS Option at the Annual Reassessment

The case manager may also enroll MDCP Individuals into the CDS option at the annual reassessment. Once an Individual has met all ongoing MDCP eligibility criteria and requests enrollment into the CDS option, case managers must send a referral to the applicant's chosen FMS provider within five working days, as described above.

FMSAs that do not Accept Referrals

FMSAs are not required to provide services to all referred individuals. In rare instances, such as anticipation of contract termination or placement on vendor or individual hold, an FMSA may not accept referrals.

If the selected FMSA is not able to provide services to the individual, the FMSA must send the case manager written notification using Form 2067. Receipt of this written notification will prompt the case manager to offer the individual another choice of FMSA and to provide the newly selected FMSA with the required documentation, following the same procedures outlined above.

 

8410 Initial Orientation of the Employer

Revision 16-1; Effective May 3,2016

Texas Administrative Code §41.207, Initial Orientation of an Employer

Employers of Record for Individuals Using the CDS option

Texas Administrative Code Chapter 41 rules regarding the Consumer Directed Services (CDS) option define a parent as a natural, legal, foster, or adoptive parent of a minor. A legally authorized representative (LAR) is a person authorized or required by law to act on behalf of an individual, including a parent, guardian, managing conservator of a minor, or the guardian of an adult. An applicant or individual age 18 and over who does not have an LAR to sign CDS forms is the employer of record, and may designate a representative to assist with the CDS option.

Upon receipt of the CDS referral from the case manager, the Financial Management Services Agency (FMSA) completes the initial employer orientation with the individual, LAR or designated representative (DR) in the individual's residence. The FMSA provides an overview of the CDS option, including the rules and requirements of applicable government agencies, and the roles of the employer and the FMSA.

The individual, LAR or DR signs and submits all required forms for participation in the CDS option and returns the forms to the FMSA within five calendar days after the date of initial orientation.

The individual and FMSA notify the case manager when all initiation activities are complete.

 

8420 Service Back-Up Plans

Revision 15-3; Effective March 11, 2015

 

§41.217. Service Back-up Plan

(a) An employer or DR must develop and document a service back-up plan for each service to be delivered through the CDS option that the individual's service planning team has determined to be critical to the health and welfare of the individual.

(b) An individual's service planning team must describe:

(1) which services are critical; and

(2) the length of time that constitutes a service interruption or an emergency for the individual.

(c) An employer or DR must develop a service back-up plan that:

(1) ensures the provision of services when the employer's regular service provider is not available to deliver the service or in an emergency; and

(2) may include the use of:

(A) paid service providers;

(B) unpaid service providers, such as family members, friends, or non-program services; or

(C) use of respite, if included in the authorized service plan.

The case manager must discuss with the individual, legally authorized representative (LAR) or designated representative (DR) the services delivered through Consumer Directed Services (CDS) that are critical to the individual's health and welfare and inform the individual, LAR or DR to develop a service back-up plan to ensure the health and safety of the individual when regular service providers are not available to deliver services or in an emergency. The individual, LAR or DR must develop a back-up system to assure the provision of all authorized services without a service break.

The individual, LAR or DR, with the assistance of the case manager if needed, develops a service back-up plan. The service back-up plan must list the steps the individual, LAR or DR will implement in the absence of the service provider. The service back-up plan may include the use of paid service providers, or unpaid service providers such as family members, friends or non-program services, or Flexible Family Support Services if included in the authorized service plan. The individual, LAR or DR is responsible for implementation of the service back-up plan in the absence of the employee.

Service back-up plans are submitted by the individual, LAR or DR to the case manager. The back-up plan is approved as being viable in the event a service provider is absent by:

  • the case manager;
  • the individual; and
  • the primary caregiver.

The case manager, individual and the primary caregiver must approve each service back-up plan, as well as any

Revision, before implementation by the individual, LAR or DR. The case manager approves the service back-up plan by signing and dating the plan and returning a copy of the plan to the individual, LAR or DR.

The individual, LAR or DR is required to:

  • budget sufficient funds in the CDS option budget to implement a service back-up plan;
  • review and revise each service back-up plan annually;
  • revise a service back-up plan if:
    • the individual experiences a problem in the implementation of a service back-up plan;
    • there are changes in availability of service back-up plan resources; and
    • the individual, LAR or DR redistributes funds that are not utilized in carrying out a service back-up plan; and
  • provide a copy of the initial and revised service back-up plans and budgets to the Financial Management Services Agency (FMSA) within five working days after a plan's approval by
    • the case manager;
    • the individual;
    • the primary caregiver; and
    • other individuals participating in the individual's care.

The FMSA must assist an individual, LAR or DR, as requested, to revise budgets to meet service back-up plan strategies approved by the individuals specified in the previous paragraph, reimburse documented, budgeted, allowable expenses incurred related to implementing service back-up plan strategies; and retain a copy of service back-up plans received from the individual, LAR or DR.

 

8430 Corrective Action Plans

Revision 15-3; Effective March 11, 2015

 

§41.221. Corrective Action Plans

(a) A written corrective action plan may be required from an employer or DR if the employer or DR:

(1) hires an ineligible service provider;

(2) submits incomplete, inaccurate, or late documentation of service delivery;

(3) does not follow the budget;

(4) does not comply with program requirements related to the CDS option; or

(5) does not meet other employer responsibilities.

(b) An employer must provide written corrective action plans to the person requiring the plan within 10 calendar days after receiving the request. Corrective action plans may be requested in writing by:

(1) a FMSA, related to employer responsibilities;

(2) a case manager or service coordinator;

(3) a service planning team; or

(4) a DADS representative.

(c) A written corrective action plan must include:

(1) the reason the corrective action plan is required;

(2) the action to be taken;

(3) the person responsible for each action; and

(4) the date the action must be completed.

(d) An employer or DR may request assistance in the development or implementation of a corrective action plan from:

(1) the FMSA or others if the plan is related to employer responsibilities, as described in this subchapter;

(2) if applicable, the support advisor as described in Subchapter F of this chapter (relating to Support Consultation Services and Support Advisor Responsibilities); and

(3) the case manager, service coordinator, or others if the corrective action plan is related to program rules or requirements.

The individual, legally authorized representative (LAR) or designated representative (DR) must provide written corrective action plans to the person requiring the plan within 10 calendar days after receiving the request to provide a plan. Corrective action plans may be requested in writing by a:

  • Financial Management Services Agency (FMSA), related to employer responsibilities;
  • case manager or service coordinator;
  • service planning team; or
  • DADS representative.

The written corrective action plan, Form 1741, Corrective Action Plan, must include the:

  • reason the corrective action plan is required;
  • action to be taken;
  • person responsible for each action; and
  • date the action must be completed.

The individual, LAR or DR may request assistance in the development or implementation of a corrective action plan from the:

  • FMSA or others if the plan is related to employer responsibilities; and
  • case manager if the corrective action plan is related to program rules or requirements.

FMSA Quarterly Reports

§41.317. CDSA Reports

(1) compile a report in accordance with the format provided by DADS addressing each service delivered through the CDS option, including the actual number of hours or units of service delivered;

(2) provide the report no less than quarterly, and monthly if requested, to:

(A) the employer or DR; and

(B) the case manager or service coordinator; and

(3) provide a copy of the report to DADS, upon request by a DADS representative.

The FMSA must provide the budget status report at least quarterly to the individual or LAR and case manager. The individual or LAR may request the FMSA provide the budget report on a monthly basis. The individual or LAR must initiate budget

Revisions if needed to ensure sufficient funds and units of a service are available through the end date of the individual plan of care.

 

8500 Employer Difficulty Managing the CDS Option

Revision 15-3; Effective March 11, 2015

 

If during the 30-day contact or individual plan of care (IPC) service monitor review, it is evident the Consumer Directed Services (CDS) employer is having difficulty in the management of services under the CDS option, the case manager may consult with the Financial Management Services Agency (FMSA).

Examples of CDS employer difficulty in managing services under the CDS option:

  • Lack of adequate supervision of the employee resulting in necessary services not being delivered; and
  • Misuse of funds so that the annual authorized amount of services will be expended before the IPC period is over.

The case manager may recommend additional training for the CDS employer in certain areas or relay concerns on budget management.

Problems with the FMSA should be resolved following procedures in Section 5200, Service Delivery Issues Reported to DADS Staff.

Problems noted with services delivered through the CDS option should be sent to the FMSA via Form 2067, Case Information. The case manager may recommend additional training for the individual, LAR, or DR in certain areas or relay concerns on fiscal management. The case manager may request a corrective action plan. Refer to Section 8430, Corrective Action Plans.

Problems with the FMSA should be noted and resolved with the FMSA, or sent to Consumer Rights and Services.

 

8600 Transfer Procedures

Revision 15-3; Effective March 11, 2015

 

The case manager follows normal agency transfer procedures. If issues with the current agency cannot be resolved, the individual has the right to transfer.

The individual has the right to transfer to a different Financial Management Services Agency (FMSA) or request a transfer back to the Home and Community Support Services Agency (HCSSA) option at any time.

If the individual chooses to transfer back to the HCSSA option, the case manager negotiates a transfer date not to exceed 14 days to begin flexible family support or respite services through the HCSSA.

The case manager sends both the FMSA and the HCSSA a new service authorization, with one showing an end date another showing a start date.

In addition, the case manager is responsible for arranging for services as quickly as possible and assisting individuals in exploring other resources, as necessary.

 

8610 Termination of Participation in the CDS Option

Revision 15-3; Effective March 11, 2015

 

§41.407. Termination of Participation in the CDS Option

(a) An employer may request voluntary termination of participation in the CDS option and receive services through a program agency provider at any time. The termination must last at least 90 calendar days.

(b) An individual may be involuntarily terminated from participation in the CDS option in accordance with the requirements of the individual's program.

(c) FMS and, if applicable, support consultation, are terminated in the individual's service plan when participation in the CDS option is terminated.

The Financial Management Services Agency (FMSA) is responsible for:

  • notifying the case manager of concerns about the individual's inability to comply with CDS option requirements and for providing the case manager with supporting documentation, such as a corrective action plan; and
  • providing documentation to the case manager when interventions and assistance provided to the individual have not resolved the individual's refusal or inability to comply with CDS option requirements.

The case manager is responsible for:

  • notifying the FMSA of concerns noted by the case manager or regional nurse about the individual's circumstances or inability to comply with CDS option requirements; and
  • providing supporting documentation of any concerns.

With supporting documentation from the FMSA, the case manager can recommend to the individual that he voluntarily request to change to the Home and Community Support Services Agency (HCSSA) option.

The case manager transfers the individual back to the HCSSA option. Form 2065-B, Notification of Waiver Services, is sent to the individual to notify of the termination of the CDS option.

Issues of non-compliance with CDS option requirements may result in the termination of an individual's participation in the CDS option. The case manager, in consultation with the primary caregiver, may recommend immediate termination of participation in the CDS option when the:

  • individual's health or welfare is immediately jeopardized by the individual's participation in the CDS option;
  • designated representative (DR) has been convicted of an offense under Chapter 32 of the Penal Code or an offense barring employment as listed in the Texas Health and Safety Code, §250.006(a) and (b); or
  • Department of Aging and Disability Services (DADS) or another government agency with applicable regulatory authority recommends that participation in the CDS option be immediately terminated.

Before an FMSA recommends involuntary termination of participation in the CDS option to the case manager, the FMSA must:

  • provide documentation to the case manager of additional and ongoing training and supports provided by the FMSA when an individual, legally authorized representative (LAR) or DR demonstrates noncompliance with employer responsibilities;
  • provide assistance requested by the individual, LAR or DR to develop and implement a corrective action plan;
  • provide documentation of any corrective action plan required of the individual, LAR or DR by the FMSA;
  • notify the case manager in writing of the recommendation to terminate the individual's participation in the CDS option.

The individual, LAR or DR must be given the opportunity to implement interventions to:

  • eliminate jeopardy to the individual's health or welfare;
  • successfully direct the delivery of program services through CDS;
  • meet employer responsibilities;
  • successfully implement corrective action plans; or
  • appoint a DR or access other available supports to assist the individual in meeting employer responsibilities.

The case manager must provide assistance to the individual with accessing supports, developing and implementing a corrective action plan, and documenting interventions utilized by the individual, LAR, or DR to eliminate the noncompliance with the CDS option.

The case manager meets with the individual, the primary caregiver and any other individual participating in the care of the individual to:

  • consider recommendations related to the individual's participation in the CDS option;
  • recommend additional interventions to be implemented to protect the individual's health and welfare for continued participation in the CDS option; and
  • make Revisions to the individual plan of care (IPC), if needed.

If the primary caregiver and other individuals participating in the individual's care recommend termination of participation in the CDS option, the case manager sends Form 2065-B to notify the individual of termination of participation in the CDS option. The individual has the right to appeal. Form 2065-B must include the:

  • reason(s) for the recommendation to terminate the CDS option; and
  • conditions and time frame established by the primary caregiver, the DADS nurse, and other individuals participating in the individual's care that the individual must meet prior to re-enrollment in the CDS option.

The case manager must also document in the case record:

  • the justification for any time period for a termination in excess of the minimum 90-day requirement; and
  • if applicable, the conditions and time frame specified by a hearing officer as the result of a fair hearing that upholds the termination.

When an individual's participation in the CDS option is terminated, the case manager must take steps and interventions in accordance with the requirements of the Medically Dependent Children Program to:

  • ensure delivery of program services that were being delivered through the CDS option; and
  • document arrangements made for delivery of program services that were being delivered through the CDS option to be delivered by the HCSSA or other resources.

The FMSA must provide a final report to the individual or LAR and the case manager within five working days after the individual's termination. The FMSA must provide copies to the individual or LAR of documentation as received and filed on behalf of the individual following the individual's termination from the CDS option and submit a satisfaction survey to the employee.

For involuntary termination, the individual cannot be re-enrolled in the CDS option until he has met the time frame and conditions established by the:

  • case manager;
  • primary caregiver; or
  • hearings officer.

The case manager is required to complete Form 1584, Consumer Participation Choice, any time the individual chooses a different service delivery option.

If the individual is being involuntarily terminated from the CDS option and the case manager is unable to get Form 1584 signed, the case manager must document the reason in the case file.

 

8620 Re-enrollment in the CDS Option

Revision 16-1; Effective May 3,2016

Texas Administrative Code §41.409, Re-enrollment for Participation in the CDS Option

Upon receipt of request from an individual to re-enroll in the Consumer Directed Services (CDS) option after a suspension or termination of the CDS option, the case manager determines if established criteria to return to the CDS option is met in consultation with the:

  • individual;
  • primary caregiver;
  • Department of Aging and Disability Services (DADS) nurse; and
  • other individuals participating in the individual's care, as appropriate.

The case manager reviews the reason for the suspension or termination, determines if any issues relating to the suspension or termination are still unresolved, and verifies time frame requirements.

If an individual's request for re-enrollment in the CDS option is approved, the case manager revises the service plan, ensures service back-up plans are in place and authorizes the CDS option.

The case manager follows routine transfer procedures to refer the individual to the Financial Management Services Agency (FMSA) and sends Form 2065-B, Notification of Waiver Services, to notify the individual, Home and Community Support Services Agency (HCSSA) and the FMSA of the transfer of the individual back to the CDS option.

If a request for re-enrollment is not approved, the case manager sends Form 2065-B to notify the individual the request is not approved. The case manager must notify the individual of the reason the request for re-enrollment is not approved and assist the individual in resolving any issues that prohibit re-enrollment.

If the individual requests re-enrollment after a suspension, the case manager is not required to complete Form 1584, Consumer Participation Choice. CDS forms currently on file in the case record are still applicable upon reactivation of the CDS option. The case manager should complete new CDS forms only if the form requires a change related to the delivery of services, such as Form 1733, Employer and Employee Acknowledgement of Exemption from Nursing Licensure for Certain Services Delivered through Consumer Directed Services.

If the individual requests re-enrollment after a termination, the case manager shares the information on Form 1584 and obtains the individual's or legally authorized representative's (LAR's) signature documenting the choice to receive services through the CDS option. Form 1581, Consumer Directed Services Option Overview, Form 1582, Consumer Directed Services Responsibilities, Form 1583, Employee Qualification Requirements, and Form 1733 must be completed with the individual before returning to the CDS option.

If approved for re-enrollment, the FMSA must provide the individual, LAR or designated representative (DR) with an initial orientation if the current individual, LAR or DR has not received an initial orientation.

The FMSA must also notify the individual, LAR or DR, and the individual's case manager in writing within two working days after any repeat of prior noncompliance or additional noncompliance with program requirements.

 

8700 CDS Contact Chart

Revision 15-3; Effective March 11, 2015

 

Due to the involvement of different entities in the provision of Consumer Directed Services (CDS), it is sometimes difficult to determine who is responsible for responding to questions asked by an applicant, individual or the applicant’s or individual’s family.

The table below was developed for the DADS case manager to use when making this determination.

If an individual asks the case manager a question related to CDS that falls under the Financial Management Services Agency (FMSA) purview to answer, the case manager must refer the individual to the FMSA rather than attempting to answer the question himself. He can also contact the FMSA for the individual. If the case manager has a general non-individual specific question about the CDS option, the case manager must contact the regional CDS liaison rather than contacting an FMSA. If the regional CDS liaison cannot answer the question, the question is forwarded to state office.

CDS Contact Chart

Issue or Question Related to: Contact:
  • Service authorization
  • Rates for CDS services (unrelated to wages)
  • Offering the CDS option upon enrollment and annually thereafter
  • CDS backup service plan request and approval
  • Approving or requesting a corrective action plan for an individual who is having difficulty with the CDS option
  • Program rules, including those specifically related to the CDS option
  • Service plan (including related forms)
  • Convening all interdisciplinary team meetings, including those meetings needed to address CDS issues
  • Change in service delivery option at the individual’s request or through involuntary termination of the CDS option
  • Change in FMSA
  • Non-CDS services
Case manager contacts regional CDS liaison

 

Regional CDS liaison contacts state office – Ginny Grote
ginny.grote@dads.state.tx.us

  • Initial CDS orientation
  • Employer-related paperwork
  • Issues with service delivery
  • Ongoing training and support related to employer issues
  • CDS budget
  • Criminal history checks
  • Verification of licensing credentials of potential service providers
  • Payroll withholdings, deposits, reporting, timesheets, receipts, invoices and payment to service providers
  • Budget status report
  • Support consultation
  • Support advisor
Case manager refers individual to FMSA

FMSA contacts CDS program coordinator in the Center for Policy and Innovation via email only

  • Billing and payment issues
Case manager contacts regional CMS coordinator
  • FMSA contract issues, including difficulty locating contract numbers in the Service Authorization System (SAS) and choice list issues
Case manager contacts regional CDS liaison

Regional CDS liaison contacts state office Community Services Contracts Unit:
paul.straka@dads.state.tx.us
misti.ackermann@dads.state.tx.us
communityservicescontracts@dads.state.tx.us

CDS website: hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/consumer-directed-services-cds