Revision 12-2; Effective April 6, 2012

 

 

13100 Overview of the Consumer Directed Services Option

Revision 10-0; Effective June 1, 2010

 

 

13110 Home and Community-based Services Available Through the Consumer Directed Services Option

Revision 10-0; Effective June 1, 2010

 

In the Home and Community-based Services (HCS) program, the Consumer Directed Services (CDS) option is available only to those who live in their own home or family home. Individuals who receive foster/companion care, Residential Support or Supervised Living are not eligible to use the CDS option.

The HCS services currently available for self-direction are:

  • Supported Home Living (SHL)
  • Respite

When individuals select the CDS option, they are required to use Financial Management Services (FMS) and may access support consultation.

Financial Management Services (FMS) are provided by a Consumer Directed Services Agency (CDSA) chosen by the individual or legally authorized representative (LAR). FMS includes processing payroll and payables on behalf of the CDS employer. This includes serving as the CDS employer’s fiscal agent to ensure that federal, state and local employment taxes and labor and workers’ compensation requirements are implemented in an accurate and timely manner. FMS also includes orientation, training, support and assistance with and approval of CDS budgets.

Support consultation is an optional service that is provided by a support advisor and provides a level of assistance and training beyond that provided by the CDSA through FMS. Support consultation helps a CDS employer to meet the required employer responsibilities of the CDS option and to successfully deliver program services.

 

13120 Informing the Individual/LAR of the Consumer Directed Services (CDS) Option

Revision 11-3; Effective March 18, 2011

 

The service coordinator (SC) must inform an individual/legally authorized representative (LAR) of the CDS option:

  • at HCS program enrollment;
  • at the request of the individual/LAR;
  • at the time the individual moves out of a residential setting into his/her own or family home; and
  • annually if the individual is receiving supported home living or respite services.

Individuals have a choice in how their services are delivered:

  • Provider-Managed Option – The individual/LAR chooses to have an HCS provider deliver all of their HCS Program authorized services.
  • CDS Option – The individual/LAR serves as the employer of direct service providers for those services chosen to be delivered through CDS.

The service delivery option individuals select will be based on their own preferences, as discussed during the person-directed planning process. It is important to tell individuals that they may switch service delivery options at any time. If they select the CDS option, they can switch to the provider-managed option at any time. However, if an individual switches from the CDS option to provider-managed option, they must wait 90 days before switching back to CDS.

The SC offers the CDS option by reviewing the following Department of Aging and Disability (DADS) forms with the individual:

  • Form 1581, Consumer Directed Services Option Overview
  • Form 1582, Consumer Directed Services Responsibilities
  • Form 1583, Employee Qualification Requirements
  • Form 1584, Consumer Participation Choice
  • Form 1586, Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option

The purpose of Form 1581 is to introduce the CDS option. Form 1581 gives an overview of the differences between the CDS option and the provider-managed option. This form, when signed, provides acknowledgement that the SC has provided both orally and in writing an overview of the benefits and responsibilities of the CDS option in HCS.

  • If the individual chooses at this point to decline the CDS Option, the SC completes Form 1584, indicating the choice of the "Agency Option." The SC does not complete DADS Forms 1582, 1583 or 1586.
  • If the individual wants to know more about the CDS option, the SC continues to Form 1582.

The purpose of Form 1582 is to provide more detailed information to the individual or LAR about the responsibilities assumed if the CDS option is selected. It concludes with the CDS Consumer Self-Assessment. The purpose of the self-assessment is to:

  • assist the individual or LAR to determine if they want to self-direct their services; and
  • determine what support might be needed for the individual/LAR to self-direct services.

The self-assessment may not be used to determine that an individual/LAR cannot use the CDS option. If individuals or their LARs have difficulty responding to the self-assessment questions, they will probably need a designated representative (DR) to help them implement the CDS option, but it is the CDSA’s responsibility to assist them with appointing a DR.

  • If the individual chooses at this point to decline the CDS Option, the SC completes Form 1584, indicating the choice of the "Agency Option." The SC does not complete DADS Forms 1583 or 1586.
  • If the individual wants to know more about the CDS option, the SC continues to Form 1583.

The purpose of Form 1583 is to provide important definitions of terms used with CDS. This form includes information about who can be the CDS employer, who can be a designated representative and who can and cannot be hired as an employee in the CDS option for HCS.

  • If the individual chooses at this point to decline the CDS Option, the SC completes Form 1584, indicating the choice of the "Agency Option." The SC does not complete DADS Form 1586.
  • If the individual wants to select the CDS option, the SC continues to Form 1584.

The purpose of Form 1584 is to document the individual’s/LAR’s choice of service delivery option. If the individual or LAR is selecting the CDS option, the individual must also select a Consumer Directed Services Agency (CDSA) of his or her choice.

The SC will provide a list of CDSAs serving the individual’s waiver contract area. The CDSA choice lists can be found on the DADS website at: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/consumer-directed-services-cds.

To locate CDSAs serving the individual’s area, type in the county in which the individual resides. The SC may use the list of CDSAs obtained on CARE screen C80. The SC should encourage the individual or LAR to call and interview several CDSAs before selecting one.

Important: CDSAs are not required to be located in the same town in which the individual resides. CDSAs provide FMS. This service does not require ongoing face-to-face contact. While CDSAs are required to make one visit to the individual’s home to conduct the CDS orientation prior to service initiation, the CDSA conducts the remainder of their business via email or fax machine with the individual or LAR, or designated representative if one has been appointed.

The purpose of Form 1586 is to provide information to the individual or LAR regarding the availability of support consultation in the HCS Program. The use of support consultation is optional. If, during the development of the Person-Directed Plan (PDP), the individual or LAR requests support consultation, this service must be included in the PDP. During the development of the Individual Plan of Care (IPC), the number of units of support consultation must be determined for inclusion in the IPC.

Support consultation includes practical skills training, coaching and assistance related to:

  • principles of self-determination;
  • recruiting, screening and hiring workers;
  • completing documents and assessments required to employ a person, retain a contractor or vendor, and manage service providers;
  • negotiating service agreements, including pricing and scheduling services, goods and items;
  • effective communication, decision-making and problem-solving skills to meet employer responsibilities;
  • tools for accessing information, resources and assistance;
  • contacting appropriate persons or entities based on their roles, responsibilities and eligibility related to the individual’s program or the CDS option;
  • participating in service planning team meetings at the employer’s request; and
  • complying with requirements of the individual’s program as related to services delivered through the CDS option.

A support advisor provides support consultation. CDSAs are required to make support advisors available if the service is authorized on the IPC. The list of DADS certified support advisors can be found on the DADS website at: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/consumer-directed-services-cds/certified-support-advisors.

The individual or LAR may select a certified support advisor provided by his or her CDSA, or may opt to use a certified support advisor who is not associated with the CDSA.

 

13121 Service Back-up Plans

Revision 10-0; Effective June 1, 2010

 

The CDS employer (individual or LAR) is responsible for developing a back-up plan for each service that the service planning team identifies as critical to the individual’s health and safety. During the person-directed planning process, the service planning team must identify those CDS services that require a back-up plan from the CDS employer. Critical services are defined as those that would place the health and/or welfare of the individual in jeopardy if they are not provided. CDS service back-up plans are documented on Form 1740, Service Backup Plan. The SC completes the top part of the form, indicating why a back-up plan is needed for that particular service. The CDS employer completes the back-up strategies section of the form. The CDS employer’s plan must be reviewed for feasibility by the service planning team and signed by the service planning team. It is the SC’s responsibility to review a CDS employer’s back-up plan and determine whether the strategies are reasonable and viable contingencies exist in the event an individual is unable to receive a critical program service by their regular direct service provider. If the SC determines the strategies are not reasonable and viable, the SC may support the CDS employer as needed to develop a viable plan. The SC may also suggest the CDS employer consider using support consultation to assist in the development of a back-up plan. The CDS employer is responsible for providing the CDSA with the copy of each service back-up plan after it has been approved by the service planning team.

Back-up plan strategies may include both formal and informal supports. If back-up services are to be purchased from an HCS provider, the CDS employer must include such costs in the CDS budget. In addition, persons who are paid to provide back-up services must pass all criminal history and registry checks. Funds must be allocated in the individual’s budget for criminal history checks of back-up service providers.

 

13130 Service Planning

Revision 10-0; Effective June 1, 2010

 

The CDSA does not play a role in the HCS service planning process. Any change in the amount of a service delivered through the CDS option must go through the service planning process. DADS may, at any time, request documentation to explain the basis upon which the amount of an HCS service on an individual’s IPC was determined. If DADS requests this documentation for a service the individual or LAR has chosen to self-direct using the CDS option, the CDS employer is responsible for providing the documentation to DADS. The CDS employer may request support from the SC to provide this documentation for DADS.

If the individual has an HCS provider, the service planning team and the HCS provider must revise the IPC to include the change in the amount of service(s). If the individual does not have an HCS provider, the service planning team will revise the IPC to include the change in the amount of service(s). For all IPC revisions, the SC must provide a copy of the IPC to the CDSA.

In contrast, a support advisor may participate in service planning meetings if requested by the individual or LAR. A support advisor must notify the individual’s SC:

  • when support consultation service goals have been met;
  • if the person receiving support consultation is unable or unwilling to cooperate with service delivery; or
  • of the progress and status of the consumer-directed service (SHL or Respite) required by the individual’s program.

The individual or LAR (that is, “employer”) is responsible for:

  • ensuring that service delivery activities address the CDS (SHL or Respite) goals;
  • developing an Implementation Plan; and
  • ensuring that service delivery documentation is accurate and reflects how services address the individual’s goals.

A support advisor may provide coaching in any of the areas listed above.

 

13140 Enrolling the Individual in the Consumer Directed Services Option

Revision 10-0; Effective June 1, 2010

 

To enroll an individual in the CDS option, the SC sends to the CDSA:

  • a completed Form 1584, Consumer Participation Choice, within five days after the individual or LAR selects the CDS option to notify the CDSA of an upcoming referral; and
  • a hard copy of the completed initial proposed IPC when it is transmitted to DADS for authorization.

The CDSA needs the proposed IPC in order to conduct the required CDS orientation with the individual or LAR before services delivered via the CDS option can begin.

During the CDS orientation, several key activities must occur prior to services starting.

The CDSA will:

  • explain the hiring process to the employer, including the required criminal history, registry and Medicaid exclusion checks;
  • ensure that the employer understands who can and cannot be hired to provide SHL or Respite;
  • work with the employer to develop the draft CDS budget, which includes the hours direct service providers will work, wage rate and benefits for each employee hired and project expenditures for employer services and supports, including support consultation if included on the IPC (the draft CDS budget is based on the proposed IPC); and
  • explain that service delivery documentation must relate back to the goals identified and documented on the PDP.

The CDSA will need to know the number of hours of SHL, Respite or support consultation on the proposed IPC in order to assist the employer with development of the CDS budget. The CDSA conducts the CDS orientation while the proposed IPC is under utilization review by DADS.

When the orientation has been completed the CDSA is required to notify the SC via DADS Form 2067, Case Information. The SC files the form in the individual’s record.

Services delivered through the CDS option may not begin until:

  • the in-person CDS orientation has been completed;
  • direct service provider eligibility has been determined and verified by the CDSA;
  • the service provider agreement(s) has been signed;
  • the CDS budget has been approved by the CDSA; and
  • the IPC has been authorized in the CARE system.

The CDSA will not allow service delivery to begin until it is notified by DADS that services are authorized in the CARE system. In the event that the number of hours authorized for SHL or Respite changes as a result of DADS utilization review, the SC will notify the CDSA of the change by sending Form 2067 to the CDSA.

 

13150 Entering Consumer Directed Services on the Individual Plan of Care

Revision 10-0; Effective June 1, 2010

 

CDSAs do not have access to enter information into CARE. If the individual has an HCS provider, the HCS provider is responsible for entering into CARE the individual's IPC data, including the individual's CDS and CDSA services. If the individual does not have an HCS provider, the SC is responsible for entering into CARE the individual's IPC data, which are the individual's CDS and CDSA services.

Financial Management Services

For individuals who use the CDS option, the IPC must include FMS. FMS is authorized as a monthly service. For example, for a 12-month period, 12 units of FMS must be included on the IPC.

Support Consultation

If the individual or LAR requests support consultation or the individual's service planning team determines that support consultation would be beneficial to provide employer coaching, hours for support consultation must also be included on the IPC.

Support consultation is to be used as needed. On average, an individual may be authorized for six to nine hours of support consultation per year. It is not the type of service to be used on a weekly basis.

Note: An HCS provider is not responsible for delivering or billing for a service delivered through the CDS option.

 

13160 Monitoring Consumer Directed Services

Revision 10-0; Effective June 1, 2010

 

The SC monitors CDS services in the same manner as non-HCS services. A key monitoring role is to determine whether the individual's health and safety is at risk in the environments in which the individual receives HCS and non-HCS services and, if necessary, to take action to protect the individual's health and safety. If the SC learns of a problem with the CDSA, the SC may report the CDSA to Consumer Rights and Services at DADS.

The CDSA is required to provide the SC and employer quarterly reports of expenditures for each consumer-directed service. The purpose of these reports is to determine over or under utilization of services. The CDSA will also note any areas of non-compliance with the CDS option on the quarterly report.

 

13170 Corrective Action Plans

Revision 10-0; Effective June 1, 2010

 

Based on review of the quarterly reports or a monitoring visit, the SC may request a corrective action plan from the employer. It is important to remember that it is the employer's responsibility, not the CDSA's, to ensure that services are delivered, that service goals are being met and that program rules are being followed.

At the request of the SC or the CDSA, the CDS employer must develop a corrective action plan using DADS Form 1741, Corrective Action Plan. The person requesting the corrective action plan completes the top part of the form indicating the specific reason a corrective action plan is needed (for example, over expenditure or failure to submit required documentation to the CDSA in a timely manner). The CDS employer completes the corrective action strategies section of the form. The CDS employer must provide written corrective action plans to the person requiring the plan within 10 calendar days after receiving the request. The CDS employer's plan must be reviewed for feasibility and signed by the service planning team. It is the SC's responsibility to review a CDS employer's corrective action plan to determine whether the resolution proposed in the plan represents a reasonable and viable solution to the identified problem. If the SC determines the resolution proposed in the plan is not a reasonable and viable solution to the identified problem, the SC may support the CDS employer as needed to develop a viable plan. The SC may also suggest the CDS employer consider using support consultation to assist in the development of a corrective action plan.

Corrective action plan information needs to be specific to the identified issue and identify specific strategies and time frames for improvement. The goal of a corrective action plan is to focus on needed supports to ensure the employer succeeds in using the CDS option.

 

13180 Termination from the Consumer Directed Services Option

Revision 12-2; Effective April 6, 2012

An individual or LAR may voluntarily request to switch from the CDS option to the provider-managed option (see Section 8600, CDSA Transfer and Changing Service Delivery Option). An individual must remain with the provider-managed option for at least 90 days before requesting to transfer back to the CDS option.

The service planning team may recommend the individual be involuntarily terminated from the CDS option. For an individual participating in CDS, the SC must recommend that DADS terminate the individual's participation in the CDS option if the SC determines that:

  • the individual's continued participation in CDS poses a significant risk to the individual's health, safety or welfare;
  • the individual or LAR has not complied with the CDS rules in Title 40, Texas Administrative Code, Chapter 41, Subchapter B (relating to Responsibilities of Employers and Designated Representatives); or
  • the employer failed to implement a corrective action plan within required time frames.

To recommend that DADS terminate an individual's participation in the CDS option, the SC:

  • initiates a change in the individual's service delivery option by following the activities described in Sections 8620-8660, as appropriate to the individual's situation; and
  • submits a written request to DADS using Form 3611, Involuntary Termination of Consumer Directed Services (CDS) Individual Plan of Care (IPC) Cover Sheet, and include:
    • a description of the service component(s) recommended for termination;
    • a statement of the reasons why termination is recommended, including failure by the employer to implement the CDS corrective action plan (DADS Form 1741, Corrective Action Plan);
    • a copy of the CDS corrective action plan (Form 1741) describing the employer's attempts to resolve the issues before termination was recommended; and
    • a copy of the revised IPC.

The SC will notify the CDSA (using Form 2067, Case Information) that a request to terminate the CDS option has been sent to DADS for approval.

 

13190 Service Delivery Transfers from one Consumer Directed Services Agency to Another

Revision 10-1; Effective September 27, 2010

 

Refer to Section 8600, CDSA Transfer and Changing Service Delivery Option, when an individual requests to change CDSAs.

 

13200 Consumer Directed Services Resources

Revision 10-0; Effective June 1, 2010

 

The CDS rule is available at: http://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=40&pt=1&ch=41

Additional information regarding CDS may be found at: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/consumer-directed-services-cds/cds-training-presentations