dhss-logo

Home and Community Based Services Manual

Authorization

Home and Community Based Services Manual


Authorization

The following is an overview of CDS authorizations and tasks:

  • CDS shall be authorized in 15-minute units
  • CDS shall be included in the overall cost of care for the participant as referenced in the HCBS Cost Maximums policy
  • CDS shall not exceed 60% of the cost maximum
    • The combination of CDS and agency model PC shall not exceed 60% of the cost maximum.
  • The 60% cost maximum can be exceeded by the cost of APC and RN visits, but only up to the full monthly cost of 100%.

NOTE: When the care plan includes RN services, the cost of one RN visit shall be excluded from the overall care plan cost.

  • When the combination of CDS, other State Plan services, and an HCBS Waiver (e.g., Aged and Disabled Waiver (ADW) or ILW) services exceed the cost maximum by the cost of the waiver services:
    • The appropriate supervisor for the DSDS staff shall review all PCCP requests over the 100% cost maximum to ensure the participant’s unmet needs require the amount of service requested.
    • If documentation supports the request, the case shall be forwarded to the Bureau of Federal Programs (BFP) for consideration and approval prior to authorization over 100% of the cost maximum.
    • Pending the approval from BFP to exceed the cost maximum, CDS in combination with other State Plan or ADW services can be authorized up to 100% of the cost maximum, excluding PC and/or CDS, which may never exceed 60% of the cost maximum.

NOTE: When a PCCP includes Adult Day Care authorized through the ADW or the Adult Day Care Waiver (ADCW), the total cost of care cannot exceed 100% of the cost maximum.

Under federal guidelines, a participant can only enroll in one (1) HCBS Waiver at a time, regardless of what agency administers the waiver program.

Table of Contents