Home and Community Based Services Manual


Self Direction Determination

A current or potential CDS participant is required to have the ability to direct their care per 208.903.1.(4), RS Mo. Consumer directed is defined as the hiring, training, supervising, and directing of the personal care attendant. Section 208.909.1, RSMo states that current or potential participants must be able to fulfill the following responsibilities:

  • Supervise the personal care attendant
  • Verify the wages to be paid to the personal care attendant
  • Monitor proper Electronic Visit Verification (EVV) usage
  • Notify DSDS staff or its designee of any changes affecting the CDS Person-Centered Care Plan (PCCP) or the participant’s place of residence
  • Report any problems resulting from the quality of services rendered by the personal care attendant to the participant’s provider
    • It shall be reported to DSDS staff or its designee if the problem cannot be resolved through the provider.
  • Report to DSDS significant changes in participant’s health and/or ability to self-direct their care

Documentation shall be provided in the participant’s electronic case record if it is determined that a current or potential participant requesting CDS cannot direct their care or fulfill the responsibilities of a CDS participant. Examples of documentation may include, but are not limited to:

  • Responses to questions from the current or potential participant during the assessment process that need further clarification. Questions are to be posed to the current or potential participant.
    • If another individual responds on behalf of the current or potential participant, this must be documented in the case notes.
  • Completion of the Self Direction Assessment questions
    • If the Self Direction Assessment Questions are utilized, answers to the questions shall be provided as an exhibit if the current or potential participant appeals the decision that they cannot self-direct services.
  • Completion of the St. Louis University Mental Status (SLUMS) exam. This may be utilized when there is a concern regarding an individual’s ability to self-direct.
    • The instructions to the SLUMS provide background information on the exam, clarifies when the exam shall be utilized, and defines further evaluation which must be pursued.
  • Statements or medical records from the current or potential participant’s healthcare professional documenting any functional limitations preventing the individual from self-directing
    • The Healthcare Professional Inquiry may be utilized when there are concerns regarding the current or potential participant’s ability to self-direct. The response received from the Healthcare Professional Inquiry shall be documented and uploaded to the electronic case record along with other self-direction determination documents if utilized.

If a thorough review of all available information has taken place and the current or potential participant cannot self-direct, Adverse Action procedures shall be followed, and DSDS staff or its designee shall advise that individual and/or the authorized representative of other available options. The Collateral Contacts Policy, outlines the various services available through alternative HCBS. Current or potential participants shall be advised that Personal Care (PC) and Advanced Personal Care (APC) services are comparable to services available through the CDS program.

  • DSDS staff or its designee shall document the discussions held regarding the availability of other services.

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