Home and Community Based Services Manual
Personal Care Assistance - State Plan (Consumer-Directed Services Model)
CDS shall not be authorized to pay for services when:
- The primary benefit is to a household unit.
- The task is one that household members may reasonably be expected to share or do for one another unless the task is above and beyond typical activities provided for a household member without a disability.
- CDS does not include any task that must be performed/ trained by a licensed professional (i.e., skilled nursing, therapies ordered by a physician, etc.).
- A physically disabled person who can direct their care but has a cognitive impairment that requires a designated person to assist with the administration of the program can only be authorized through the ILW.
- Participants authorized for self-directed services through the Department of Mental Health (DMH) are not eligible for services as outlined in this policy. Staff shall refer to the Service Coordination Policy for guidance on coordinating services for participants authorized for DMH services.
- Individuals who reside in a nursing facility, Residential Care Facility (RCF) or Assisted Living Facility (ALF) licensed by DHSS, Division of Regulation and Licensure (DRL) are not eligible for CDS.
- The ‘CDS Restricted’ checkbox in the participant’s electronic case record has been checked. This box can be checked when:
- DSDS staff followed the procedures outlined in the Adverse Action policy and Appeal and Hearing Process. Services shall not be closed until the 10-day appeal time frame has passed, and the participant has not appealed, or until the Department of Social Services (DSS), Division of Legal Services (DLS) has made its final decision for the appeal hearing affirming the adverse action.
- As appropriate, all current authorization(s) for CDS shall be closed, and other HCBS that may meet the participant's needs have been offered to the participant, e.g., Agency Model.
- The attendant shall not:
- Have been involved in Medicaid fraud previously
- Be a current CDS participant
- Participants can exercise individual choice in deciding who provides their CDS. The CDS participant is the attendant’s employer-of-record.
- The attendant may be a family member. However, the attendant cannot be the participant’s spouse or legal guardian.
NOTE: An individual with a guardian or conservator cannot be rejected for CDS solely for that reason. Explanation for the need of a guardian or conservatorship can justify the reason to reject CDS due to cognitive inabilities to self-direct. DSDS staff or its designee shall obtain a copy of the appointment order.