1 Consumer Directed Community Supports Lead Agency Operations Manua
2 Tabe of Contents Introduction to Consumer Directed Community Supports (CDCS) 1 Impementation of CDCS Statewide HCBS Program Eigibiity and Access to CDCS Access to CDCS Service Option is Limited for Some Peope How Consumer Directed Community Supports Work Person-Centered Panning Process: The Foundation for Consumer-Directed Services Person-Centered Panning Features Consumer/Representative Roe in Person-Centered Panning Process and Pan Management Consumer Resources Lead Agency Roe and Tasks in Person-Centered Panning Process Other Services That Increase Fexibiity and Consumer Contro Toos and Resources to Support the Person-Centered Panning Process 14 Appendix A: Resources for Person-Centered Panning 15 Appendix A.1: CDCS Fexibe Case Management Pan Deveopment Notification Too Community Support Pan Requirements for A HCBS Programs Community Support Pan Formats (DHS 2925 or 4166) CDCS Requirements of a Person-Centered Community Support Pan CDCS Budget Amount on the Pan Appying Quaity Considerations to the CDCS Support Pan Heath and Safety: Persona Negotiated Risk Management Pan Backup Pans and Emergency Pans Reviewing the Pan Approva, Denia, or Partia Denia of a Proposed CDCS Pan Provision of Technica Assistance: Heping the Consumer Get a CDCS Pan Approved and Impemented Service Revisions and Pan Changes - Consumer Versus Lead Agency Approva Waiver Requirements Reated to A Aowabe Services Additiona Requirements for Cdcs Services: Consumer Outcomes Broad CDCS Service Categories Additiona Goods and Services That May Be Incuded in CDCS Budgets Additiona Services Authorized in Combination with CDCS Using CDCS to Purchase Conventiona Waiver Services A Note About State Pan Home Care Services 34 Appendix B: Crosswak Between Waiver & Home Care Codes and CDCS Service Categories Customizing Services Under CDCS Persona Assistance Treatment and Training 43
3 6.4 Environmenta Modifications and Provisions Guideines for Approving Specia Diets Under CDCS Sef-direction Support Activities Provider Quaifications: Persona Assistance: The Consumer Decides Provider Quaifications: Treatment & Training: Provider Quaifications: Environmenta Modifications & Provisions Provider Quaifications for Fisca Support Entities Provider Quaifications for Fexibe Case Management (FCM) Service Fexibe Case Management and Famiy or Lega Representatives Non-aowabe Expenses under CDCS Excuded Services, Support, and Items 54 Appendix C: Aowabe, Unaowabe Expenditure 55 Appendix C1: Aternative Treatment Too for MHCP-Enroed Physicians Comparison of Required and Fexibe (Optiona) Case Management Activity Required Lead Agency Functions Under CDCS Fexibe Case Management Functions & Limitations Excuded Time & CDCS The Consumer As Empoyer Three Modes of Fisca Support Entity Service Comparison of Consumer Roe as Empoyer Under 3 FSE Modes Fisca Support Entity Fisca Support Entity (FSE): Fisca Conduit & Payro Agent Services Fisca Support Entity (FSE): Agency with Choice Services Other FSE Requirements Other FSE Requirements (con t) FSE Reporting Requirements Readiness Review Invountary Exits from CDCS Procedures Reated to Invountary Exits Additiona Technica Assistance and Support Immediate Concern 75 Appendix D: Notice of Technica Assistance and Support Form Purchasing Persona Assistance Services (PAS) from a Spouse or Parent Criteria for Paying Spouse or Parent for PAS Determination of ADL Dependency Financia Considerations Limitations on Payment to Spouse or Parent Lead Agency Monitoring Requirements When Parent or Spouse is Paid for
4 Persona Assistance Service 81 Appendix E : Determining ADL Dependency in Chidren Age 18 and Under Edery Waiver and Aternative Care CDCS Budget Amount on the Pan Authorizations and Payments Under CDCS : EW and AC Summary of Changes to the Long Term Care Screening Document: EW & AC Service Agreement Changes for CDCS Under EW & AC: Procedure Codes Service Agreement Changes for CDCS Under EW and AC: Edits Other Procedure Codes That Can Be Authorized in Combination with CDCS Services: Edery Waiver and AC Caim Payments: EW and AC Consumer Scenario: Initia Opening Seects CDCS Consumer Scenario: Person Who Has Been Using CDCS Wants to Discontinue That Service Consumer Scenario: A Person Currenty Open to EW or AC Decides to Change to CDCS Consumer Scenario: Renewa of CDCS 93 Appendix F FY05 CDCS Budgets EW 94 Appendix F1: FY05 CDCS Budgets AC CDCS Service Authorizations & MMIS Activity: Persons Under Age Consumer Scenarios: Choosing CDCS Consumer Scenarios: Discontinuing CDCS Service Agreements: CAC, CADI, MR/RC, TBI Screening Document Edits Biing Cdcs Servicess CDCS & Enroment in Managed Care A.1 Medica Assistance Spenddowns When Choosing CDCS A.2 Specia Income Standard Edery Waiver and Waiver Obigation A.3 Non payment of Waiver Obigation or Spenddown Whie Using CDCS A.4 Spenddowns and Waiver Obigations under MnDHO & MSHO Notes About CDCS Under the Aternative Care Program CDCS and Unpaid Caregiver Supports Types of Caregiver Support Services HCBS Quaity Framework: Organizing Quaity Management Around Seven Quaity Focus Areas The HCBS QA/QI Pan - Loca Agency HCBS Quaity Assurance & Improvement Responsibiities Appying the Quaity Framework to CDCS 114 Appendix G: CDCS Quaity Assurance and Improvement Activity: Lead Agency Sef-assessment 116
5 Consumer Directed Community Supports Lead Agency Operations Manua Introduction Introduction to Consumer Directed Community Supports (CDCS) Consumer Directed Community Supports (CDCS) is a service that gives individuas more fexibiity in panning, and responsibiity for directing, their services and supports, incuding hiring and managing direct care staff. CDCS may incude conventiona goods and services, as we as sefdesigned services that provide needed support to recipients. Consumer Directed Community Supports (CDCS) is a service that has been avaiabe in 37 counties through the Home and Community-Based Waiver for Persons with Menta Retardation and Reated Conditions (MR/RC) since In an effort to make Consumer Directed Community Supports (CDCS) avaiabe to individuas in every county and on every Medica Assistance (MA) waiver program, the Department of Human Services (DHS) submitted amendments to a of the home and community-based waiver programs to the Centers for Medicare and Medicaid Services (CMS). The amendment, as approved, changes some aspects of CDCS as previousy impemented, and expands the CDCS service. The amendment incudes state-eve oversight of CDCS and ead agency administration of the service. The programs affected by the approved amendments are: Aternative Care (AC) program (A state-funded non-medica Assistance program) Community Aternative Care (CAC) Waiver Community Aternatives for Disabed Individuas (CADI) Waiver Edery Waiver (EW) Menta Retardation and Reated Conditions (MR/RC) Waiver Minnesota Disabiity Heath Options (MnDHO) Minnesota Senior Heath Options (MSHO) Traumatic Brain Injury Waiver (TBIW). There are sight differences as CDCS appies to some programs. These differences wi be indicated in the manua.
6 Impementation Consumer Directed Community Supports Lead Agency Operations Manua Impementation of CDCS Statewide DHS wi impement CDCS, as approved by CMS, across a programs and in a counties by Apri 1, There are two phases in the CDCS impementation pan. Phase I Impementation CDCS wi be impemented across a waivers first in the 37 counties previousy authorized to provide CDCS under the MR/RC Waiver, effective Oct. 1, This initia impementation wi incude transitioning individuas who are currenty receiving CDCS under the MR/RC Waiver to services that refect the new poicies, as we as initiating impementation of CDCS across a other programs, and MnDHO and MSHO in those counties. Phase II Impementation The second phase of impementation wi invove the remaining 50 counties, interested triba heath entities, and participating heath pans. These agencies wi begin to impement CDCS across a programs, and MnDHO and MSHO by Apri 1, Evauation of CDCS Impementation An evauation wi occur throughout impementation to determine the effectiveness and appropriateness of CDCS. The resuting recommendations wi be incorporated into CDCS poicies and procedures as appropriate.
7 Consumer Directed Community Supports Lead Agency Operations Manua Section 1: HCBS & CDCS Eigibiity 1.1 HCBS Program Eigibiity and Access to CDCS Consumer Directed Community Supports is a new service avaiabe under the home and community-based waiver and Aternative Care programs. It is not a new program. Like other services avaiabe under the state statute governing the Aternative Care Program, and the federay approved MA waiver pans, CDCS is avaiabe to an individua who is either aready receiving services on a waiver or under AC, or who meets a of the foowing eigibiity criteria for each program as determined by the ead agency. The person must meet Medica Assistance or AC financia eigibiity requirements An assessment competed by authorized professionas indicates the person needs the eve of care provided by an institution The person needs a waiver or AC service to support community aternative iving There is no aternative payor for the waiver or AC services needed The Community Support Pan, when impemented, can reasonaby ensure the heath and safety of the person Some waiver programs have additiona criteria such as diagnosis. Any person who meets a program eigibiity criteria, and receives a waiver sot aocation from the ead agency (county, tribe, or heath pan) can choose CDCS as a service option, with exceptions noted in the next section.
8 Section 1: HCBS & CDCS Eigibiity Consumer Directed Community Supports Lead Agency Operations Manua 1.2 Access to CDCS Service Option is Limited for Some Peope Living Arrangements: CDCS services are not avaiabe to waiver or AC recipients iving in residentia settings icensed by the Department of Human Services (DHS) or icensed or registered with the Minnesota Department of Heath (MDH). These incude famiy or corporate foster care, board and odge faciities, supported iving service faciities, and housing with services/assisted iving estabishments. See Department of Human Services Licensing at DHS_id_ hcsp and Department of Heath at Fraud or Abuse of Pubic Funds: CDCS services are not avaiabe to an individua or their representative who has at any time been restricted by the Primary Care Utiization Review (PCUR) Committee. Information about such restriction wi be found in the Recipient Primary Care Utiization Review (RPCR) screen in MMIS. The ead agency shoud check this information to determine whether the individua has been invoved with PCUR before discussing the CDCS option with that individua. Exits from the Waivers or AC: If a CDCS recipient exits the Waivers or AC more than once during the recipient s service pan year, the recipient is unabe to access CDCS services for the remainder of that service pan year. This does not precude the individua from using other waiver or AC services for the remainder of the service pan year. A person who does not meet a program eigibiity requirements. For exampe, a person participating in Medica Assistance whose needs can be met sufficienty with state pan home care services is not eigibe for a Medica Assistance waiver program because there is no need for a waiver service.
9 Consumer Directed Community Supports Lead Agency Operations Manua Section 2: How CDCS Works 2.1 How Consumer Directed Community Supports Work This manua wi provide more detaied information about the features of CDCS isted beow. They are presented here, in oose chronoogica order, to give ead agency case managers some context for other sections as they are presented. The outine beow aso represents the major activities the consumer, ead agency case manager and others wi perform when CDCS is eected. In addition, it outines those features of the service that ead agency case managers wi have to be most famiiar with in order to provide professiona support to consumers in decision-making about this service, as we as to carry out ead agency responsibiities under CDCS. The person is, or has been, determined to be eigibe for a home and community-based waiver program, or for the Aternative Care program. For some programs, a waiver sot has to be avaiabe to aocate to the cient before waiver program participation can begin. Persona preferences are combined with assessment information to outine a Community Support Pan. The ead agency case manager provides information about different services that can meet the person s needs and preferences, incuding CDCS. There are consumers who do not have access to CDCS as a service option. There are other options that increase fexibiity and choice-making in addition to CDCS. This incudes PCA Choice and aternative providers of waiver services such as homemaker or adut day care service. The ead agency gives the consumer information about budgets for CDCS and non-cdcs options. CDCS information given incudes written materias that outine the consumer s roe and responsibiity under CDCS, the ist of aowabe and unaowabe expenditures, generic support pan requirements and criteria for approva of a consumer-deveoped pan for CDCS. The person seects CDCS. The ead agency gives the consumer information about options for person-centered panning toos and approaches. The ead agency provides a summary of assessment information in order to guide the consumer s pan deveopment. The person deveops the support pan, with or without assistance from others. If desired, the person can receive forma assistance from three sources: If they sti ive in an institution and are eigibe for Medica Assistance, a Reocation Services Coordinator can assist in pan deveopment. If they are eigibe for AC, they can access AC conversion case management to assist in pan deveopment. They can choose to spend some of their CDCS budget to purchase assistance from a quaified Fexibe Case Manager. Fexibe Case Managers must pass a training course and receive certification from DHS to provide service under CDCS.
10 Section 2: How CDCS Works Consumer Directed Community Supports Lead Agency Operations Manua They can be served under a non-cdcs support pan and receive assistance from their waiver or AC case manager to deveop a CDCS pan to move from non-cdcs to CDCS at a point in the future. The ead agency provides a ist of DHS-certified Fisca Support Entities under contract with the county. The Fisca Support Entity is the Medicaid-enroed provider under CDCS. The consumer is the empoyer of support staff funded with CDCS. The consumer can purchase support to carry out empoyer functions. Every CDCS consumer must have an agreement with a Fisca Support Entity. The Fisca Support Entity assists the consumer in managing CDCS funding in a variety of ways, incuding support with empoyer functions, if the person chooses. The consumer submits the support pan for ead agency approva. The pan can incude conventiona and sef-designed services, paid and unpaid support, and persona risk management pans to meet heath and safety needs. CDCS services cannot begin unti the support pan is approved by the ead agency. The pan must incude emergency and backup pans, and break out panned services into severa categories. Some categories have restrictions. The consumer defines provider quaifications for persona assistance. The consumer can add training requirements to meet preferences. The consumer can request background checks of proposed staff. If that person fais this check, they cannot work for the consumer. The person outines a pan for monitoring service impementation and quaity. The pan incudes resuts or outcomes the person wants to achieve by impementing the pan. A spouse or parent can provide persona assistance and be paid for this assistance for up to 40 hours per week when other criteria are met. 3. The ead agency appies stated criteria to approve the pan or outine changes that need to be made to receive approva. The ead agency approves or denies the pan within 30 caendar days of receipt from the consumer. Any support the consumer is purchasing from a Fisca Support Entity or Fexibe Case Manager must be incuded in the pan, incuding specific tasks, the schedue of service, and negotiated payment for these tasks. A written denia of the pan, or reduction in services proposed in the pan, must incude specific reasons and appea rights (Fair Hearing) information. The signed, approved support pan is copied to the consumer, ega representative(s) and the seected Fisca Support Entity.
11 Consumer Directed Community Supports Lead Agency Operations Manua Section 2: How CDCS Works The ead agency creates a Service Agreement in MMIS for the person that can incude ony CDCS, required case management, state pan home care service, background checks, and higher costs for home modifications for certain programs. The consumer and Fisca Support Entity receive copies of the Service Agreement. The consumer enters into written agreements with seected support staff for whom the consumer acts as common aw and managing empoyer, and can deegate some empoyer tasks. The consumer can purchase support to carry out empoyer responsibiities. The pan is impemented. The Fisca Support Entity receives invoices for approved expenditures incuding support staff timesheets. The Fisca Support Entity submits caims to MMIS that break out CDCS spending into four categories of service: Persona assistance Environmenta modifications and provisions, and Sef-directed support The Fisca Support Entity provides monthy reports to the consumer and ega representative, and quartery summaries to the ead agency. The Fisca Support Entity is required to notify the ead agency when monthy spending significanty exceeds or fas short of projected spending in order to identify potentia probems with support pan impementation. There are opportunities for ead agency staff to provide interventions to hep the person succeed in the community with CDCS and meet program and service requirements. There are criteria for invountary exit from CDCS of an individua. The consumer, with or without paid or unpaid support, monitors and evauates the impementation of the pan, the quaity of service, and progress toward or achievement of outcomes. The ead agency continues to provide HCBS quaity assurances to a waiver or AC program participants as outined in their HCBS Quaity Assurance Pan submitted to the Department. Adut and Chid Protective Services referras and services continue to provide protections to vunerabe peope in the community. Reassessments are performed by ead agency staff at east annuay, and when significant changes in need occur. The person can make some amendments to their support pan without ead agency approva; other kinds of changes require ead agency participation and agreement.
12 Section 3: Support Panning Consumer Directed Community Supports Lead Agency Operations Manua 3.1 Person-Centered Panning Process: The Foundation for Consumer-Directed Services The phiosophy and process of person-centered panning provides the foundation for consumerdirected home and community-based services. Home and community-based services support peope in everyday ife. These services have an impact on the person s abiity to participate as a member within their community, and to fufi their own ife-stye choices. Person-centered panning can organize and direct resources in a manner that wi make a difference in a person s quaity of ife, eve of independence, and satisfaction with pubic services. Whie person-centered panning shoud be the foundation for a home and community-based services panning, an expicit person-centered panning process is required when an individua seects CDCS. Understanding person-centered panning processes is a key and necessary ead agency ski. Consumer Directed Community Supports aows greater fexibiity in taioring services to meet individua needs and preferences. It is through a person-centered panning process that the consumer, aong with sef-seected friends, famiy, and providers, determines what, where, when, how, and from whom they wi receive the assistance that is needed. The resuting pan refects goods and services designed by the consumer to meet identified needs and achieve individuay identified resuts or outcomes. Person-centered panning is an ongoing activity that incudes monitoring the effectiveness of the pan and progress toward achieving resuts, and changing the pan over time to incorporate new types of services or ways of deivering services, or to address changed needs, or support revised persona goas or desired resuts. There are various approaches to the person-centered panning process that have been put into pubic practice, and different approaches wi be preferred by individuas. Some peope wi choose to deveop their CDCS pan with itte or no assistance, whie others may want more support in pan deveopment. The ead agency must provide resources and information about the person-centered panning process, incuding the avaiabiity of Fexibe Case Management service to assist in pan deveopment, and offer choices in panning toos to consumers. The Department offers a too box of person-centered panning information and resources isted in Appendix A.
13 Consumer Directed Community Supports Lead Agency Operations Manua Section 3: Support Panning 3.2 Person-Centered Panning Features A person-centered panning approaches share some features in common. The foowing ist of features can be used to provide basic information about what a person-centered panning process might incude, and what opportunity and responsibiity the person has under person-centered panning. The individua chooses the type and extent of person-centered panning activity they want to participate in to deveop their CDCS Community Support Pan. The individua seects other individuas they want to participate in providing support and assistance in the panning process. The individua can seect a person to faciitate panning. The person chooses the meeting dates, setting, time, pace, and ength of any panning meetings. The individua chooses how to start, work through, and end any panning meetings, incuding what he or she wants to get done in a meeting. The individua chooses areas of ife they want hep from other in panning for. For some, a ife vision, dream, or desire forms the foundation for deveoping their personcentered pan. The person-centered panning process is respectfu of the individua, and buids on strengths and taents of the person to design a pan. The individua makes choices and decisions about services and goods. The person achieves increased opportunity for contro over their services under the pan. The person makes decisions about their:: Living situation Providers Service deivery schedue Daiy and vocationa activity Leve of contro and responsibiity Leve of risk management Back up and emergency pans These decisions are refected in the pan. The individua describes desired resuts, deveops persona outcome indicators to monitor and evauate the impementation of the service pan, and the schedue for monitoring.
14 Section 3: Support Panning Consumer Directed Community Supports Lead Agency Operations Manua 3.3 Consumer/Representative Roe in Person-Centered Panning Process and Pan Management One of the responsibiities a consumer accepts when seecting CDCS is taking the primary roe in support pan deveopment. Each consumer wi have persona preferences about the eve of contro they wish to assume in the overa person-centered panning process. The consumer can seect other peope to assist with the tasks isted beow, as ong as the person seected is not otherwise prohibited from performing these tasks. The foowing panning tasks wi be performed by the consumer (or their representative) under CDCS: Initia/Annua Activities Performed by the Consumer Direct the deveopment and revision of the Community Support Pan. Participate in a forma or informa person-centered panning process that addresses individua strengths, needs, and preferences, incuding preferences about the nature of the panning process. The panning process can be informa or forma, and can be competed without paying anyone to hep deveop the pan. Choose peope to assist them in the person-centered panning process if they wish. This assistance can come from friends or famiy or can be purchased.. Partner with the ead agency case manager in the pan deveopment, approva, and funding within the CDCS budget amount. Choose who wi provide direct services, goods, or supportive services, and decide how much service wi be required to meet identified needs. Negotiate payment rates for direct services, goods, and supportive services requested under the CDCS budget that are within reasonabe range of access to comparabe or ike services within the community, and that do not exceed any State-estabished rates. Deveop a pan to monitor service deivery and effectiveness. Outine desired resuts and a pan to measure achievement of resuts. Submit a pan for ead agency approva. CDCS services cannot begin unti the CDCS pan is approved by the ead agency. Ongoing Activities Performed by the Consumer Monitor pan impementation and effectiveness, and achievement of desired resuts. Make revisions to the pan as needed and submit back to the ead agency for approva as needed. This incudes revisions to back up or emergency pans. See Section 4 regarding revisions to the pan. Notify ead agency case manager of significant changes in need, function, or condition. Whie others may assist the individua in carrying out activities and tasks isted above, ony a Fexibe Case Manager can be paid to perform these tasks for the person, and ony at their request and agreement. 10
15 Consumer Directed Community Supports Lead Agency Operations Manua Section 3: Support Panning 3.4 Consumer Resources Additiona resources reated to the panning process are avaiabe to the consumer, are optiona and can be seected by the consumer in any combination or eve of invovement. The person can: Request the use of a particuar person-centered panning process, too or approach. If desired, seect a quaified Fexibe Case Manager (FCM) to provide support and assistance during the person-centered panning process. This assistance must be described in the preiminary CDCS pan, and incude projected tasks or functions the FCM wi perform, the schedue and ength of this service, and the rate approved by the consumer for payment for this service. Costs for this service ARE incuded in the CDCS service budget, and must be authorized on a Service Agreement in MMIS, and must be bied by a Fisca Support Entity chosen by the person. The tota CDCS authorization in this case coud incude the estimated costs for Fexibe Case Management, Fisca Support Entity services, and Required Case Management and Background Checks. Receive training or education to gain a better understanding of roes and responsibiities in the consumer-directed and person-centered panning processes. Estabish additiona quaification requirements for Fexibe Case Managers based on individua needs and preferences. These additiona requirements must be defined in the CDCS Community Support Pan aong with a process for documenting and monitoring that requirements are met for each person hired to serve in this roe. If the person has not seected CDCS because more assistance is requested for panning, the person may: Receive assistance in CDCS pan deveopment PRIOR to a fina seection of CDCS service by the waiver or AC case manager, bied as waiver or AC case management, for a person currenty supported by (or initiay opening to) any of the HCBS programs. Receive assistance in CDCS pan deveopment from a certified fexibe case manager PRIOR to fina seection of CDCS. Provision of this FCM must be approved by the RCM and outined on a form provided by DHS. Under these circumstance, the fexibe case manager wi receive payment ony when the pan is approved, effective the date CDCS services are authorized by the ead agency. See Appendix A.1. for a copy of the form. Receive assistance in CDCS pan deveopment from a Reocation Services Coordinator if they are eigibe for Medica Assistance and currenty reside in an institution. Persons eigibe for AC can access AC conversion case management. Receive conventiona AC or waiver services, incuding assistance in deveoping the CDCS support pan, under an interim Community Support Pan impemented whie the CDCS pan is deveoped. 11
16 Section 3: Support Panning Consumer Directed Community Supports Lead Agency Operations Manua 3.5 Lead Agency Roe and Tasks in Person-Centered Panning Process Information: A person needs information in order to decide if CDCS might be a good option for them. The ead agency must: Provide information and consumer education about the combination of aowabe goods and services that may be purchased under the consumer-directed community support budget. Provide information that heps the consumer understand their roes and responsibiities under consumer-directed services and person-centered panning processes. Provide information about resources, toos, and technica assistance avaiabe. Provide information about Fisca Support Entity services avaiabe, incuding those that aow the consumer varied eves of autonomy and contro as an empoyer. Provide information about the quaifications for and activities of a Fexibe Case Manager. Budget Amounts: DHS wi make individua CDCS budget information avaiabe to ead agency case managers as a monthy amount isted on the Long Term Care Screening Document for EW and AC (athough proposed expenditures for CDCS are not imited monthy by this amount), and as an annua budget for other waivers incuding CAC, CADI, TBI, and MR/RC in the Waiver Management System. The person needs to know how much money wi be avaiabe for goods and services to begin to sketch out a pan. The ead agency must: Inform the consumer of their CDCS and non-cdcs budget(s) avaiabe for purchasing services over a one-year period. Prorate the amount of money avaiabe under either CDCS or non-cdcs if the service pan wi cover ess than one year. Faciitate the Person-Centered Panning Process: The ead agency wi aso: Hep the consumer outine their interests, strengths, desired outcomes, and preferences for services during assessment, as is competed for a HCBS appicants or recipients. Outine panning process options so the consumer can choose the eve of direction and contro they prefer for the person-centered panning process. Give professiona feedback about the eve of provider training, standards, and quaifications the consumer shoud consider given assessed needs. Provide information about the background check process, benefits of the process, and how these background checks wi be paid for under CDCS. 12
17 Consumer Directed Community Supports Lead Agency Operations Manua Section 3: Support Panning 3.6 Other Services That Increase Fexibiity and Consumer Contro It is important that ead agency staff be thoroughy famiiar with other service options that increase consumer direction and fexibiity in services panning and deivery. This information must be avaiabe to consumers to hep them make the most informed choice about not ony services avaiabe, but the range of consumer direction and contro avaiabe in the waiver and AC service deivery system. Consumer Directed Community Supports, when propery impemented, offers the most fexibiity and consumer contro in service design, seection of supports, and managing individua budgets. However, some consumers may not want to assume the eve of responsibiity and contro expected under CDCS, but sti want more fexibiity in designing their services, may want to have more authority to direct their care, or may want more choices in who can provide support or service to them. PCA Choice, for exampe, can aow a person to recruit, hire, train, and supervise a direct support worker. Under this option, the person receives assistance in deveoping a service pan, and receives fisca management support from a PCA Choice provider. See the Disabiity Services Program Manua for more compete information about this option at and cick on CountyLink. The consumer guidebook for PCA Choice is aso avaiabe on the web. Look for Persona Care Assistance Program Consumer Guidebook, DHS Form Go to dhs.state.mn.us/fserver/legacy/dhs-3858-eng There has aso been an expansion of caregiver services and respite options for famiies of persons age 60 or oder that incudes new services, new fexibiity in the provision of these services, and an abiity to taior these services to meet individua caregiver and recipient needs. See Buetin for compete information about these options. In addition, quasi-forma and informa support networks exist in many communities that can offer very individuaized service provided by vounteer or paid staff support. These services can be very fexibe and incude socia service and nursing services such as Living At Home Bock Nurse Programs and respite. Agencies such as the Area Agency on Aging (AAA) or Centers for Independent Living may ink consumers and famiies with a variety of non-paid hep avaiabe from vounteers or from faith-based communities, for exampe. See Buetin for information about coaborations between AAAs and the communities they serve designed to increase avaiabiity of these kinds of supports. Go to pub/dhs_id_ pdf These quasi-forma community based supports can offer individuaized service and support from non-traditiona providers, and can be an important component of a Community Support Pan for CDCS as we as non-cdcs consumers. 13
18 Section 3: Support Panning Consumer Directed Community Supports Lead Agency Operations Manua 3.7 Toos and Resources to Support the Person-Centered Panning Process Panning toos and resources can assist the person in designing a meaningfu person-centered pan. The ead agency wi provide information about the avaiabiity of these toos and resources. Refer to Appendix A: Resources for Person-Centered Panning. Resources wi be made avaiabe through the Department to ead and other agencies free of charge to pass on to consumers free of charge. There are numerous additiona resources that peope can access without charge. The ead agency wi need to become famiiar with these resources in order to provide information about person-centered panning options, and to provide assistance with suppementa materias if needed. If a Fexibe Case Manager offers assistance in support pan deveopment and intends to use proprietary toos for which the person wi be charged, the person must be tod about and agree to these charges prior to competion of the agreement between the person and the vendor. In some cases, a person may discover a too that is perfect for them that they must purchase to use. In this case, resource materias for pan deveopment can be paid for under the person s CDCS budget using the Treatment and Training CDCS service category for caims. Support Pan Components are outined in Section 4, as are criteria for ead agency approva of a consumer-designed CDCS support pan. 14
19 Consumer Directed Community Supports Lead Agency Operations Manua Section 3: Support Appendix Panning A Appendix A: A Web Resource List on Person-Centered Panning Web Resources: is the main web address to the compete toos kit created for person-centered panning under CDCS. The text of and inks within the page are recreated here. Consumer Directed Tookit: The Consumer Directed Tookit contains a variety of resource materias to assist consumer direct and manage their own supports. Section 5 of the tookit focuses on person-centered panning. Minnesota Governor s Counci on Deveopmenta Disabiities, cick on Pubications: Two manuas are avaiabe through the Research and Training Center on Community Living, a division of the University of Minnesota: Increasing Person-Centered Thinking: Improving the Quaity of Person-Centered Panning - A Manua for Person-Centered Panning Faciitators (PDF): pcpmanua1.pdf Training Person-Centered Panning Faciitators: A Compendium of Ideas (PDF): 15
20 Appendix Section 3: A.1 Support Panning Consumer Directed Community Supports Lead Agency Operations Manua Appendix A.1: CDCS Fexibe Case Management Pan Deveopment Notification Too Consumer Name: Date of Birth: PMI #: This too can be used to inform a parties of the use of fexibe case management services to deveop an initia community support pan for Consumer Directed Community Supports (CDCS). The estimated cost of the pan deveopment wi be added to the consumer s CDCS budget and may be paid to the fexibe case manager after the pan has been approved. Estimated Cost of Pan Deveopment: I understand that a fexibe case manager who heps deveop the initia community support pan wi not be paid if the pan is not approved or if the consumer decides not to pursue CDCS. Fexibe Case Manager: Signature: Date: Consumer: Signature: Date: Lega Representative (if appicabe): Signature: Date: ***Note: This too is not a contract; it is an optiona too 16
21 Consumer Directed Community Supports Lead Agency Operations Manua Section 4: Support Pan Components 4.1 Community Support Pan Requirements for A HCBS Programs The Community Support Pan deveoped by a consumer who has chosen CDCS must incude certain components required for a HCBS waiver or AC pans. The pan must identify: A forma and informa services, goods, and supports that wi meet assessed needs The frequency and duration of service, the price for that good or service, and who wi provide the service or support Safeguards to reasonaby address and maintain the individua s heath and wefare Backup services, contingency pans, and emergency service to address potentia situations that may arise The person s desired outcome or resut to be achieved with the pan in pace Contact information. 17
22 Section 4: Support Pan Components Consumer Directed Community Supports Lead Agency Operations Manua 4.2 Community Support Pan Formats (DHS 2925, 4166 or 4556) The Community Support Pan (DHS-2925) form can be used to outine the required CDCS pan components, and can provide a basis for the person-centered panning process. Use of the budget pages and the caregiver support pan can hep the consumer outine proposed expenses and ensure caregiver panning occurs. The attached services grid can be used in combination with the crosswak found in Appendix B in this manua to organize conventiona waiver or AC services into the appropriate CDCS categories within the pan. DHS Form 4166 offers an aternative support panning format. Used as an eectronic form, detaied assessment information can be merged from the eectronic version of DHS Form 3428 (the assessment form) to popuate the support pan form. This wi aow the consumer to see summary information about assessed needs that must be addressed in the pan, either through paid or informa services, or through a persona risk management proposa. DHS Form 4556 is the Rue 185 compiant Community Support Pan and meets standards of the MR/RC Waiver. This pan can aso be used with the other home and community based waiver programs (CAC, CADI, TBI and EW and AC program). Any pan format can be used by the consumer that can outine a of the required pan components and that refects required documentation as isted in the next parts of this Section. The requirements can be isted on a form of the consumer s own creation to guide the panning process and ensure submission of a compete pan, or one can be created by a oca agency for OPTIONAL use by consumers. Forms isted in this manua can be accessed at (form number)-eng. 18
23 Consumer Directed Community Supports Lead Agency Operations Manua Section 4: Support Pan Components 4.3 CDCS Requirements of a Person-Centered Community Support Pan Within the overa pan requirements isted in Section 4.1, a pan deveoped with CDCS as the choice of service must incude the foowing detai: A description of a services and goods that wi be purchased under the individua s CDCS budget cap, incuding payment rates for each service or good, and staff, if known Informa or quasiforma supports that are part of an ongoing, predictabe, reiabe method to meet identified needs Schedue of services (how often, for how ong) Proposed aocation of CDCS doars between the four categories of CDCS services identified in Section 5.3 and more fuy described in Section 6 Choice of Fisca Support Entity option, incuding tasks, schedue, and fees Outine of pan to monitor pan impementation and effectiveness of services/supports, incuding desired resuts or outcomes, the schedue of monitoring activity, how progress wi be measured, and who wi perform monitoring activity Specific provider quaifications, incuding training requirements, estabished by the consumer Identification of the person(s) responsibe to ensure that provider quaifications and training requirements are met, incuding whether or not background checks are requested and who wi perform the checks Individuaized Fexibe Case Management pan, as proposed by the consumer, incuding tasks, schedue, and fees As noted in 4.1, heath and safety needs are addressed, incuding backup and emergency pans, and persona risk management pans, if appicabe. 19
24 Section 4: Support Pan Components Consumer Directed Community Supports Lead Agency Operations Manua 4.4 CDCS Budget Amount on the Pan The CDCS budget amounts avaiabe to purchase services wi be issued annuay by the department. Budget amounts wi be cacuated according to federa waiver authority for each waiver program, based on historica expenditures across the categorica popuations. The ead agency professiona conducting the LTCC or DD assessment process wi inform the consumer of their avaiabe budget amount and non-cdcs service cap amount as part of the information about CDCS services options presented to them when they are determined to be eigibe for HCBS, or at reassessment. This budget amount must be incuded on the pan in order for the consumer and the ead agency case manager to evauate cost effectiveness, and the ikey success of the proposed pan. The person-centered Community Support Pan can incude costs for services up to the annua CDCS budget amount. Unexpended CDCS budget funds cannot be carried over to subsequent service pan years. See Section 14 for more information about budgets and authorization processes for peope age 65 and oder, and Section 16 for information about budgets and authorizations under MnDHO and MSHO. Information about budgets and authorizations for peope under 65 is found in Section 15. Reassessment Reassessment may change the CDCS budget. If that occurs, the ead agency wi inform the person of the new budget amount. If the budget is increased, the individua shoud determine whether there are currenty unmet needs and if so, revise the Community Support Pan and submit to the ead agency for approva and/or reauthorization. If the budget decreases, and is ess than the amount currenty authorized, the individua must determine changes to services or supports within the new budget amount. The Community Support Pan wi refect these changes when re-submitted for ead agency approva. 20
25 Consumer Directed Community Supports Lead Agency Operations Manua Section 4: Support Pan Components 4.5 Appying Quaity Considerations to the CDCS Support Pan A. Program Requirements: Whie CDCS aows an individua to design services and goods that are unique and meet the person s needs and preferences, there are criteria for purchasing services under CDCS, as we as specific types of goods and services that are NOT aowed to be purchased with CDCS funding. Goods and services that are NOT aowabe are described in Section 8. The goods and services purchased through CDCS must meet a the basic waiver and AC requirements for authorized services. Proposed services: Meet the individua s needs identified in the Community Support Pan AND Assure heath, safety, and wefare AND Goods and services coectivey provide an aternative to institutiona pacement AND Are the most cost efficient (east costy aternative that reasonaby meets heath and safety needs) AND Be for the soe benefit of the person. B. Persona Outcomes: For every person participating in HCBS programs, taking about desired outcomes shoud be part of the initia discussions about service options. When a person thinks and taks about resuts they want, it heps them make choices about the types of services, the types of providers, goods, and supports that wi best hep them achieve those resuts. If a of the criteria for aowabe expenditures in A. are met, goods and services are appropriate purchases under CDCS when they are reasonaby necessary to support any or a of these individuaized outcomes: Maintain community iving. Enhance or maintain famiy or community invovement. Deveop or maintain socia, physica or work-reated skis. Decrease dependence on forma support services. Increase independence of the person. Increase abiity of unpaid famiy and friends to receive training and education needed to provide support. A CDCS Support Pan must incude the resuts the person wishes to achieve under the pan. 21
26 Section 4: Support Pan Components Consumer Directed Community Supports Lead Agency Operations Manua C. Measuring and Monitoring Pan Impementation and Resuts: Given the person s stated desired resuts, does the pan to monitor hep the person identify needs for revision to the pan, and hep demonstrate achievement of or progress toward desired outcomes or resuts? Does the pan incude a schedue to periodicay measure progress? What wi be measured (indicators)? Who wi do the monitoring? What steps wi be taken, by whom, if the pan proves to be ineffective? Exampes: Empoyment Desired Resut Measure I want to work at east 5 hours a week by summer and 10 hours a week by fa. What wi be monitored? By whom? How and how often? Improved Heath Increased Independence My evauation of my heath is fair now and wi be good in 6 months. I wi have no emergency room visits for one year. What wi be monitored? By whom? How and how often? I can create a menu, shop and cook for a week s meas within a year. What wi be monitored? By whom? How and how often? The pan to monitor and periodicay evauate the effectiveness of the pan in heping the person achieve desired resuts must aso incude what steps wi be taken if the pan does not seem to be effective, cannot be impemented according to the approved service design, or if backup or emergency pans are frequenty reied upon. 22
27 Consumer Directed Community Supports Lead Agency Operations Manua Section 4: Support Pan Components 4.6 Heath and Safety: Persona Negotiated Risk Management Pan Peope take risks every day as part of ife. Our abiity to assume and manage risk refects our competence, our independence, our abiity and right to make choices, and our right to assess benefits and consequences of choices we make in ife. A persona negotiated risk management pan is a refection of the consumer s choices that strike a baance between the recommended eve of service coverage (care, supervision, and safety) and the person s desired eve of independence. For exampe, a consumer with quadripegia may decide that 24 hour care and supervision impinges too much on their feeing of iving independenty in an apartment, does not aow them enough time to be aone, and interferes with persona privacy, and abiity to achieve restfu seep at night. The consumer may choose not to have services during a 10 hour period at nighttime, even though there are persona risks that something may happen. The person is aware of risks or consequences and has proposed a method to manage the risk. For exampe, an emergency aarm device is used at night, or a neighbor or friend agrees to be avaiabe in the event of an emergency. Home modifications may be part of a pan to address environmenta hazards or concerns about evacuation. An edery person agrees to home modifications but does not want to utiize a waker, and has a pan to impement in the event of a fa. The consumer has weighed the cost-benefit and has decided to assume a eve of risk and manage it. The persona negotiated risk management pan shoud be documented in the Community Support Pan and shoud be tied to the pans for backup services and community emergencies. A ead agency or fexibe case manager can hep identify potentia risks or consequences as part of the support and risk management panning. Uness a consumer s pan, incuding persona risk management, resuts in unaddressed heath and safety issues that are so significant that a referra to Adut Protective Services or Chid Protective Services wi resut, a pan shoud not be denied for heath and safety reasons. In other words, heath and safety considerations under CDCS shoud foow the practice in pace for a HCBS service pans and protections. Liabiity: According to MN Statute 256B.0916 Subd. 6a (c), MN Statute 256B.49 Subd. 16 (e), and MN Statute 256B.0915 Subd. 8 (c), the state of Minnesota, county agencies, triba governments, or administrative entities under contract to participate in the impementation and administration of the home and community-based waiver for persons with menta retardation or a reated condition, persons with disabiities, and the edery waiver: sha not be iabe for damages, injuries, or iabiities sustained through the purchase of support by the individua, the individua s famiy, ega representative, or the authorized representative with funds received through the consumer-directed community support service under this section. Liabiities incude but are not imited to: workers compensation iabiity, the Federa Insurance Contributions Act (FICA), or the Federa Unempoyment Tax Act (FUTA). (itaics added) 23