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Consumer Directed Community Support

Expenditure Guide

Consumer Directed Community Support A Service funded by a waiver

FORMS & INFORMATION WEBSITE: http://www.dakotacounty.us and search for the full program title Consumer Directed Community Supports. *Note: Using the CDCS acronym may not produce accurate search results. This guide does link to forms when stated. This guide has been reviewed and approved by the CLS Supervisors

CONTENTS *NEW -Big Changes Page 2 *What do these acronyms even mean? *Updated-Expenditures- DHS CDCS Manual Page 3-4 *NEW- Will the items in my plan be approved? Page 4 CDCS Expenditures Alphabetized so you can find info by Category Pages 5-7 Dakota County CDCS Expenditures by Category Personal Assistance Pages 8-9 Treatment and Training Pages 10-11 Environmental Modifications and Provisions Pages 12-15 Self Direction Support Activities Page 16 Unallowed Expenditures Pages 17-18 CDCS Community Purchasing Quick Reference Examples Page 19 Official USDA Food Plans: Cost of Food at Home Page 20

Acronymns

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CA= Certified Assessor. A person who has been trained to do a MnCHOICES Assessment and is employed directed by the county. Sometimes referred to as your Re-assessor (which means you have had an assessment once and each year you need a new one completed by a Re-assessor). CDCS= Consumer Directed Community Supports --a waiver service that provides a flexible use needs based plan that does not require licensed services but enhanced community engagement based on informal supports. CDCS Plan = Specific plan that must be based on the CSP/CSSP that spells out specifics about what services and supports an individual will use in their flexible that is within their CDCS DHS max. The service of CDCS has particular rules and parameters that must be in place in order to use this service. CM= Case Manager from the County or contracted by the county. CSP= Community Support Plan –a plan written by an assessor who did a MNC (or a case manager if no MNC) that addresses a persons wants and needs and shows eligibility for services to meet those needs. CSSP= Community Services & Support Plan = is a part of the CSP based on the services that were decided after the assessment and CSP are written which specifically states the services that are authorized and directs the service provider in what needs to be covered in their provider plan. DHS= MN Department of Human Services –the state department that is responsible for all Home and Community Based services and the rules and regs of such. FSE= Fiscal Support Entity is the vendor that pays the bills between the approved CDCS plan and the services within that plan. They understand tax implications for your unique & Labor Law experts and offer a variety of ways to pay staff. This vendor will cease to be enrolled in CDCS by 3-1-19. FMS= Fiscal Management Service is the vendor that pays the bills between the approved CDCS plan and the services within that plan. They understand tax implications for your unique & Labor Law experts and offer one staff employment model of payroll. New Enrollment started 10-1-18 and all people on CDCS must have one by no later than 3-1-19. HCBS= Home & Community Based Services are umbrella Term for long term supports and services –a division of the MN Department of Human Services. MNC= The state of MN’s name for a statewide assessment to measure needs and wants that is completed on an electronic tool and completed by a “CA” or Certified Assessor. MNC-R= A MnCHOICES Assessment Reassessment or renewal that needs to be done annually.

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BIG UPDATES to the System for CDCS is Effective 7-9-18: CDCS is a flexible service option for people whose service is funded by a waiver. The system is changing to accommodate Person Centered Thinking/Planning and the Olmstead principles in all we do at the county. A goal for the state system is having similar services across counties in the state. In that effort, you have or will be assessed in all areas of your of wants and needs using the MnCHOICES Assessment tool (MNC). This assessment is completed by a neutral party ( person certified by the state to do a MnCHOICES Assessment called a “Certified Assessor”) coming into your home to comprehensively assess needs and write your Community Support Plan(CSP). The Community Support plan is the plan that describes what you like, what wats. After your MnChoices Assessment you & your team/ case manager writes a Consumer Supports & Services Plan (CSSP) (directions for what you need to address in your CDCS plan based on the MnCHOICES interview). Your CDCS plan is due about that same time and must address the assessed needs that are described in your CSP/CSSP. It is important to understand this process because you will need to start preparing for your MnChoices Assessment and include the assessed needs in the annual CDCS plan.

The process looks like this:

Prep for MnChoices Assessment MnChoices Assessment CSP CSSP CDCS

You will receive a letter from the county 2 months before your plan is to renew explaining that the MnChoices assessor will be contacting you to make an appointment to come to your home for the assessment.Your assessor writes the CSP which documents your wants and needs addressed in the MNC Assessment. Then you and your team/case manager will write specific services to be provided & any directions for your CDCS service which is based on the CSP, followed by you and your support planner writing your CDCS plan. When you get your letter cueing you that you will be assessed in MNC it is the time to discuss with your case manager and support planner what new considerations are warranted, new issues are needing to be addressed, and are there gains in areas that no longer need the level of support that were in the old plan.Review last year’s CSP/CSSP to make sure you are considering a comprehensive plan that is consistent with the assessed needs. You may wish to send it to your CDCS support planner. Considerations for preparing for your annual MnCHOICES assessment

1. Prepare for your MnCHOICES by being clear about what is needed, what you do for the person, consider what the person loves and wants out of life, what are their strengths, (they sing beautifully, they are charming, etc.), and what are their dreams/goals. (THE PERSON’S dreams and goals not yours!). These are all important to principles for Person Centered Planning. Involve a support planner early so everyone is speaking the same language and heading in the same direction for the next CDCS plan

2. Please be sure to prioritize your MNC.Assessment appointment. You cannot continue your waiver if you

miss the MNC.Assessment. This is important. If there is a guardian, they must be present. Our county does not have capacity to take on last minute assessments or easily reschedule. Payroll service gaps happen if there is no assessment completed to continue on CDCS. The new plan needs to be approved in a timely manner.

3. YOUR CDCS plan has to address all the needs and wants written into the CSP/CSSP so it is vital you are clear in your Assessment about what help is needed, what changes from last year, what goals you are going to be working on. Don’t be shy, if you didn’t want to say something to the assessor in front of others but feel you need to clarify or talk about a touchy issue that needs to be addressed be sure to get a phone number and call the assessor with additional information.If they don’t have the information accurately your budget could be affected. MNC often changes budgets a little here and there so its important to try to be clear about the needs,and what others help with.

4. When talking about behaviors tell a story about how the behaviors affect the day to day needs. Tell a story of

an incident to demonstrate the issues and depth of the need. Behavioral needs do not get measured accurately if you can’t articulate how the behaviors affect others/ what staff have to do/ is there a plan in place even though it isn’t written down? This is helpful for the assessor to get a realistic view of what is needed.

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5. Describe the communication pattern, fluency, and ability to make needs known of the person whose plan it is.

6. We are not able to approve CDCS plans that do not meet all of the needs written into the CSP/CSSP. It does not mean they have to be paid for by CDCS, it means there has to be a plan to meet the need informally or with unpaid help, etc.

7. The system is moving towards a one employer model –Payroll Model. FMS will be asking you to choose a FMS

by March 31st, 2019.

8. Your budgets: We don’t want people to have a gap in services so We realize that you may not know your annual budget until after you are required to submit your annual CDCS plan to your worker for approval. a. For first time Budgets: Dakota County will give you either a DHS approved amount or if that is not

available we will give you an “estimated” budget. Understand that estimated budgets are only an estimate and only DHS approved budgets will be approved. Your estimated budget is considered pending DHS approval.

b. Renewal Budgets: Submit your plan based on your last budget and know that it is pending DHS approval. c. What happens if DHS approved budget changes? You & your case manager will be able to change the

plan using a CDCS Plan Change Requests DAK7112. Your case manager approves this and copies approval to the FMS. We consider that a Plan Change Addendum to your approved plan.

When approving plans it is not unusual to “Pend” a requested line item or service in order to approve the rest of your plan in a timely way while we are requesting more information regarding that “Pended line”. That means the “Pended” item or service is not approved until we get additional information. The FMS can’t pay out that item or service until the pending status is resolved with the county.Talk to your Case manager to get more information regarding the possible resolution of pended items. When approved we will do a Plan Change Form Approval and send to FMS/participant. Sometimes we do not approve an item. We typically just talk it over and come to a concensus in CDCS plans–but sometimes that isn’t enough to approve the request. You have the right to request a Notice of Action that the request was denied. You have appeal rights that will be described in the Notice of Action.

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Consumer Directed Community Support Service Expenditures- DHS CDCS Manual Says:

A good or service is an unallowable waiver expenditure if it: • Duplicates other goods or services in the CDCS CSP • Is available through other funding sources. • Is not the least costly and most effective way to meet the person’s needs • Is provided prior to the CDCS CSP’s development • Supplants natural supports that appropriately meet the person’s needs Since covered CDCS goods and services are paid for with waiver funds, they must meet waiver criteria for allowable expenditures. A good or service is an allowable waiver expenditure if it is: • For the direct benefit of the person • Included in the person’s CDCS community support plan (CSP) • Necessary to meet one of the person’s assessed needs • Related to the person’s disability and/or condition (BI, CAC, CADI and DD only). Waiver funds cover only those goods and services in the person’s CSP that collectively represent a feasible alternative to institutional care.

Unallowable Expenditures Allowable Expenditures

Unallowable CDCS expenditures include:

• Services and goods covered by the state plan,

Medicare, or other liable third parties (including

education and vocational services)

• Travel, lodging, or meal expenses related to

training for the person, his or her representative, or

paid or unpaid caregivers

• Services and goods provided to or directly

benefiting individuals other than the person who uses

CDCS

• Services and goods that are diversionary or

recreational

• Services and goods for comfort or convenience

• Items or support normally provided by the person,

or his or her parents, family or spouse (e.g. a parent

helping his or her two-year old child with toileting). Examples of unallowable CDCS expenditures include: • All prescription and over-the-counter medications,

compounds (as defined in Minn. R. 6800.3100), solutions and related costs (including premiums and co-payments)

• Animals, including service animals, and related costs • Attorney costs or costs related to advocate agencies • Experimental treatments • Fees incurred by the person (e.g., MHCP fees and co-

pays, Parental fees) • General vehicle maintenance • Gym membership dues or costs (exception: those

related to fitness or physical exercise for adults as specified in the person’s CSP)

• Home modification of a residence other than the primary residence of the person (this includes the parent(s) of a minor’s primary residence when the minor

Allowable CDCS expenditures may include traditional goods and services available through the state plan, AC and waiver programs, as well as alternatives designed by the person. Home care and waiver/AC goods and services For more information about home care and traditional waiver/AC goods and services under the CDCS service option, see: • Purchasing traditional waiver/AC goods and services • Purchasing home care services. The following are also allowable CDCS expenditures as long as they meet the allowable waiver expenditure criteria and fit into one of the service categories: • Goods and services that augment state plan services, or

provide alternatives to waiver or state plan services • Therapies, special diets, thickening agents, and

behavioral supports that mitigate the person’s disability and are not available through the state plan (note: a physician enrolled as an MHCP provider must prescribe these)

• Expenses related to the CSP’s development and implementation

• Fiscal management services (FMS)provider’s costs related to managing the person's budget

• Maintenance of vehicle modifications (e.g., fixing the person’s wheelchair lift)

• Internet access. * Warranties are not approved if there is nothing you get

in return as that is considered insurance. Warranties that include something of benefit (annual maintainence, an ability to bring in for little maintainence) may be approvable.

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does not live there) • Home modification that adds square footage (exception:

the lead agency can request DHS approval to increase a home’s square footage when the increase is necessary to build or modify a wheelchair accessible bathroom. For more information, see CBSM – Additional square footage.)

ICF/DD Services • Insurance (exception: employee insurance coverage for

direct support workers) • Room and board • Personal items • Tickets to attend a sporting event and related costs • Vacation expenses beyond direct service costs.

Will the items in my plan be approved?

We can approve plan expenditure items if we can say yes to all of these;

☐ The expenditure is for the direct benefit of the person (as opposed to the caregiver, or siblings. For example okay for

massage therapy for calming of the person, but not massage for the caregiver who has back problems because of the transferring of the person)

☐ The expenditure is included in the person’s Community Support Plan CSP/CSSP as a need or specifically stated in

the CDCS plan as a need.

☐ The expenditure is necessary to meet one of the person’s assessed needs (your plan may explain it if it isn’t in the

CSP/CSSP & it is a need). If the Assessor or Case manager does not agree it is a need then you can’t have it in your plan.

☐ The expenditure is related to the person’s disability and/or condition.

☐ All of the assessed needs in the CSP/CSSP must be addressed in the CDCS plan. Example: if a need is listed as

respite for caregiver relief that needs to be addressed in the CDCS plan (it may be unpaid or informal but it needs to be addressed in the plan).

☐ The expenditure is related to the person’s wants and needs for full community access using principles from Person

Centered Thinking/Planning and Olmstead. (Approvers: LISTEN to the full story before you make personal judgement calls and deny things.)

We will deny plan expenditure items if we have to check any of these;

☐ The expenditure is on the DHS “unapprovable” list.

☐ “Duplicates other goods or services”

☐ “Is available through other funding sources”.

☐ ”Is not the least efficient/costly and most effective way to meet the person’s needs.” Articulate what you have

tried and why this particular item is needed and why other alternatives could not work.

Some more costly items are considered a ‘Lifestyle ‘choice (Example: a request for more expensive items because of association rules, property features, to match other features of a home ) and these should be denied. The plan could pay a reasonable amount towards the Lifestyle choice so we keep within the parameters of the program and the family pays the additional cost to get what they want).

If the costly item is based on the disability AND the person has tried less costly alternatives and researched why this is better based on the individual we should approve that. (Example: a request for an expensive bike comes in, they have tried less costly alternatives and person has a specific need that can’t be met unless they buy a specific item and it is not just because we want that bike- but certain enhancements are individual disability related. This item could be approved.

☐ “If the items are provided prior to the date span of the plan or before the approval of the case manager.”*ONLY

exception is support planner bill for an activated plan.

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CDCS EXPENDITURES ALPHABETIZED Adaptive Clothing – Environmental Modifications and Provisions Adaptive Equipment – Environmental Modifications and Provisions Additions to Homes – Environmental Modifications and Provisions Advocacy Services – Unallowed Alternative Therapy – Treatment and Training Alternative Therapy Supplies – Environmental Modifications and Provisions Babysitting – Unallowed Bed – Environmental Modifications and Provisions Bed Linen – Environmental Modifications and Provisions Behavioral Rewards/Reinforcers – Environmental Modifications and Provisions Bikes – Environmental Modifications and Provisions Books and Subscriptions and Software – Environmental Modifications and Provisions Cable Television – Unallowed Camp as Caregiver Relief – Personal Assistance Car Washing Services – Environmental Modifications and Provisions Caregiver Relief - In Home – Personal Assistance Caregiver Relief - Out of Home – Personal Assistance Cell Phone – Environmental Modifications and Provisions Child Care of Non-disabled Siblings – Unallowed Chore Services – Environmental Modifications and Provisions Clothing – Environmental Modifications and Provisions Community Activities – Treatment and Training, Unallowed Community Education Classes – Treatment and Training Companion Care Under 14 years old – See Peer Companion under 14 years old. See specific FMS employee policy. Compounds – Unallowed Computers – Environmental Modifications and Provisions Day Care – Personal Assistance Day Programs –Treatment and Training Dietary Supplements – Unallowed Educational Costs – Unallowed Employee Health Insurance – Self Direction Support Activities Employer of Record – See Agency with Choice Employer Costs – Self Direction Support Activities Enteral/Nutritional Products – Environmental Modifications and Provisions Equipment – Environmental Modifications and Provisions Experimental Treatments and Therapy – Unallowed Experimental Treatment and Therapy Supplies – Unallowed Extended Employment – Treatment and Training Fences – Environmental Modifications and Provisions Fiscal Management Services(FMS) Fees – Self Direction Support Activities Fitness and Exercise Programs, Adults – Treatment and Training Fitness and Exercise Programs, Minors (under 18) – Unallowed Flexible Case Management – See Support Planner Food – Unallowed -SSDI covers room and board Food Thickeners – Allowed with Prescription Formal Licensed Waiver Services – Treatment and Training Furniture – Unallowed Gift Cards as Reinforcers – Unallowed Guardianship/Conservatorship Costs – Unallowed (Dakota County courts allow court costs to be covered) -ask a lawyer who does guardianship. Habilitation Activities (Skill Building) – Treatment and Training Habilitation Materials (Skill Building) – Environmental Modifications and Provisions Home Modifications – Environmental Modifications and Provisions Home Schooling Costs – Unallowed Insurance (Not Related to Employees) – Unallowed Internet – Allowed (environmental Modificatons & provisions) iPads/Tablets – See computers (Environmental needs) Laundry Costs – Environmental Modifications and Provisions

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Legal Fees – Unallowed Maintenance/Repair – Environmental Modifications and Provisions Medical Co-pays – Unallowed Medical Mileage – Unallowed Memberships: Zoo, Science Museum, etc. – Unallowed Mileage Out of State for Recreational and Leisure Purposes – Unallowed Mileage Reimbursement to PARENTS OF ADULTS – Environmental Modifications and Provisions Mileage Reimbursement to PARENTS OF MINORS/SPOUSES – Unallowed Mileage Reimbursement to Support Staff (Includes Other Family Members) – Environmental Modifications and

Provisions Over the Counter Medications – Unallowed Pager – Environmental Modifications and Provisions Parking Reimbursement to Parents of Adults – Environmental Modifications and Provisions Parking Reimbursement to Parents of Minors – Unallowed Parking Reimbursement to Support Staff (Includes Other Family Members) – Environmental Modifications and

Provisions Parking Reimbursement – Spouses – Unallowed Payroll Model Fees – Self Direction Support Activities Peer Companionship – Personal Assistance Personal Care Supplies - Disability Related – Environmental Modifications and Provisions Personal Care Supplies - Not Disability Related – Unallowed Pets/Animals and Related Costs – Unallowed Prescriptions Not Covered by MA – Unallowed Property Damage – Environmental Modifications and Provisions Ramps – Environmental Modifications and Provisions Record Keeping Costs – Self Direction Support Activities Recreational/Leisure Activities – Unallowed Rewards – see Behavioral Rewards/Reinforcers Environmental Modifications and Provisions Room and Board – Unallowed Safety Equipment – Environmental Modifications and Provisions Sensory Supplies and Equipment – Environmental Modifications and Provisions Support Planning/Service Coordination/Flexible Case Management by Parents of Minors/Spouses – Unallowed Sibling Care – Unallowed Skill Building Activities – Treatment and Training Skill Building Materials – Treatment and Training Socialization – Unallowed Special Diets – Environmental Modifications and Provisions Solutions – Unallowed Storage/Locked Cases – Environmental Modifications and Provisions Strollers – Environmental Modifications and Provisions Summer Activities – Unallowed Support Agent – See Support Planner Supported Travel as Caregiver Break – Personal Assistance Support Planner/Service Coordination/Flexible Case Management – Self Direction Support Activities Support Planning/Service Coordination/Flexible Case Management by Parents of Adults – Self Direction Support Activities Support Staff - Family Members (other than Parent/Guardian) of Client – Personal Assistance, Treatment and

Training Support Staff - Formal for Personal Care (PCA Agency) – Personal Assistance Support Staff - Informal for Habilitation/Skill Building – Personal Assistance, Treatment and Training Support Staff - Informal for Personal Care – Personal Assistance Support Staff - Parent/Guardian of Adult Client – Personal Assistance, Treatment and Training Support Staff - Parent of Minor Child – Personal Assistance Support Staff - Spouse of Client – Personal Assistance Support Staff When Client is out of United States – Unallowed Supported Employment – Treatment and Training Supported Travel – Personal Assistance Swing Sets/Play Sets – Environmental Modifications and Provisions Toys/Games/Videos – Unallowed Training for Caregiver – Treatment and Training Training for Caregiver/Related Expenses – Unallowed

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Tuition (including MN Life College) – Unallowed Tutoring – Treatment and Training Utilities – Environmental Modifications and Provisions Vacation Expenses – Unallowed Vehicle Adaptations – Environmental Modifications and Provisions Vehicles – Unallowed Vitamins/Supplements – Unallowed Wheelchairs – Environmental Modifications and Provisions Wills and Trusts – Unallowed

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DAKOTA COUNTY CDCS EXPENDITURES BY CATEGORY

Expenditures require a Community Support Plan (CSP) approved by Dakota County. Everything purchased must be related to the disability and outside of what is typical age appropriate parenting responsibility or typical spousal responsibility. Everything on the plan must be cost effective and within typical costs. Categories are:

Personal Assistance Treatment and Training Environmental Modifications and Provisions Self Direction Support Activities Unallowed

PERSONAL ASSISTANCE Camps as Caregiver Relief – Camps offer a variety of experiences and are also often used as a caregiver relief and are fundable. Camps are not licensed. Caregiver Relief (previously called Respite Care)– In Home- Unlicensed/Informal

Family members who reside in the client’s home may not provide daily caregiver relief, unless the family member is NOT the primary caregiver AND the primary caregiver is away overnight.

Caregiver relief services are NOT tax exempt.

Unlicensed/informal individuals providing caregiver relief must be paid an hourly rate through Payroll Model through the FMS(Fiscal Management Service). Daily rate is not allowed.

The term “Respite” may only be used to describe a licensed provider.

Unlicensed/informal individuals providing caregiver relief working overnight must be paid hourly. There are no daily rates for Caregiver Relief.

Caregiver Relief– Out of Home- Unlicensed/Informal

Unlicensed individuals providing out-of-home caregiver relief do not qualify as independent contractors and must be paid hourly through the FMS via the Payroll model. Daily rates can only be paid to a contracted licensed provider. FMS will provide 1099.

Day Care/Child Care – Consider these things for approval:

When a parent is working, day care costs are typical parenting responsibility for children ages 10 and under.

Costs above and beyond typical parental responsibility are fundable. (for instance they need to hire a 1:1 due to needs of individual)

For children under 10, the difference between the cost of regular day care and specialized day care due to disability is fundable.(For typical costs of day care for Mn Metro counties refer to internet …) we are not.

Day care is not considered typical parental responsibility for children ages 10 and over.

Parent/guardian/spouse) for Personal Care and/or Habilitation/Skill Building – Is fundable, and is limited to 40 hours a week per family member who lives in the household. The rate of pay must be within typical wages of $15 to Family members must meet the staff qualifications described in the CSP. If a support staff is under age 18, this must be identified in the plan. FMS Employer Models vary in paying staff under 16 years old. This is a 1:1 ratio. Shared staff ratios are not allowed.

Criminal Background Study Information All direct care, paid and unpaid, persons on the CSP must have a background study. Licensed service providers are responsible for coordinating background studies on prospective employees. Individuals who fail to pass the background study may not be hired to provide CDCS services. Your plan must indicate all person who are direct care. Respite-Licensed- Is approvable if waiver enrolled. CDCS is not able to pay for ICF/DD Respite. PCA Staff - Personal Care Attendant Using a PCA Agency – The staff person must meet the requirements in state law and meet the qualifications described in the CSP. The formal PCA agency must be identified in the CSP. NOTE: These services come out of the CDCS budget total. Worker must include RN supervision and PCA line in SMARTS. See “Using a Formal Service” within a CDCS Plan Reference Guide.

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Assessed annually

RN Supervision Support Staff – Informal for Personal Care and/or Habilitation/Skill Building – The staff person must meet the qualifications as described in the CSP. Pay for staff is within typical wages of $12.-17/hour. If a support staff is under age 18, this must be identified in the plan. Support Staff - Parent/Guardian of Adult Client for Personal Care and/or Habilitation/Skill Building – Is fundable, and is limited to 40 hours a week per parent/guardian if applicable. The parent/guardian must meet the staff qualifications described in the CSP. The rate of pay must be within typical wages of $12-17/hour. This is a 1:1 rate. No shared staffing ratios allowed. NOTE: Parent Pay Addendum (More Than One Participant) DAK7231 needs to be completed and attached if parent is being paid for more than one child. Support Staff - Parent of Minor Child –See Above for details. Support Staff - Spouse of Client – Is fundable and Payment must be for tasks above and beyond typical spousal responsibility. Client must have at least one dependency on the LTCC Functional Assessment: Activities of Daily Living.

Support Staff – Eligiblity for Paid Spouse or Parent of Minor Child Paid Spouses & parents of a minor continues to be a controversial and misunderstood issue. A spouse or parent cannot assume they may be paid. The participant of CDCS services AND the spouse or parent of a minor must be eligible. How is a minor child eligible?

1. A MINOR CHILD participant of CDCS services must have at least one dependency on the MNC Assessment or on the LTCC in order to have a paid parent. . (Before the MnCHOICES Assessment you were to use Minnesota Department of Human Services

Supplemental Assessment for Children Under 18 DHS-3428C-EN

2. A SPOUSE PARTICIPANT OF CDCS services must have least one dependency on the MNC

Assessment or on the LTCC Long Term Care Fucntional Assessment: Activities of Daily

Living. -Link here 3 The participant of CDCS Services must have a documented need for staff & description of duties. Duties must be stated in the CSP/CSSP. 4. Is the spouse or the parent of a minor able to do the tasks as listed? The duties must all be beyond what is considered the responsibility of any spouse or parent of same aged child. 5.Parent must pass a criminal background check to be hired.

Pay Rate for Paid Spouse or Parent of Minor Child – If your plan includes paid spouse/ parents of minors it must be no more than the current set State PCA rate including all related taxes and benefits for paid parents of minors and spouses. This will vary by individual FMS rates. Please refer to them specifically for their current rates. Paid Spouses or Parent of Minor must do work under “Personal Assistance” CDCS code only. Paid Spouses is limited to 40 hours per 7 days. Paid Parents of Minors is limited to 40 hours of parent pay per week total regardless of the number of children with disabilities and/or the number of parents being paid. Parents include biological parents, step parents and adoptive parents. The CDCS plan for Paid Spouse or Parent of Minor Child must include a work schedule and tasks that are above & beyond typical parenting/ spousal responsibilities.parents.

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Spouse must meet the staff qualifications described in the CSP. The CSP must include a work schedule and work tasks. The rate of pay, including payroll costs cannot exceed the current rate allowed by the MN DHS for payment of PCA services Supported Travel Through an Agency as Caregiver Break (Off the Beaten Path, Search Beyond, etc) – Supported travel through an agency up to $120/day for staff support may be fundable as part of a CSP.

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TREATMENT AND TRAINING Alternative Therapy – Is non-experimental therapy (see Unallowable Category for definition of experimental) that is not covered by straight MA. Is allowed when Form DHS-5788-ENG is filled out and signed by a Minnesota MA enrolled physician. The form must be attached to the CSP. Related equipment and supplies do not require a separate physician’s prescription. The form needs to be renewed annually. Community Activities –While community activities are typically considered family responsibility some may be fundable. If a plan using community settings to increase a skill or increase sensory tolerance is being considered for training purposes the plan must describe the specific skills being targeted and worked on, along with a description of the desired outcome, frequency of training to occur and a statement of the criteria of when the goal would be considered met. Activities are limited to a couple of specific opportunities that focus on specific skill development. Related staff time and mileage is fundable. Adaptive Community activities such as Special Olympics, Project Explore are allowable. Memberships, Food, are not allowed Enrichment classes (karate, music lessons, pottery, etc.), are considered typical parental/individual responsibility, but may be approved with a therapist’s recommendation and identification of specific disability related goals. All activities must be considered cost effective. Community Education Classes – for documented needs, skill development is fundable when part of an approved plan. Exception: Classes related to fitness and exercise for minors is not allowed. Day Programs – DT&H, Supported Employment, Extended Employment, Sheltered Workshops, Enclaves, Adult Day Care are fundable. Fitness and Exercise Programs for Adults – Are fundable when necessary and appropriate to treat a physical condition or improve or maintain the client’s physical conditions as identified in the CSP, and monitored by a MHCP-enrolled physician. A prescription is required to document care by a physician. The payment structure must be the most cost effective payment option depending on the client’s actual and projected use. The CSP must delineate how the client will use the program and how the usage will be documented. If used last year, how often? Formal Licensed Waiver Services – Are fundable. Costs are billed through the Fiscal Management Service and the costs come out of the individual budget. Staff must meet the requirements in state law and the qualifications described in the CSP. Habilitation Activities (Skill Building) – Are waiver fundable. (Are mandatory for DD waiver and need to be described clearly in the plan.)

Activities must be directed toward increasing and maintaining physical, intellectual, emotional, and/or social functioning.

May include therapeutic activities assistance, training, supervision, and monitoring in the areas of self-care, sensory and motor development, interpersonal skills, communication, socialization, reduction or elimination of maladaptive behavior, community living and mobility, healthcare, leisure and recreation, money management, and household chores.

Whenever the CSP includes activities that look like they should be paid for by the school, by parents of a minor, a spouse or when there are items that look very similar to recreation/leisure or socialization activities, a skill-building program needs to be clearly detailed in the CSP describing the needed skill and if renewal, based on outcomes of previous plans. See also “Community Purchasing Quick Reference Examples”.

Things that are “unallowed”, such as tickets, food, going to restaurants may not be purchased even if they are used for habilitation purposes.

Music Therapy- is fundable when certified therapist is used or consulting fee of a certified therapist for the regular music teacher is used with a disability related need. Instrument costs are not funded. Please refer to Community Activities and Habilitation Activities for required documentation. Alternative Treatment form for alternative therapies must be included and signed by a MN MA physician (DHS-5788). Music Lessons- Not fundable. See Music Therapy.

Skill Building Activities – See Habilitation Activities.

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Support Staff - Family Member (Non Parent/Guardian/Spouse) for Habilitation/Skill Building – Is fundable and is limited to 40 hours a week per family member who lives in the household. Family members must meet the staff qualifications described in the CSP. If a support staff is under age 18, this must be identified in the plan. Parents and guardians of minors who are being paid as a caregiver may not also be listed as a person who is providing the unpaid habilitation. Support Staff – Informal for Habilitation/Skill Building – The staff person must meet the qualifications as described in the CSP, as well as have duties relating to habilitation/skill building as specified in the CSP. If a support staff is under age 18, this must be identified in the plan. Support Staff - Parent/Guardian of Adult Client for Habilitation/Skill Building – Is fundable and is limited to 40 hours a week per parent/guardian. Parent/guardian must meet the staff qualifications described in the CSP. Supported Employment – Is fundable. Training for Caregiver – The registration fees for conferences, classes and workshops are fundable. Expenses for travel, lodging or meals related to training are not fundable. Tutoring – Is fundable when it is above and beyond what school is required to provide based on the client’s Individual Education Plan (IEP).

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ENVIRONMENTAL MODIFICATIONS AND PROVISIONS

Adaptive Clothing – See “Clothing” Adaptive Equipment – Based on the disability is fundable. Adaptive equipment may include adaptive couches, chairs, tables, portable ramps, etc. Adaptations/Modifications to Homes- See Environmental and Equipment Modifications. The first 5000.00 must come out of the CDCS budget– Adaptations to a person’s primary residence(s) or construction of a new primary residence may include, but are not limited to:

Installation and maintenance of ramps, grab bars, and widening of doorways.

Modification of bathrooms and kitchens.

Installation of electric or plumbing systems to accommodate medical equipment.

Shatterproof windows.

Floor coverings for allergenic or mobility purposes.

Modification to meet egress requirements.

Alarm systems/safety equipment to meet life safety and fire codes. Monthly security service fee is not generally approved unless there are unique circumstances.

NOTE: There is a DHS maximum per year for environmental accessibility adaptations –talk to your Supervisor for your particular request. EW (Elderly Waiver) has a lower limit per year than other waivers.

See Policy 7008-Modifications and Physical Adaptation Approval Process for Home and Vehicles. You can not add square footage of usable space with CDCS funds. Please see policy details as some mods for bathrooms may be an exception. Adaptations over 1000.00 requires 2 estimates. Alternative Therapy Supplies – When there is a prescribed approved alternative therapy in the CSP, related equipment and supplies are allowed and do not require a separate physician’s prescription. Bed – Typical beds and request for larger beds due to growth are parent responsibility and not fundable. Full cost of adaptive beds only may be covered if denied by MA and other sources and there is a documented disability related need in the CSP. Adaptations to a current bed may be fundable for health and safety if there is a documented disability related need. Bed Linens- May be fundable with an explanation of medical or behavioral need. See “Property Damage”. Behavioral Rewards/Reinforcers – Rewards that look very similar to parental responsibility (such as toys, *See Video Games.) or recreational activities (videos, books) are not fundable unless part of a structured behavioral plan. This plan must be written in consultation with a professional,(therapist, skills worker, behavioral analyst, school psychologist), and must be described in detail in the Support Plan. Only items listed on your approved support plan will be reimbursed by an FMS. The behavioral plan must include target behaviors to be addressed, a structured reinforcement schedule, and list of effective rewards. Gift cards and monetary awards are not allowed. An alternative to monetary reward could be a token economy strategy which allows the individual to work toward an approved reward identified in the behavioral plan. allowances are not allowed. Video games that are considered violent or M-Rated will not be reimbursed.Progress on behavioral goals must be updated annually in the Support Plan or CSP. Bikes– Are fundable when adaption is related to disability. Adaptive may include tandem bike, side by side bike or uses hand controls in place of pedals, for example. Expenditures should be no more $3,500 without a clear reason to go beyond that. Age appropriate raining wheels and larger bikes for growing children are typical parental responsibilities. Books and Subscriptions and Software – Are fundable when related to the client’s disability and are needed to support an outcome in the CSP. Example: Exceptional Parent. Books for pleasure reading are not allowed. Car Washing Services – Only interior car washes with a justification are fundable and must be disability related. They cannot be due to normal ‘wear and tear’. (Urine, feces, vomit, etc. – one time per quarter or less.) See also “Property Damage”. Camera’s for Monitoring- See Video Monitoring Systems/Cameras

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Cell Phone 24 Hour Emergency Assistance Service In today’s world a cell phone is a typical family expense. A cell phone may be funded under 24 hour emergency assistance, if you do not currently have a cell phone and the phone is needed for disability related emergency situations. Cell phones used on a routine basis or for social purposes or communication between school or county, will not be funded. When a request for a cell phone is submitted to the case manager, a plan should also be submitted that explains the specific reasons for the request and how the use of the cell phone relates to the person’s disability and need for emergency assistance. Monthly cell phone should cost up to $40.00. The following are common situations when emergency assistance use of a cell phone may be appropriate:

1. To call for assistance in case of injury or accident that is disability related. 2. For use during transport of a client, if assistance is needed in the event of mechanical trouble, behavioral or

medical issues. 3. GPS – if use of GPS for emergency assistance requires an upgrade in service of current phone. 4. For Client safety net to allow for independence and also access to caregiver when need for access to cell to call

for immediate emergency assistance for health and safety. Consider this if you are eligible:

Prepaid Cellular Phone – CDCS plan could pay up to $40.00 per month for prepaid cellular minutes for emergency use, when the person does not already have access to a cell phone. CDCS plan could pay, as needed also the cost of the prepaid phone up to $150. OR Monthly Contract Cellular Phone – CDCS plan couldl pay up to $40.00 per month for a contracted cell phone. Each request is approved by the case manager on an individual basis. Chore/Housekeeping Services – Consider these things:

Chore services, such as lawn mowing, snow removal and/or housekeeping, may be allowed when it enables the caregiver to support the client and is unavailable to do these chores. If this same client lives in a home where; client them self, an able teen, young adult or another parent; these services are typical family responsibilities and it should be expected that the family incur the costs. Rational for expense must be documented in the CSP/CSSP

Labor costs only are allowed. Related supplies such as chemicals, Chemlawn, etc. are not fundable.

IRS rules for reporting wages apply. Cleaning Supplies- The difference between the typical cost and organic may be fundable if disability related. Cost must be comparible to similar supplies offered at retails like Target, Walmart. Clothing – Clothing is a typically a parental responsibility. Clothing purchased through a specialty store that has adaptations built into the clothes by design may be fundable. Replacement clothing and shoes due to excessive wear and tear due to the disability may be fundable as ‘Property Damage’. Alterations to clothing due to the disability may be fundable.

Sensory friendly Clothing as a general rule is a parental or individual’s responsibility and not fundable, unless the cost of the item is significantly more than a similar non sensory friendly item. The difference between typical clothing cost and disability related may be fundable. Computers/ iPads/Tablets (Choose one of these options based on needs. May NOT have two options.) Either a computer or an electronic tablet, (one or the other not both) can be purchased every two years. We recommend thinking carefully about which devise works best for the participant before making a request. Research with teachers, therapist, etc., on the best option based upon the participants needs and plan ahead on what would be needed over the upcoming three years. Considerations:

Put safeguards in place immediately if there are behavioral concerns or safety concerns about lost or damaged computers/ Ipads. We do not replace things because no safeguards were in place, only when the safeguard was thought out and should have worked but the disability symptoms damaged the device.

Protected cases should be considered when behaviors warrant.

iPads typically are to be used for communication purposes and may be considered for other disability related needs.

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The cost effective amount for computers and their peripheral equipment is typically up to $1,200.

The cost effective amount for iPads is $700.00 unless there is clear documented need for more.

Educational programs are not allowable as such. See “Habilitation Materials”.

Adaptations required to enable the client to use the computer or iPad are fundable.

Replacements for computers or iPads purchased with CDCS funds will be considered if computer or iPad is more than 2 years old.

Use of the computer must be related to client disability related need.

Warranties are not allowed. But warranties that include purchasing other service benefits i.e. annual servicing or other considerations may be allowed.

If iPad is used only as augmented communication device please explore MA funded options.

A request for replacement costs for lost compluters/ipads/tablets are not fundable unless an attached police report is available.

Enteral/Nutritional Products – Allowed when prescribed by a MN MA physician and denied by MA or when exceeding what is covered by MA. Examples include items such as Boost, Ensure, etc. Items purchased must be on the current SADMERC (Statistical Analysis Durable Medical Equipment Regional Carrier) list available on the DHS website. Educational Costs- Are not fundable when child is enrolled in school. The school district is considered financially responsible. Educational toys/supplies that are disability related and supplement learning may be fundable when need is described in the CDCS plan. Educational training costs for caregivers, see “Training for Caregivers”. Homeschooling costs are not fundable. Post secondary educational training is not fundable unless classes are directly disability related. Environmental and Equipment Modifications - . Home/vehicle modifications are fundable. Modification must be related to the individual’s needs, disability and/or health and safety. Modifications/equipment that are over $1,000 in cost require 2 bids when the labor/cost are not done by caregivers or over $1,000 for the requested Modifications/equipment to determine cost effectiveness. If you are doing a home modification/Equipment that will be over $5,000 then the 1

st $5,000 is required to come out of

the CDCS Plan/ Budget. Remaining costs may be requested through your case manager and be paid through the waiver system. They must meet Dakota County’s policy 7008-Modifications and Physical Adaptation Approval Process for Home and Vehicles (Case managers can get this for you). All Modifications/equipment will be pending until the 2 bids are reviewed and approved by case manager and their supervisor through the Change Form Approval Process. Employer Costs-Employer costs such as payroll FICA,FUTA,Workers Compensation, wages, employer shares of benefits, paid time off and liability insurance are fundable. Processing fees are fundable. See “Fiscal Management” Essential oils are used in many situations to provide assistance with calming/mood, sleeping and disorders/complaints such as joint pain or headaches. Using essential oils as an insect repellent or household cleaner would be considered a personal choice and not directly related to the participant’s disability.

Initially, may only purchase one essential oil per need to be able to determine which is benefitting the

participant.

Where you purchase your oils from is a personal choice. CSG guidelines allow reimbursement up to about

$15.00 per oil based on typical cost effectiveness

Must include the name of oil purchasing and how it addresses the participants’ needs related to their disability.

Habilitation (Skill Building) Materials – Are fundable. Materials that look very similar to parental responsibility (such as toys, etc.) or recreational activities (videos, books) must be related to a skill building program that is described in detail, (i.e. targeted skills, plan for teaching skills and description of method of teaching targeted skill in the CSP (Things that are “unallowed”, such as tickets, food, going to restaurants may not be purchased.) CDCS funds are not approved for violent or M rated videos or games.

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Home Modifications –All modification/projects will be pending until the 2 bids are reviewed and approved by case manager and their supervisor. Fences – Are fundable when CSP documents that it is needed for health and safety or as part of an outcome on the CSP. Cost effective is typically up to $7,500.00 to $8,000 for a large enough space for behaviors and . Consider that the costs can not cover lifestyle choices vs what is cost effective for a portion of your lot that is considered typical. Internet- Is fundable when a disability related need is documented in the plan. We encourage families writing their own plans to communicate electronically. Fundable up to $40.00/MO. Laundry Costs – Extra supplies/utilities resulting from the person’s disability are fundable. The all-inclusive cost of doing laundry is $6 per load and should be documented with date and number of loads. The number of fundable loads must exclude the number of weekly loads every person typically completes regardless of disability. Laundry detergent and other supplies are NOT fundable. Laundry done at Laundry matts may be reimbursed at a higher rate with documentation and only if disability related and over typical laundry needs costs. Maintenance/Repair – Of client’s disability related equipment is fundable. Warranties are considered insurance by DHS and are a DHS “unallowable” expenditure. There may be an exception for adaptive equipment in excess of $1200. See Team C for discussion. Mileage Reimbursement to Parents of Adults and Support Staff – Is fundable. The amount for a car cannot exceed the county mileage reimbursement rate. Mileage must be documented. Mileage Reimbursement to Parents of Minors – Even as paid staff is not allowed due to waiver rules.. Parking Reimbursement to Parents of Adults, Support Staff (Includes Other Family Members) – Is fundable when related to the disability and CSP. Personal Care Supplies That ARE Disability Related – And are above and beyond typical personal care supplies are fundable as described in the CSP/CSSP. Property Damage – Parents/Caregivers are expected to take protective/preventive measures to protect their property when participant is prone to property damage behaviors. Lifestyle choices such as expensive large TV’s, china, etc. will not be replaced. Property damage to common household items may be replaced when directly related to the participant’s disability and there must be a documented behavior prevention plan prior to replacing the item in order to prevent repeated replacements. Prevention plans may include behavior program for prevention, behavioral intervention techniques, training, and environmental adaptations. Increased parental supervision or staff supervision alone is not an acceptable behavior intervention plan. When considering whether property damage can be used, remember it must be a responsible use of taxpayer dollars and be fiscally responsible. Normal wear and tear as related to the participant’s disability may be considered. When requesting replacement of an item used by the whole family, only a portion may be covered. An individual cost over $200.00 requires Case Manager approval. Normal wear and tear and the age of the item are considered in how much funding is allowed. Sometimes a contribution towards replacement is most appropriate.

Excessive wear and tear related to the disability may be considered when considering replacing items.

Individual costs/items over $200 must have individual Case manager approval.

For each maladaptive behavior that results in property damage, there must be a documented prevention plan in the CSP. Prevention plans need to include both behavior intervention techniques and training, and environmental adaptations. Increased parental or staff supervision alone is NOT an acceptable behavior prevention plan.

Only bed linens with an explanation of medical or behavioral need are acceptable fundable expenditures. Ramps – Are fundable when cost effective based on need. Safety Equipment – Such as alarms, monitors, and shatterproof windows are allowable expenditures. Ongoing monthly monitoring is rarely fundable, as they are not cost effective. Alerting others that a person is gone can be purchased without having an ongoing monthly cost. Consider cost effectiveness and individual circumstances. Is it cost effective in terms of replacing staff? No monthly monitoring. Sensory Supplies and Equipment – Are fundable when directed toward increasing and maintaining physical, intellectual, emotional and/or social functioning. See Community Activities and Educational Costs. Any skill building material costing more than 200.00 requires case manager’s approval before the purchase.

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Skill Building Materials – See Habilitation Materials in this section. Special Diets – Are fundable when prescribed by a physician who is enrolled as an MHCP provider (can bill MN’s MA). The MN Department of Human Services designated a list of allowable special diets. NO OTHER DIETS OR FOOD ITEMS BEYOND THIS LIST ARE ALLOWED: Special diet monthly allowable amounts are based on the Official USDA Food Plans : Cost of Food at Home Liberal Plan and found on page 23.

Anti-dumping diet – 15% of Liberal Food Plan (LFP)

Controlled protein diet (40-60 grams and requires special products) – 100% LFP

Controlled protein diet (less than 40 grams and requires special products) – 125% LFP

Gluten free diet – 25% LFP

High protein diet – 25% LFP

High residue diet – 20% LFP

Hypoglycemic diet – 15% LFP

Ketogenic diet – 25% LFP

Lactose free diet – 25% LFP ()

Low cholesterol diet – 25% LFP

Pregnancy and lactation diet – 35% LFP Storage/Locked Cases – For specific equipment related to the disability and safety are fundable Strollers – Adapted strollers are fundable. Typical strollers for babies and toddlers are parental responsibilities. Swing Sets/Play Sets – Are a typical family expense. Sometimes, due to disabilities one may need more than a typical family swing set. (Sensory needs for a specific type of swing, or person’s size is larger than the typical play set etc.) In these cases the disability related need should be documented in the support plan (Think in terms of what is the reason why a typical swing set that the family would purchase can’t meet the needs.) Sensory and social skill building purposes are allowed if described in the CSP fundable up to $2,000. If costs to meet the disability related need are over this amount consult with clients case manager is required. Utilities – The waiver does not pay for room and board costs that are not related to the client’s disability. If the client receives a social security benefit, extra utilities costs due to the disability must be paid out of the client’s monthly social security.

To be considered for any reimbursement, overall costs for utilities must exceed the typical cost of utilities for a home that size with that number of occupants and documented in the CSP.

The costs for extra water/sewer, electric, heating, cooling, etc, must be documented and the method of determining the cost must be clearly identified in the CSP.

At a minimum they must exceed $330 a month for a house or $85 a month for an apartment and the excess cost must be directly attributable to the client’s disability and documented in the CSP.

Vehicle Adaptations – Such as lifts, ramps, and tie downs are fundable. The adaptations are based on needs as described in the CSP. Video Monitoring System/Cameras – there must be documented needs in the support plan or CSP for cameras that are disability related. Cameras in the bathroom are not allowed. Cameras in the bedroom to monitor a child for health and safety may be approved after discussing the need with the case manager. DHS form-Edocs 6789 Monitoring Technology. Must be completed and attached to the plan- Link here. Case manager should note in the CDCS plan the answers to the following: Why is a camera needed? When will the camera be used? What else has been tried? Is this the least restrictive option?

Vitals Aware Services– this App and associated beacons help to protect participants by voluntarily communicating critical information in real time to nearby law enforcement and first responders. Vital App and Beacons are fundable.Link here. Wheelchairs – Are fundable if not covered by MA or other insurance and when needed as described in the CSP. Wills and Trusts –Are not fundable by any government funding source.

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SELF DIRECTION SUPPORT ACTIVITIES Employee Health Insurance – Is fundable when cost effective and meets community standards. Employer Costs – Employer costs such as payroll FICA, FUTA, SUTA, Workers’ Compensation, wages, employer shares of benefits, and liability insurance are fundable. Processing fees are fundable. Fiscal Support Entity Fees – Are fundable. Payroll Model Fees – Are fundable. Recording Keeping Costs – Such as postage, copying, print cartridges, supplies are fundable as identified in the CSP. Service Coordination – See Support Planner. Specialist Service (for DD Waiver) – Must be approved by the County as a service under the DD waiver. The specialist must be a QMRP and have duties needed and described within the CSP and are duties that are above and beyond what a support planner can do. Hiring, recruiting and training staff are not within the scope of a specialist service. Consults, which may include taking person to an appointment for coordination program development. Support Planning (Formerly known as Service Coordination/Flexible Case Management) by Parents of Adults – Is allowed if parent of an adult is certified by the State as a flexible case manager. If being paid as the support planner, the parent cannot also be paid as staff. Parents of minors are not allowed to be paid as a support planner. A support planner may hire, recruit and model staff expectations. Direct care is NOT in the scope of a support planner. *Certificate must be attached. Parent of minors are not allowed to be paid as a support plan for their own child. Support Planner (Service Coordination/Flexible Case Management) –Is fundable and may be purchased from the County, another individual or agency. Flexible Case Managers/Support Planners must be certified by the state. A support planner may hire, recruit and model staff expectations. Direct care is NOT in the scope of a support planner. *Note make sure you have a written agreement with the support planner as to what is expected and the cost estimate. DHS Support Planner Certificate must be attached to CDCS plan for consumer protection.

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UNALLOWED Advocacy Services – DHS unallowable list. Are not waiver fundable. Babysitting – Is a parental responsibility and as such is not fundable. See Personal Assistance/Support Staff. Cable Television – Is not fundable. Child Care of Non-Disabled Siblings – Is not fundable. (DHS Rule: For sole benefit of the participant.) Community Activities – Memberships to the Zoo, Science Museum, YMCA or fitness centers for minors, are not fundable. Restaurant food is never allowable. Tickets to sporting events, plays, movies, etc. are not allowable. Activities NOT related to the disability that are typically paid by parents of non-disabled children are not fundable. (See “Community Purchasing Quick Reference Examples”, and “Community Activities” as reference under Treatment and Training.) Compounds – Are not fundable. Compounds are defined as prescriptions prepared in accordance with Minnesota Rules 6800.3100. Compounded prescriptions are not commercially available. Dietary Supplements – Are not fundable, even with a prescription. Dietary supplements, like vitamins, are considered over the counter medications. Some dietary supplements may be covered by Medical Assistance. See Enteral/Nutritional Products. Educational Costs – For clients are not fundable when client is still enrolled in school. The school is considered financially responsible. See “Habilitation Activities/Materials”. For educational costs for caregivers, see “Training for Caregiver”. Postsecondary school tuition is not fundable unless the costs are classes that are directly disability related. See Tutoring and Home Schooling Costs. Experimental Treatments and Therapy – Are not waiver fundable. Experimental Treatment is defined as “drugs, therapies, or treatments that are unproven, have been confined largely to laboratory use, or have progressed to limited human application and trials, and lack wide recognition from the scientific community as a proven and effective measure of treatment.” Using the Alternative Therapy form lets the MD answer whether or not it is experimental or alternative. See “Alternative Therapy” under “Treatment and Training”. Experimental Treatment and Therapy Supplies – Are not waiver fundable. Food – Is not waiver fundable. The waiver does not pay for room and board. See “Special Diets”. Furniture – The waiver does not pay for basic furniture. Also see “Property Damage”. Gift Cards as Reinforcers – Are not fundable per DHS. Guardianship/Conservatorship Costs – Are not waiver fundable. Health and Fitness Activities for Minors – Are not fundable. This includes fitness club annual memberships, day passes, swimming lessons and the like. Home Schooling Costs – Are not fundable under the waiver. Education is considered the school’s financial responsibility. If the participant is home schooled, any educational items on the CSP requires a home school plan to determine whether any cost if fundable. Insurance– Is not fundable except for insurance costs related to employee coverage. Warranties have been declared by DHS as insurance. May be fundable when cost effective in specific situations. Legal Fees – Are not fundable. See “Wills/Trusts”. Medical Co-Pays – Including MA, PMAP (Prepaid Medical Assistance) and private insurance are not fundable. Medical Mileage – Is not fundable. May be fundable through straight MA. MTM- Non-Emergency Medical Transportation 1-866-467-1724

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Memberships: YMCA, Zoo, Science Museum, Arc, Autism Society, Weight Watchers, Etc. – Are not fundable for minors. Memberships: Zoo, Science Museum, Arc, Autism Society, etc. – Is not fundable. YMCA may be funded for adults. See Fitness Programs for Adults. Mileage Out of State for Recreational and Leisure Purposes – Is not fundable. Mileage Reimbursement to Parents of Minors – Is not fundable, per DHS. Mileage Reimbursement to Spouses – Is not fundable, per DHS. Over the Counter Medications – Are not fundable, even with a prescription from a MHCP enrolled physician. Personal Care Supplies NOT Disability Related – Are not fundable. Pets/Animals and Related Costs – Including service animals are not fundable. Prescriptions – Are not fundable. Recreational/Leisure Activities – Are not fundable. See “Community Activities”. Room and Board – Is not fundable. Support Planning/Service Coordination/Flexible Case Management by Parents of Minors/Spouses – Is not fundable. Sibling Care – Is not fundable. Socialization – Is not fundable. See “Community Activities” or “Habilitation Activities/Materials”. Solutions – Are not fundable. Solutions are dose forms of prescriptions or over the counter medications available either commercially or compounded individually by a pharmacist. Examples are: irrigating solutions, wound care solutions, solutions made from tablets or capsules for those who can’t swallow a tablet or capsule. Summer Activities – Are not fundable. See “Community Activities”. Support Staff When Client is Out of United States – Is not fundable. Waivered services must be provided in the United States. Toys/Games/Videos – Are not fundable. See “Habilitation Activities/Materials”, “Behavior Reinforcers/Rewards” or “Property Damage”. Training for Caregiver/Related Expenses – Lodging, meals and travel related to conferences, classes, and workshops are not fundable. Tuition – To any private school or institution of higher learning is not waiver fundable. Some post secoundary institutions do provide disability related independent living curricula and support that may be fundable. Vacations Expenses – Are not fundable. See “Supported Travel as Caregiver Break”. Video Games & Consoles – Video games and consoles have become a common activity and expense for families and are considered typical parental responsibility. Video games and consoles may be funded with defined, recommended therapeutic needs and goals. Video games and consoles must be related to a skill building program that is described in detail in the Support Plan. If you are requesting an upgraded console and the current console is meeting the described need, a new console would not be fundable violent video games are not fundable; this includes any M rated games. Video Monitoring System/Cameras – there must be documented needs in the support plan or CSP for cameras that are disability related. Cameras in the bathroom are not allowed. Cameras in the bedroom to monitor a child for health

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and safety may be approved after discussing the need with the case manager. DHS form-Edocs 6789 Monitoring Technology. Must be completed and attached to the plan- Link here. Case manager should note in the CDCS plan the answers to the following: Why is a camera needed? When will the camera be used? What else has been tried? Is this the least restrictive option? Vehicles – Are not fundable. Vitamins/Supplements – Are not fundable, even if prescribed by a physician who is enrolled as an MHCP provider (can bill MN MA). Wills and Trusts –Are not fundable by any government funding source.

COMMUNITY PURCHASING QUICK REFERENCE EXAMPLES

CAN CDCS PAY FOR CLIENT EXPENSES?

CAN CDCS PAY STAFF ACTIVITY

COST?

CAN CDCS PAY STAFF

WAGES?

CAN CDCS PAY FOR

STAFF MILEAGE?

Tickets to a movie, play, sporting event

NO. Tickets not allowed NO YES

YES Parent of Minor: NO

Going to a restaurant NO. Even when part of habilitation plan. No food allowed.

NO YES YES

Parent of Minor: NO

Activity Memberships for Minors (YMCA, MN Zoo, Science Museum)

NO. No memberships allowed, even with a prescription. NO

YES, to take someone who has personally purchased a membership.

YES, to take someone who has personally purchased a membership.

Fitness and Exercise Activity Memberships for Adults

YES, with doctor’s prescription. See Expenditure Guide for details.

NO YES YES

Other memberships for adults (Zoo, Science Museum)

NO NO YES YES

Organization Memberships (Arc, Autism Society, Pacer)

NO NO Not Applicable Not Applicable

Community Ed Classes (excluding fitness and exercise related for minors)

YES, when part of an approved plan. NO YES

YES Parent of Minor: NO

Adapted sports & related adaptive equipment

YES, when part of an approved plan. NO YES

YES Parent of Minor: NO

Swim lessons, ski lessons and other health and fitness activities for minors, & related adaptive equipment

Only a 1:1 cost above the cost of the activity for all participants to allow for inclusive participation, when part of an approved plan. Only equipment that is

NO YES YES

Parent of Minor: NO

All purchases must be related to the disability/condition of the client, be above and beyond normal expectations for parents of minor (under age 18) children or spousal responsibilities, and be part of an approved Community Support Plan.

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disability related and is not typically used by other activity participants is fundable.

Karate, gymnastics, dance, adapted/consulted music lessons and related adaptive equipment

Allowed only when habilitation outcomes are clearly defined in the CSP. Only equipment that is disability related, and is not typically used by other activity participants is fundable.

YES

YES- Parent of a Minor- No

Fee or day passes for a specific activity at the YMCA.

NO for minors. YES for adults, when part of an approved plan.

NO YES YES

Horseback Riding Therapy, Music Therapy

YES, with a doctor’s order when part of an approved plan.

Not Applicable YES YES

Parent of Minor: NO

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Special Diets – Are fundable. Special diet monthly allowable amounts are based percentages of December 2014 Official USDA Food Plans (Appendix): Cost of Food at Home Liberal Plan.

Anti-dumping diet-15% of Liberal Food Plan (LFP)

Controlled Protein diet (40-60 grams and requires special products)-125% LFP

Gluten Free Diet -25% of LFP

High Protein Diet -25% of LFP

High Residue Diet -20% of LFP

Hypoglycemic Diet-15% of LFP

Ketogenic Diet-25% of LFP

Lactose Free/Dairy Free Diet -25% of LFP

Low Cholesterol Diet -25% of LFP

Pregnancy and Lactation Diet -35% of LFP