CDCS: Focus on the need before the solution - mn.gov · •CDCS workers are not “PCA’s – refer to them as workers, paid caregivers, waiver service providers, etc. •The CDCS

CDCS: Focus on the need before the solution

Cindy Grebin | State Program Administrator| Disability Services Division

July 2019

Minnesota Department of Human Services | mn.gov/dhs 1

Learning objectives

You will learn how to:• Determine a CDCS participant’s service needs, such

as type and frequency

• List what factors are needed when determining the role of paid providers in a CDCS plan

• Successfully review hours and job descriptions for workers who are also parents of minors


Consumer Directed Community Supports

Determining a participant’s

service needsMinnesota Department of Human Services | mn.gov/dhs 3

What waiver services are needed?The MnCHOICES assessment will help identify:

• The person’s support needs

• The services or programs to meet those needs, including public programs that might pay for services

• How to get those services


Eligibility

After the assessment, a written summary describes:

What the assessor learned about the person and their needs

What services and supports can help

Public programs they might be eligible for and other resources in your community


Eligibility

The goal of an assessment is to determine which services the individual is eligible to receive regardless of who will eventually be paid to provide those services.

The focus should be determining the needs of the potential program recipient and not who the paid caregiver may or may not be.


Selecting self-direction

If the person is eligible for waiver services, the person may choose to self-direct their services through CDCS.

• Self Direction = Alternative to traditionally delivered services

• Promotes personal choice and control


If the person is eligible for a waiver or the AC program, they have two options:


What Is self direction?

Who provides services;

How services are delivered;

Where are when services are delivered.

A service delivery model

Minnesota Department of Human Services | mn.gov/dhs

What is CDCS?

•CDCS is simply a way for people to use their waiver funds in a self-directed way


How Does CDCS Work?



Reviewing the Plan


Addressing service needs in the plan

•The person-centered CDCS Community Support Plan has been developed by the participant and submitted to the lead agency for review.

•How do you ensure the plan is addressing the person’s service needs?


CDCS Community Support Plan

Community Support Plan (CSP)

Formal and

Informal Supports

Unpaid Services

Paid Services


Addressing service needs in the plan

Self direction is . . .

The freedom to design and direct services within waiver

criteria

Self direction is not. . .

Completefreedom to design and

direct services

8/26/2019 Minnesota Department of Human Services | mn.gov/dhs 15

Plan review


Review plan as a whole and not just

line items.


Unallowable & unallowable expenditures


Allowable goods and services

Always apply basic waiver criteria when authorizing goods and services


!

Waiver funding criteria

• Must be necessary to meet one of the person’s assessed needs

• Be for the direct benefit of the person

• Be included in the person’s CDCS community support plan (CSP)

• Must be related to the person’s disability and/or condition (BI, CAC, CADI and DD only).


Waiver funding cannot be used for services that are . . .

•Services/goods covered by the State Plan or other liable third parties or funding source

•Are not the least costly and effective way to meet the participant’s needs


Waiver funding cannot be used for services that . . .

•Are provided prior to the development of the community support plan

•Supplant natural supports appropriately meeting the participant’s needs


Policy: CDCS funds cannot be used for services that are . . .

•Diversionary or recreational

•For comfort or convenience

•Travel, lodging or meal expenses related to training


CDCS funds cannot be used for . . .

•Items or support normally furnished by the person, or his/her parents, family or spouse


CDCS funds cannot be used for services that are . . .

•Not meeting an assessed need

•Not approved in the support plan


Applying basic waiver criteria

How can you apply the waiver criteria when evaluating:

• what services the person needs

• who will provide the service

•the type and frequency of the service



Waiver service providers

(CDCS workers)Minnesota Department of Human Services | mn.gov/dhs 26

CDCS Workers providing services under the Personal Assistance category

Personal Assistance

• Services and supports that do not require a professional license, certification or credentialing

• Support in completion of activities of daily living

• Participant determines qualifications


Tips & helpful hints

28

Paid Caregivers (workers)

• CDCS workers are not “PCA’s – refer to them as workers, paid caregivers, waiver service providers, etc.

• The CDCS participant or designee is the employer and is responsible to hire workers, set qualifications, create job descriptions, and create work schedules.

Workers

• All CDCS workers must enroll with DHS

• All CDCS workers must pass a DHS background study

• All direct support workers are included in the Collective Bargaining Agreement between SEIU and the State

• Workers and employers must follow both the federal and the state Department of Labor regulations

• Workers and employers must follow IRS laws


Tips & helpful hints: Paid caregivers

30

Paid caregivers (workers)

• The lead agency’s primary focus should be the participant’s service needs. It’s not about working ‘hours’ . . . it’s about service needs.

• The amount of paid hours to any provider (worker) will depend on the service needs of the person

Frequently asked questions

31

Paid Caregivers (workers)

• Determining the number of work hours needed?

• Schedules and job descriptions?

• Determining their hourly wage?

• What tasks are they being paid to perform?

• Determining their qualifications?

• Wage increases (raises)?

• What duties can family members get paid to perform?

• Schedules and paid tasks for parents of minors and spouses?

• Live-in boyfriends/girlfriends?

Questions so far?



Paying parents of minors &

spousesMinnesota Department of Human Services | mn.gov/dhs 33

Parents of minors & spouses• Can be paid for personal

assistance under CDCS

• See policy page titled, “Paying a spouse or parent of a minor for personal assistance”


Parents of minors & spouses

At a minimum, to pay a spouse or parent of a minor for personal assistance services:

• the person who uses CDCS must be assessed as dependent in at least one activity of daily living (ADL). This determination is based on the ADL items contained in the assessment the person receives.


Parents of minors & spouses

The person's ADL dependency does not represent the only allowable activities for which a spouse or parent of a minor can be paid.

The lead agency considers all of the person's other assessed needs that are within the parameters of the personal assistance service category when it reviews the spouse or parent of a minor's hours and duties


Parents of minors & spouses cannot:

• Be paid for services other than personal assistance

• Be paid for more than 40 hours/7 days (includes both parents)

• Be paid a rate exceeding the rate established for Personal Care Assistance (PCA) in the same fiscal year


The personal assistance services the spouse/parent is paid for must:

Meet the same criteria used evaluating work

performed by any worker

Allowable in the personal assistance category

Be related to the person’s disability or functional

limitation

Be directly related to at least one ADL dependency

Not be an activity a spouse or parent of a minor would

ordinarily perform

Age appropriate supervision

Transportation of children

Household maintenance

etc


Parents of minors as paid providers: requirements


Parent of minors need to:

• Pass a DHS background study

• Create job descriptions outlining the paid tasks

• Develop a general work schedule – the work schedule may include variability

Parents of minors as paid providers: common questions

•Common questions from lead agencies . . .• How to determine the number of hours they

should get paid?• How to decide what is a parental responsibility of

the parent (unpaid) and what is a task that can be paid?

• Can we ‘deny’ allowing parents of minors to be paid providers?

• Are live-in boyfriends/girlfriends considered “parents of minors”?


Parents of minors as paid providers: number of hours

How to determine the number of hours they should get paid?•While providing personal assistance services as identified in the CDCS CSP, the parent of a minor functions as a paid staff providing a waiver service, not as a parent.


Parents of minors as paid providers: Number of hours

How to determine the number of hours they should get paid?

Evaluate what tasks they are being hired to perform

• If the parent of a minor must assist the person with tasks beyond what is considered ordinary responsibility, he/she may be paid.

•The parent may be providing intermittent waiver services throughout the day.


Parents of minors as paid providers: Number of hours


•Evaluate the waiver services (personal assistance) the child needs and the time when those services are needed.

•40 hours of service is the maximum. Not all minors are assessed to need this level of service.



•Do an analysis of the tasks and times of day the waiver service is needed.

For example, AM routine of 8 year old child without a disability vs. AM routine of 8 year old child with attentional or behavioral concerns

A portion of morning routine tasks might be able to be ‘paid’, while other tasks (i.e. supervision) are parental responsibilities and would not be paid


Parents of minors as paid providers: Parental responsibility


How to decide what is a parental responsibility of the parent (unpaid) and what is a task that can be paid?

• The lead agency needs to differentiate between waiver services and parental responsibility.

• What are the assessed waiver needs?

• What are paid tasks vs parental responsibility.

Parents of minors as paid providers: Common questions

Can we ‘deny’ allowing parents of minors to be paid providers?

• If there is an active child protection investigation?

No –however, the lead agency is still responsible to oversee waiver services and ensure the person’s plan meets their needs and assures their health and safety.



Can we ‘deny’ allowing parents of minors to be paid providers?

• If they are not fulfilling their paid duties?

No – but the lead agency has authority to approve and person’s plan and recommend revisions as needed. What are they hired to perform? What are they not doing? Do they need more training?



Are live-in boyfriends/girlfriends considered “parents of minors”?No -But if they are performing tasks that are considered the responsibility of the parent, they cannot receive payment.

For example, after-school care for a 6 year old. Dad is at work and his live-in girlfriend is providing care



CDCS workers


CDCS workers: Hourly wage

Determining their hourly wage?

A CDCS participant determines the hourly rate for the worker. Rates must be:

• Within a reasonable range of similar services in the person’s community

• Aligned with the skills and experience required to perform the job tasks the person needs.


CDCS workers: Qualifications

Determining their qualifications?

The CDCS participant establishes provider qualifications based on their needs.

For example:

If a person requires lifting and transferring, the person being hired must be physically capable of performing these tasks.

If a person needs a worker with a specialized communication method, the person being hired must have that qualification.


CDCS workers: Number of hours

Determining the number of work hours needed and schedules

• Establish what waiver tasks they are being hired to perform and when those tasks are needed.

What duties can family members get paid to perform?

• Besides our limitations for parents of minors and spouses, family members are simply “CDCS workers”


CDCS workers: Raises and bonuses

Raises and Bonuses

A CDCS participant can incorporate worker raises and/or bonuses into their plan.

• The raise or bonus must be purposeful (planned) and based on established criteria (i.e. performance, length of service, etc.)



Budgets & service

provisionMinnesota Department of Human Services | mn.gov/dhs 54

Budgets & services

When CDCS budgets change, participants may need revise their plans.

A budget may decrease, could result in the need to reduce the amount/frequency of services.


Questions


?

Thank you!


Cindy [email protected]

Optional Tagline Goes Here | mn.gov/websiteurl 57

Documents

CDCS: Focus on the need before the solution - mn.gov · •CDCS workers are not “PCA’s – refer to them as workers, paid caregivers, waiver service providers, etc. •The CDCS