HCBS Policy Manual 3.25 — Personal Care Assistance – State Plan (Consumer-Directed Model)

What this rule requires your agency to do

• 1The CDS attendant may be a family member but cannot be the participant's spouse or legal guardian, must not have been previously involved in Medicaid fraud, and cannot be a current CDS participant; the participant is the attendant's employer-of-record.(HCBS Policy Manual 3.25 — Personal Care Assistance – State Plan (Consumer-Directed Model))
• 2CDS shall not be authorized to pay for tasks whose primary benefit is to the household unit, tasks household members may reasonably share, or any task that must be performed/trained by a licensed professional (e.g., skilled nursing, physician-ordered therapies).(HCBS Policy Manual 3.25 — Personal Care Assistance – State Plan (Consumer-Directed Model))
• 3When a determination is made that a participant cannot self-direct their care, supporting documentation must be placed in the participant's electronic case record and Adverse Action procedures followed.(HCBS Policy Manual 3.25 — Personal Care Assistance – State Plan (Consumer-Directed Model))
• 4CDS must be authorized in 15-minute units and shall not exceed 60% of the cost maximum (the combination of CDS and agency-model PC also may not exceed 60%).(HCBS Policy Manual 3.25 — Personal Care Assistance – State Plan (Consumer-Directed Model))
• 5CDS participants must select an HCBS provider enrolled as a CDS provider with DSS/MMAC; the provider receives payment on behalf of the participant and processes payroll to the individual providing services.(HCBS Policy Manual 3.25 — Personal Care Assistance – State Plan (Consumer-Directed Model))
• 6Participants must be at least 18 years of age, physically disabled as defined by 19 CSR 15-8.100, able to self-direct their CDS, in active Medicaid status, meet nursing facility level of care, and not have been previously involved in Medicaid fraud.(HCBS Policy Manual 3.25 — Personal Care Assistance – State Plan (Consumer-Directed Model))