Vendor Fiscal Intermediary Option

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Consumer Directed Services (CDS)

• CLASS, DB-MD, and CMPAS
• Habilitation Services,
• Personal Assistance Services,
• and Respite Services

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History of Consumer Directed Services in Texas

• Advocates help create HB 2084 75th Legislature
  (1997)
• The DHS CMAS and TRC PAS Programs implement a
  consumer managed model
• Report presented to Legislature
• Due to successful pilot, SB 1586 is passed by the
  76th Legislature (1999)

• The Department of Human Services (DHS)
  implements Consumer Directed Services for
  Habilitation and Respite in the CLASS and DB-MD
  1915(c) Medicaid waiver programs September 1,
  2001.
• The model was initially referred to as the
  Vendor Fiscal Intermediary (VFI) Option.

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Objectives for Case Manager CDS Training

• Case Managers will be able to present CDS to
  participants applicants
• Case Managers will learn paperwork requirements

• Case Managers will learn monitoring requirements
• Case Managers will be able to help resolve
  problems participants have related to consumer
  directed services

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Objectives for Consumer Directed Services
Agencies (CDSA) Training

• CDSA will understand philosophy of consumer
  directed services
• CDSA will be able to present CDS to participants
  applicants
• CDSA will learn paperwork requirements

• CDSA will learn monitoring requirements
• CDSA will be able to help resolve problems
  participants have with employer-related
  responsibilities
• CDSA will learn billing procedures for CDS and
  CDSA services

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What is Consumer Directed Services (CDS)?

• An optional means given the participant to
  directly control their habilitation and respite
  services
• Participant is the employer and hires and manages
  his/her own employees
• Participant selects a CDSA to calculate, make,
  and deposit federal and state agency withholding
  payments as agent for the employer

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What difference are there between Agency and
CDS service delivery?

• Direct Services Agency
• DSA hires the service providers
• DSA sets wages and benefits for the employees
• DSA does payroll and taxes

• Consumer Directed Services
• Participant hires his own employees
• Participant sets wages and benefits based on
  their service budget
• Participant selects a CDSA to do payroll and taxes

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Differences
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Why would a participant want to choose Consumer
Directed Services?

• Participants can often find family, neighbors, or
  friends to be their employees
• Within the participants allotted service budget,
  he/she can set his/her employees wages and
  benefits
• Participants should hire a back-up employee(s),
  or make other arrangements for assistance for
  those times when the regular employee(s) is
  unable to work

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How will the participant find people to hire?

• The participant may advertise and recruit his/her
  own employees
• Participants can also ask friends, neighbors, and
  family members if they are interested in working
  for them
• In some instances, participants can contract with
  their Direct Service Agency to provide back-up
  services

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How are employees paid in CDS?

• Participants must have each employee complete
  timesheets
• The CDSA processes payroll, makes deposits for
  employer and employee- related taxes
• The participants budget includes a fee that is
  paid to the CDSA for services provided by the
  agency

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Who trains the employees?

• Participants train their employees for specific
  tasks to be performed
• Participants must ensure that each employee
  maintains certification in CPR and Abdominal
  Thrust (Heimlich) procedures (if required by the
  program)
• Participants evaluate the job performance of each
  employee and provides additional training as
  needed

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How do participants do all the paperwork that is
required of an employer?

• Participants receive training from the CDSA on
  required paperwork and an overview of the
  services the CDSA will provide for the
  participant
• Participants will also be given information on
  what paperwork they will need to keep for their
  records

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What do participants do if the personal assistant
doesnt work out?

• Participants receive employer-related training
  from the CDSA
• As the employer, participants can fire employees
  who do not meet their needs and expectations

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What happens if a participant choose CDS and
later changes their decision?

• Participants may elect to participate in
  Consumer Directed Services
• Participants may transfer those services back to
  the direct services agency
• Participants must remain with the agency for at
  least 90 days before transferring back to CDS

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Who do participants call if help is needed?

• If participants need help with employer related
  questions, they call their CDSA
• If participants need assistance with unresolved
  issues with their CDSA, they call their Case
  Manager

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CDSA - Agency Requirements

• 1. Be a contracted Texas Department of Human
  Services (DHS)/Community Care for the Aged and
  Disabled (CCAD) or Medicaid waiver program
  provider and have attended required DHS training
  for CDS Agencies.
• 2. Maintain the contract that is amended allowing
  the provider agency to perform CDSA services to
  program participants.

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CDSA - Agency Requirements

• 3. Maintain financial resources necessary to make
  payroll twice per month and pay expenses incurred
  by CDS participants prior to reimbursement being
  available to the provider agency and per DHS/CCAD
  contract fiscal requirements for provider
  agencies.

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CDSA - Agency Requirements

• 4. Maintain separate accounting for CDSA
  revenues, expenses, and for reimbursements to,
  and on behalf of, CDS participants.
• CDSA expenses (rent, utilities, payroll,
  etc.) must not be included in cost reporting for
  other programs of the contracted provider agency.

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CDSA - Agency Requirements

• 5. Be able to make timely initial face-to-face
  contact with each program participant that
  selects the provider agency to provide CDSA
  services.
• 6. Have access to the Internet to conduct Texas
  DPS Criminal Conviction History inquiries, for
  correspondence with participants, access to DHS
  forms correspondence, billing, etc.

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CDSA - Agency Requirements

• 7. Have sufficient dedicated toll-free telephone
  line(s) for participants outside of the local
  calling area to contact CDSA staff for assistance
  and for participants, as applicable, to submit
  documents and correspondence by fax and/or email.

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Consumer Directed Services Agency Training Manual

• TRAINING
• Agenda and Notes
• PRE-DECISION HANDBOOK Case Manager and
  Participant
• POST-DECISION HANDBOOK CDSA and Participant
• GOVERNMENTAL AGENCIES Internal Revenue Service,
  EEOC, INS, TWC, DPS, Etc.

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CDSA Training Manual

• RULES and MISCELLANEOUS
• DHS CDS Rules, Payroll Definitions, Other
  Information, and Other Forms and Information
• CLASS CHAPTER 9000
• Provider Training Manual

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Participant Self-Assessment

• Participant decides on services needed within
  Habilitation Services and Respite Services
• Selecting Service Providers
• How to find
• Plan for training/supervising
• Providing performance feedback
• Willing to ask for help
• Who can help make decisions (if necessary)

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Responsibilities of the Case Manager in Consumer
Directed Services (CDS)

• .Working with the participants Interdisciplinary
  Team to assess service level needs
• .Coordinating the development of the service plan
• .Presenting the list of CDSA that are available
  to the participant
• .Educating the participant on his rights,
  responsibilities, options, and resources
• .Re-developing the service plan with the team
  when needs change
• .Be a resource to the participant for health,
  safety and/or exploitation concerns
• .Monitoring all services at least quarterly, to
  include CDSA and services delivered through
  consumer direction

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Responsibilities of the CDSA in Consumer Directed
Services

• Train the participant in CDS requirements
• Explain employer-related requirements to the
  participant
• Assist the participant in budgeting expenses
  within the approved service plan and program
  expense limits
• Assist the participant in becoming registered as
  an employer by obtaining an employer
  identification number (EIN) from federal and
  state agencies
• Compute and pay all federal and state employment
  taxes and those required and/or optional
  deductions for the participants employee(s)
• 6. Receive and process employee time sheets at
  least tow times each monthly

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Responsibilities of the CDSA in Consumer
Directed Services (CDS)

• Maintain records of reimbursement received,
  payments made and budget balance
• Provide summaries of payroll and deductions at
  least quarterly and when requested by the
  participant
• Conduct criminal history checks of applicants, if
  requested by the participant verify employment
  status based on findings
• Prepare and file employer-related tax forms and
  reports related to being an employer. This does
  not include filing income tax returns for the
  participant or the employees.
• Pay the participant incurred costs related to
  employee recruitment, advertisement, and other
  allowable expenses within expense limits and
  budgets

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Responsibilities of the Consumer in Consumer
Directed Services (CDS)

• 1. Hiring, firing, and managing employees and
  back-ups
• 2. Developing a Wages and Benefits Plan for each
  employee within the available
  service funds and budget.
• 3. Conduct criminal history checks, or have the
  applicant or the CDSA acquire the current TDPS
  report
• 4. Securing arrangements for, or training your
  employee(s)
• 5. Evaluating each employees job performance
• 6. Reviewing and approving/signing timesheets
• 7. Providing timesheets and employment forms to
  the CDSA within required timeframes
• 8. Resolving employee-related complaints
• 9. Maintaining personnel files on each employee

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Wages and Benefits

• Participant decides what compensation (wages,
  benefits) to provide within the allotted budget
  and the expense limits set for the program.
• Employment Related Costs
• Participant decides what administrative,
  employment-related costs, to incur. Each
  item/service must be considered an allowable
  expense in order to receive reimbursement for the
  expense. Examples include
• Employee recruitment costs, such as advertising
• Criminal history checks of applicants / potential
  employees
• Provision of CPR training for employees
• If the participant pays any of the above costs
  himself, the CDSA will pay with appropriate
  receipts.
• If the participant arranges for the item to be
  billed, the CDSA will pay the vendor directly
  from an appropriate invoice.

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Training of Employees in CDS

• The participant is responsible for all
  disability related training for each employee,
  including
• Nature of the participants specific disability/
  disabilities
• Type of care needed
• Steps in carrying out each needed procedure
• Safety precautions, and
• Any required program-specific training

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Back-up Employee(s) and Arrangements

• Each participant hires they should consider
  hiring employees or making other arrangements for
  back-up for emergency situations and when an
  employee is not available as scheduled.
• The same training and other program procedures
  are necessary for all service providers,
  including back-up and respite providers.
• The participant may be able to contract with the
  DSA for back up arrangements, if available
  through the DSA.
• The participant may be able to coordinate backup
  coverage with other CDS participants employees

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Employee Expectations

• Employees should know
• specific tasks required on the job
• work schedule, specific hours and days
• hourly rate of pay, pay periods, and benefits
• job performance expectations and
• situations and actions that may result in being
  released (dismissed) from the job

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Examples of Some Forms Participants Must Have for
Each Employee

• W-4, I-9, etc.
• List of Specific Tasks Duties,
• Wages Benefits Plan
• Employment Agreement,
• Job Description,
• Performance Evaluations, and
• All Documentation Required by Law.

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Liability Issues

• TAC ? 41.105 (13)
• Each program participant using Consumer Directed
  Services must... assumes liability.

. employees of consumers in consumer directed
services are considered employees of the
participant . . . . . . . . . . they are NOT the
employees of the CDSA or of DHS the CDSA and
DHS are NOT responsible or liable for any
negligent acts or omissions by the employer OR
the employees.
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Liability - Clarification

• Employee -Employer Acknowledgements
• Post-Decision, Page 62, 65 /or 66
• 1. Employees (full-time, back-up, etc.) and
  Respite Providers are employed by the CDS
  Participant, or the CDS Participants Guardian,
  NOT by the CDSA or by DHS.
• 2. Workers Compensation Subscriber / Non-
  Subscribers Notice (TWCC Required Forms, Page(s)
  65/66)
• 3. Employers Arrangements for Liability Related
• to Employee Injuries.