DAKOTA COUNTY
Consumer Directed Community Support
Expenditure Guide for CSP
NOTE: Client Driven Supports is a flexible service option. Funds can be budgeted in a plan for services and items when Medical Assistance or Private Insurance will not cover the cost. The purpose for budgeted services or items must be client focused, include goals and outcomes, be fiscally responsible, and address the health, safety and developmental concerns of the recipient. Approval of services or items on a plan is based upon if these principles are addressed in the plan itself. This Expenditure Guide is a guideline. Possible exceptions may be considered when circumstances warrant.
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.
CONTENTS
CDCS Criteria for Allowable Expenditures Page 1
CDCS Expenditures Alphabetized Pages 2-4
Dakota County CDCS Expenditures by Category
Personal Assistance Pages 5-6
Treatment and Training Pages 7-8
Environmental Modifications and Provisions Pages 9-12
Self Direction Support Activities Page 13
Unallowable Expenditures Pages 14-16
Environmental Modification and Equipment Guidelines Page 17
CDCS Community Purchasing Quick Reference Examples Page 18
Official USDA Food Plans: Cost of Food at Home Page 19
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Consumer Directed Community Support ServiceCriteria for Allowable Expenditures
The Purchase of goods and service must meet all of the following criteria:1. Must be required to meet the identified needs and outcomes in the individual’s community support plan and assures the health, safety and welfare of the individual; AND
2. Goods and services collectively provide a feasible alternative to an institution; AND
3. Be the least costly alternative that reasonably meets the individual’s identified needs; AND
4. Be for the sole benefit of the individual
If all the above criteria are met, goods and services are appropriate purchases when they are reasonably necessary to meet the following consumer outcomes:
· Maintain the ability of the individual to remain in the community;
· Enhance community inclusion and family involvement;
· Develop or maintain personal, social, physical, or work related skills;
· Decrease dependency on formal support services
· Increase independence of the individual
· Increase the ability of unpaid family members and friends to receive training and education needed to provide support
Allowable Expenditures /
Unallowable Expenditures
Consumer directed community supports (CDCS) may include traditional goods and services provided by the waiver as well as alternatives that support recipients. There are four general categories of services which may be billed:· Personal Assistance
· Treatment and training
· Environmental modifications and provisions
· Self direction support activities
Additionally, the following goods and services that may also be included in the individual’s budgets include as long as they meet the criteria and fit into the above categories:
· Goods and services that augment State plan services or provide alternatives to waiver or State plan services
· Therapies, special diets and behavioral supports not otherwise available through the State plan that mitigate the individual’s disability when prescribed by a physician who is enrolled as a MHCP provider
· Expenses related to the development and implementation of the community support plan
· Costs incurred to manage the individual’s budget
· Fitness and Exercise Programs for ADULTS only. / Goods and services that shall not be purchased within the individual’s budget are:
· Services provided to people living in licensed foster care settings, settings licensed by DHS or MDH, or registered as a housing with services establishment;
· Services covered by the State plan, Medicare, or other liable third parties including education, home based schooling, and vocational services;
· Services, goods or supports provided to or benefiting persons other than the individual;
· Any fees incurred by the individual such as MHCP fees and copays, attorney costs or costs related to advocate agencies, with the exception of services provided as flexible case management;
· Insurance except for insurance costs related to employee coverage;
· Room and board and personal items that are not related to the disability;
· Home modifications that adds any square footage;
· Home modifications for a residence other than the primary residence of the recipient or, in the event of a minor with parents not living together, the primary residences of the parents;
· Expenses for travel, lodging, or meals related to training the individual or his/her representative or paid or unpaid caregivers.;
· Services provided to or by individuals, representatives, providers or caregivers that have at any time been assigned to the Primary Care Utilization and Review Program;
· Experimental treatments;
· Home-based schooling;
· Membership dues or costs, except for fitness and exercise programs for ADULTS ONLY;
· Vacation expenses other than the cost of direct services;
· Vehicle maintenance, does not include maintenance to; modifications related the disability;
· Tickets and related costs to attend sporting or other recreational events;
· Animals and their related costs;
· Costs related to internet access;
· REMINDER:Over the counter medications and dietary supplements;
· Medication Prescriptions, including compounds and solutions
· Gift cards as behavior rewards.
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
Agency with Choice Fees – Self Direction Support Activities
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. Pre-paid cell phone cards or $20 per month on plan.
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 FSE 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 Support Entity (FSE) 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
Food Thickeners – Unallowed
Formal Licensed Waiver Services – Treatment and Training
Furniture – Unallowed
Gift Cards as Reinforcers – Unallowed
Guardianship/Conservatorship Costs – Unallowed
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 – Unallowed
iPads/Tablets – See computers (Environmental needs)
Laundry Costs – Environmental Modifications and Provisions
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
Support Staff - Ages 14 to 16 – Personal Assistance
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
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
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:
v Personal Assistance
v Treatment and Training
v Environmental Modifications and Provisions
v Self Direction Support Activities
v 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 with a CSP. Camps are not licensed. For a list of Minnesota camps certified by the American Camp Association, see http://find.acacamps.org/finding_a_camp.php
Caregiver Relief – In Home
· 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 individuals providing caregiver relief must be paid an hourly rate through the Agency with Choice or Payroll Model. Daily rate is not allowed.
Caregiver Relief– Out of Home
· Unlicensed individuals providing out-of-home caregiver relief do not qualify as independent contractors and must be paid hourly through the FSE via the Payroll or Agency with Choice model.
· Daily rates can only be paid to a contracted licensed provider. FSE will provide 1099.
Day 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 children under 10, the difference between the cost of regular day care and specialized day care due to disability is fundable.
· Day care is not considered typical parental responsibility for children ages 10 and over.
· In instances where we would pay 1:1 staff, day care may be most cost effective.
Support Staff – Family Members (non 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 $10-15/hour. 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. FSE 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 and Agencies with Choice 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.