Revision17-1; Effective November 1, 2017
In the Community Living Assistance and Support Services (CLASS) program, the Consumer Directed Services (CDS) option is available to individuals who choose to self-direct one or more of the following program services:
- CFC PAS/HAB;
- CLASS transportation - habilitation;
- in and out-of-home respite;
- nursing (includes registered nursing, licensed vocation nursing, specialized registered nursing and specialized licensed vocational nursing);
- employment assistance;
- supported employment;
- cognitive rehabilitation therapy;
- physical therapy;
- occupational therapy; or
- speech/language pathology.
When individuals select the CDS option, they are required to use Financial Management Services (FMS). Individuals may also access support consultation if it is determined to be a necessary support to assist the individual in successfully using the CDS option.
A Financial Management Services Agency (FMSA) chosen by the individual or legally authorized representative (LAR) provides FMS. FMS includes processing payroll and payables on behalf of the CDS employer. This includes serving as the CDS employer's fiscal/employer agent to ensure that federal, state and local employment taxes and labor and workers' compensation requirements are implemented in an accurate and timely manner. FMS also includes orientation, training, support and assistance with and approval of CDS employer budgets.
Support consultation is an optional service provided by a support advisor and provides a level of assistance and training beyond that provided by the FMSA through FMS. Support consultation helps a CDS employer to meet the required employer responsibilities of the CDS option and successfully deliver program services. Individuals may choose a support advisor from the list of support advisors who have met Texas Health and Human Services Commission (HHSC) support advisor training requirements, located on the HHSC website at apps.hhs.texas.gov/providers/CDS/advisors.cfm. The FMSA must make a qualified support advisor available to individuals to whom they provide FMS. The CDS employer may choose to receive support consultation services from the support advisor associated with their FMSA or another qualified support advisor. Payment for support consultation is budgeted within the CDS portion of the individual's budget and is not a separate and distinct service on the Individual Plan of Care (IPC). Support consultation is available for CDS employers who choose additional support for hiring, dismissing, and training attendants. Support consultation provides more extensive training than CFC support management described below.
Community First Choice (CFC) support management offers training on how to select, manage, and dismiss an unlicensed service provider of CFC PAS/HAB. Support Management is a voluntary training benefit rather than a service. There is no reimbursement rate. A Direct Services Agency (DSA) and a FMSA are required to offer support management. DSAs and FMSAs will provide the CFC Support Management Handout (PDF) |Spanish (PDF), along with a verbal explanation, to individuals whose service plan includes support management.
Revision 17-1; Effective November 1, 2017
The individual's CLASS case manager at the case management agency (CMA), is required to offer the CDS option at the time of CLASS program enrollment, at least annually, and at any other time upon request of the individual or LAR.
Individuals have a choice in how their services are delivered:
- Agency Option — The individual/LAR chooses to have a CLASS direct service agency (DSA) deliver their CLASS program services.
- CDS Option — The individual/LAR serves as the employer of direct service providers for those CLASS program services chosen to be delivered through CDS.
The service delivery option individuals select is based on their own preferences, as discussed during the service planning process. It is important to tell individuals they may switch service delivery options at any time. It is possible to have some services delivered through the CDS option and have other services delivered through the agency option. If they select the CDS option, they can switch to the agency option at any time. However, if an individual switches from the CDS option to the agency option, they must wait 90 days before switching back to CDS.
The CLASS case manager offers the CDS option by reviewing the following HHSC forms with the individual.
Form 1581, Consumer Directed Services Option Overview — The purpose of Form 1581 is to introduce the CDS option. Form 1581 gives an overview of the differences between the CDS option and the agency option. This form, when signed, provides acknowledgement the CLASS case manager has provided, both orally and in writing, an overview of the benefits and responsibilities of the CDS option in CLASS.
- If the individual chooses at this point to decline the CDS Option, the case manager completes Form 1584, Consumer Participation Choice, indicating the choice of the agency option. The case manager does not complete HHSC Form 1582, Consumer Directed Services Responsibilities, Form 1583, Employee Qualification Requirements, or Form 1586, Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option.
- If the individual wants to know more about the CDS option, the case manager continues to Form 1582.
Form 1582, Consumer Directed Services Responsibilities — The purpose of Form 1582 is to provide more detailed information to the individual or LAR about the responsibilities assumed if the CDS option is selected. It concludes with the CDS Consumer Self-Assessment. If the individual or LAR (the employer) is not able to complete the Consumer Self-Assessment, a person appointed by the employer to be the employer's Designated Representative (DR) must be able to complete the Consumer Self-Assessment for the individual receiving services to participate in the CDS option. Form 1720 designates a representative for employer duties. The purpose of the self-assessment is to:
- assist the individual or LAR determine if they want to self-direct their services; and
- determine what support might be needed for the individual/LAR to self-direct services.
The self-assessment may not be used to determine that an individual/LAR cannot use the CDS option. If the individual or their LAR has difficulty responding to the self-assessment questions, they probably will need a designated representative (DR) to help them implement the CDS option. It is the FMSA's responsibility to assist them with appointing a DR.
- If the individual chooses at this point to decline the CDS option, the case manager completes Form 1584, indicating the choice of the agency option. The case manager does not complete HHSC Forms 1583 or 1586.
- If the individual wants to know more about the CDS option, the case manager continues to Form 1583.
Form 1583, Employee Qualification Requirements — The purpose of Form 1583 is to provide important definitions of terms used with CDS. This form includes information about who can be the CDS employer, who can be a DR, and who can and cannot be hired as an employee in the CDS option for CLASS.
- If the individual chooses at this point to decline the CDS option, the case manager completes Form 1584, indicating the choice of the agency option. The case manager does not complete HHSC Form 1586.
- If the individual wants to select the CDS option, the case manager continues to Form 1584.
Form 1584, Consumer Participation Choice — The purpose of Form 1584 is to document the individual's/LAR's choice of service delivery option. If the individual or LAR is selecting the CDS option, the individual also must select an FMSA of his or her choice.
The case manager will provide a list of FMSAs serving the individual's CLASS catchment area. The FMSA choice list is available at apps.hhs.texas.gov/providers/cds/cdsas/CLASS.cfm.
To locate FMSAs serving the individual's local area, type in the county in which the individual resides. The case manager should encourage the individual or LAR to call and interview several FMSAs before selecting one.
Important: FMSAs are not required to be located in the same town in which the individual resides. FMSAs provide FMS. This service does not require ongoing face-to-face contact. While FMSAs are required to make one visit to the individual's home to conduct the CDS orientation before service initiation, the FMSA conducts the remainder of their business via email or fax with the individual or LAR, or DR if one has been appointed.
Form 1586, Acknowledgement of Information Regarding Support Consultation Services — The purpose of Form 1586 is to provide information to the individual or LAR regarding the availability of support consultation in the CLASS program. The use of support consultation is optional. If the individual or LAR requests support consultation during the service planning process, this service must be included in the IPC. During the development of the IPC, the number of units of support consultation must be determined for inclusion in the IPC. The amount and duration of support consultation needed by the individual will vary. Since payment for support consultation is drawn from the CDS employer's service budget, there are no additional funds available to pay for support consultation.
Support consultation provides practical skills training, coaching, and assistance related to employer responsibilities, including:
- principles of self-determination;
- recruiting, screening and hiring workers;
- completing documents and assessments required to employ a person, retain a contractor or vendor, and manage service providers;
- negotiating service agreements, including pricing and scheduling services, goods and items;
- effective communication, decision-making and problem-solving skills to meet employer responsibilities ;
- tools for accessing information, resources and assistance;
- contacting appropriate people or entities based on their roles, responsibilities and eligibility related to the individual's program or the CDS option;
- participating in service planning team (SPT) meetings at the employer's request; and
- complying with requirements of the individual's program as related to services delivered through the CDS option.
A support advisor provides support consultation. FMSAs are required to make support advisors available through their agency.
The individual or LAR may select a qualified support advisor provided by his or her FMSA, or may opt to choose a certified support advisor who is not associated with the FMSA from the list of qualified support advisors.
The list of support advisors who completed the required support advisor training is available on the HHSC website at apps.hhs.texas.gov/providers/CDS/advisors.cfm.
Form 1720, Appointment of a Designated Representative
The purpose of Form 1720 is to appoint a representative to perform specific employer tasks delegated by the Individual or LAR. The individual or LAR will choose a designated representative to perform certain employer tasks. If the designated representative is not a relative, the FMSA must conduct a criminal conviction check using the Texas Department of Public Safety public website.
Form 1735, CLASS, Service Provision Requirements Addendum
The purpose of Form 1735 is to provide program specific information about the services that can be self-directed, the provider qualifications, service delivery documentation and training requirements. By signing and dating Form 1735-CLASS, the CDS employer (individual or LAR) or DR certifies that they have read, understood, and agreed to comply with the CLASS program requirements.
Revision 17-1; Effective November 1, 2017
The CDS employer (individual or LAR) is responsible for developing a backup plan for self-directed CFC PAS/HAB and nursing services. CLASS Transportation - Habilitation services do not require a service backup plan. CDS service backup plans are documented on Form 1740, Service Backup Plan. The CDS employer's plan must be reviewed and approved by the SPT.
It is the case manager's responsibility during each IPP Service Review to review a CDS employer's backup plan to determine whether the strategies are reasonable and viable contingencies in the event an individual is unable to receive a critical program service by their regular service provider. If the case manager determines the strategies are not reasonable and viable, the case manager may support the CDS employer as needed to develop a viable plan. The case manager may also suggest the CDS employer consider using support consultation to assist in the development of a backup plan.
The CDS employer is responsible for providing the FMSA with the copy of each service backup plan within five working days after it has been approved by the SPT.
Backup plan strategies may include both formal and informal supports. If backup services are to be purchased from a CLASS DSA, the CDS employer must include such costs in the CDS budget. In addition, people who are paid to provide backup services must pass all criminal history and registry checks. Funds must be allocated in the individual's budget for criminal history checks of backup service providers.
Revision 17-1; Effective November 1, 2017
The SPT consists of the case manager, the applicant/individual/LAR, DSA representative(s), and other people requested by the applicant/individual/LAR to develop a proposed IPC, using Form 3621, CLASS/CFC – Individual Plan of Care. The FMSA does not play a role in the CLASS service planning process. FMSA staff does not attend SPT meetings, unless requested by the individual. The CDS employer is responsible for developing the PAS/Habilitation Plan - CLASS/DBMD/CFC in conjunction with the SPT. Any change in the amount of a service delivered through the CDS option must be discussed and justified by the SPT as part of the SPT process.
HHSC may, at any time, request documentation to justify a service. If HHSC requests this documentation for a service the individual or LAR has chosen to self-direct using the CDS option, the CDS employer is responsible for providing the documentation to HHSC. The CDS employer may request support from the case manager to provide this documentation for HHSC.
The SPT must revise the IPC to include any change in the amount of a service(s). For all IPC revisions, the case manager must provide a copy of the IPC to the FMSA within five business days of HHSC transmission of the authorized IPC, as evidenced by the fax transmittal date on the documents.
A support advisor may participate in service planning meetings if requested by the individual or LAR. A support advisor must notify the individual's case manager:
- when support consultation service goals have been met;
- if the person receiving support consultation is unable or unwilling to cooperate with service delivery; or
- of the progress and status of the consumer-directed service required by the individual's program.
The individual or LAR (that is, "employer") is responsible for:
- ensuring service delivery activities are in accordance with the individual's service plan and justification for the CDS service; and
- ensuring service delivery documentation is accurate.
A support advisor may provide coaching in any of the areas listed above.