Updated July 2021 - Wright County
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Updated July 2021
The following is information and updates regarding Consumer-Directed
Community Support Services (CDCS). This material may change in the future as
Home and Community-Based (HCBS) waiver policy is subject to State, Federal, and
County approval and interpretation. It is the participant’s responsibility to obtain
the most current guidelines. The guidelines can be found at
http://www.co.wright.mn.us/648/Consumer-Directed-Community-Supports-
CDC
TABLE OF CONTENTS
Consumer Directed Community Supports Description .............................1
NOTE: “Participant” refers to the individual receiving waiver services. “MnCHOICES assessment”
includes LTC and DD screening assessments. “Insurance” refers to Medical Assistance, Medicare,
MSHO, MSC+, managed care, and private insurance.
CDCS Eligibility Criteria .............................................................................2
CDCS Annual Resource Allocation ............................................................2
Mandatory CDCS Training ........................................................................2
CDCS Screening Team (CST) .....................................................................3
Overview of CDCS Expenditures ...............................................................3
Criteria for Allowable Expenditures (CDCS Amendment Language) ..... 3-4
CDCS Expenditures by Service Category ............................................. 5-28
PERSONAL ASSISTANCE .............................................................. 5-8
TREATMENT AND TRAINING… .................................................. 8-13
ENVIRONMENTAL MODIFICATIONS & PROVISIONS ............... 13-27
SELF DIRECTION SUPPORT ACTIVITIES.................................... 27-28Unallowable Expenditures ............................................................... 28-34
Other ............................................................................................... 34-37
Other Section Includes:
o Admission to Hospital
o Admission to Nursing Home
o Amending the Plan
o Appeals
o Criminal Background Study
o 20-30% Exception to Budget Methodology
o Exclusion Rule/IRS Notice 2014-7
o Exiting/Involuntary Exiting
o Financial Management Service (FMS)
o Notice of Technical Assistance
o Participant Education
o Paid Time Off
o Providing Care Outside State of MN
o Repayment of Goods Returned/Sold
o Support Planner
o Unique MN Provider Identifier (UMPI)
o Unspent Funds
LIST OF FORMS.......................................................................................38CONSUMER DIRECTED COMMUNITY SUPPORTS (CDCS) DESCRIPTION
Consumer Directed Community Supports (CDCS) is a Home and Community-Based (HCBS) waiver and
Alternative Care grant (AC) service option that offers participants a person-centered approach allowing
more flexibility and responsibility for directing their own services and supports, including hiring and
managing direct care staff. It may include services, supports and/or goods currently available through
licensed waiver service providers, as well as additional services/goods that provide needed “unlicensed”
support to the participant. There are specific requirements for all services, supports and/or goods that
are available through HCBC waivers and AC grants, including CDCS.
Services under the CDCS option offer support, care and assistance to participant(s) in order to prevent
institutionalization and allow them to live an inclusive life in their community. Supports are designed to
build, strengthen, or maintain the informal networks of community supports for the participant. It allows
the participant to purchase services that will best meet their needs from people they have selected
themselves and trust, such as family and friends. The participant identifies staff qualifications and training
requirements. The participant can direct their own assigned resource allocation within the established
state, federal, and county approved parameters and guidelines. All services must be paid within the
participant’s CDCS resource allocation. Approval of certain services or goods may be denied if health,
safety and/or welfare concerns are not met, funds are misused, or criteria are not met.
The CDCS option places increased responsibility on the participant and their support team. In Wright
County, the participant and their support team must document in the Community Support Plan (CSP) how
CDCS will enable the participant to live an inclusive life in their community, build a practical network of
support, and work on specific goals and outcomes, specified by the participant and based on documented
needs in the annual MnCHOICES assessment.
It is important that waiver participants who utilize the CDCS option understand what their rights and
responsibilities are when using these services. People who are well-informed may more easily exercise the
increased freedom, authority, responsibility, and control of resources through CDCS. Wright County
provides information about the CDCS option through the case manager, online links to training through
the MN Department of Human Services, and written information to educate participants on available
service options, their responsibilities, and the service limitations. Waiver funds, using the CDCS service
option, do not equate to a cash allowance. Services and/or goods are authorized by Wright County and
may be purchased as part of an approved person-centered plan using a preset individualized resource
allocation determined by the MN Department of Human Services.
All CDCS waiver fund expenditures must be prior approved and traceable back to an authorized service or
good approved in the CSP based upon a current assessed need. New services, supports, or goods are not
allowed to be added to the CSP 30 days prior to the end of the participant’s annual service plan date.
NOTE: “Participant” refers to the individual receiving waiver services. “MnCHOICES assessment”
includes LTC and DD screening assessments. “Insurance” refers to Medical Assistance, Medicare,
managed care, MSHO, MSC+, and private insurance.
~1~CDCS ELIGIBILITY CRITERIA
The participant must meet the eligibility requirements of the Home and Community-Based Waiver (HCBS)
or Alternative Care (AC) program they are receiving.
The participant must be the financial responsibility of Wright County, maintain Medical Assistance (MA)
eligibility for waivers, and receive Home and Community-Based waiver services or Alternative Care
program services. Wright County has the responsibility of determining the appropriateness of
participation in CDCS and discretion regarding methods for disbursement of funds.
The participant must be able to manage their support, budget, and services within Wright County
guidelines.
The following individuals are NOT eligible for CDCS:
CDCS participant who exits the waiver or AC program more than once during the service
plan year
o Unable to access CDCS services for the remainder of that service plan year
o May be approved to use other waiver or AC services for the remainder of the
service plan year
Individual placed in the Minnesota Restricted Recipient Program (MRRP).
Waiver recipients living in residential settings (e.g., foster care, SLS home) licensed by the
Department of Human Services (DHS) or licensed/registered with the Minnesota
Department of Health (MDH).
CDCS ANNUAL RESOURCE ALLOCATION
Individuals receiving HCBS waiver services or Alternative Care (AC) program services requesting the CDCS
option will be notified by their case manager of their resource allocation. The annual MnCHOICES
assessment is used to determine the participant’s resource allocation. Services/goods will not be
authorized without a signed and completed CDCS Community Support Plan (CDCS CSP) unless
documented approval from the case manager has been received. Participant’s resource allocation will be
pro-rated if there is a gap between approved plans.
MANDATORY CDCS TRAINING
Wright County requires CDCS participants complete CDCS training within one year of initiating CDCS. The
MN Department of Human Services provides an on-line training course to meet this requirement:
http://pathlore.dhs.mn.gov/courseware/DisabilityServices/3-DirectAccess/CDCS/multiscreen.html
~2~CDCS SCREENING TEAM (CST)
The CDCS Screening Team (CST) is made up of a team of Wright County staff and supervisors from Social
Services.
CST must review and approve select services/goods on the CDCS CSP. The committee may request
additional information based on the below criteria for allowable expenses to complete the approval
process.
CST also provides consultation and direction to case managers.
OVERVIEW OF CDCS EXPENDITURES
CDCS expenditures may include services, supports, and/or items that supplement state plan services or
provide alternatives to waiver or state plan services. All expenses MUST fit into one of four service
categories:
Personal Assistance
Treatment and Training
Environmental Modifications and Provisions
Self-Direction Support Activities
Furthermore, the following goods and services may be included in the participant’s Community Support
Plan (CSP) as long as they meet the criteria below and fit into one of the five categories:
Therapies, special diets, and behavioral supports not otherwise available through Minnesota
Health Care Programs (MHCP) or private insurance that directly benefit the individual’s needs
based on their disability/condition and are prescribed by a physician/nurse practitioner who is
enrolled as an MHCP provider
Expenses related to the development and implementation of the CSP
Costs related to managing the participant’s resource allocation
IMPORTANT! All services and items should be the least costly alternative or may have
suggested limits. Limits are included as a guide to what is considered “customary”
and “fiscally responsible.” Requested amounts beyond what is suggested will require
additional written explanation in the CSP and/or an evaluation.
CRITERIA FOR ALLOWABLE EXPENDITURES
For services, supports and/or goods to be purchased under CDCS, they must meet criteria surrounding
the use of Medicaid funds and criteria listed in the state and federal waiver amendments (May refer to
MN DHS Lead Agency Manual 5.1 and 5.2)
~3~The CDCS Screening Team (CST) decides whether the purchase of goods and services meet all the
following criteria:
An individual written CSP must be developed for each participant. Services included in the CSP
must:
Be necessary to meet a need identified in the participant’s MnCHOICES assessment;
Be for the direct benefit of the participant ensuring the health, safety and general
wellbeing of that person; and
Be related to the participant’s disability and/or condition.
Costs of goods and services represent those that are “over and above” the normal costs of
caring for a person without a disability.
The goods and services approved in the CSP collectively represent a feasible alternative to
institutional care.
Services not included in the CSP are not covered.
In addition, goods and services are not covered when they:
Are provided prior to the development of the CSP;
Duplicate other services in the CSP;
Supplant natural supports appropriately meeting the participant’s needs;
Are not the least costly and effective means to meet the participant’s needs; or
Are available through other funding sources, including, but not limited to, funding
through Title IV-E of the Social Security Act.
If all the above criteria are met, goods and services are appropriate purchases when they are reasonably
necessary to meet at least one the following consumer outcomes:
Maintain the ability of the participant 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 participant
Increase the ability of unpaid family members and friends to receive training and education
needed to provide support
CDCS cannot be used to cover goods and services that are:
Covered by the State plan (Medical Assistance), Medicare, private insurance or other liable third
parties including educational and vocational services;
Expenses for travel, lodging, or meals related to training the individual or his/her representative
or paid or unpaid caregivers;
Provided to or directly benefiting persons other than the individual;
For comfort or convenience;
The responsibility of the child’s parent; or
The responsibility of the homeowner.
If CST determines a good or service does not meet the criteria, other options will be suggested and/or
the participant will be notified and given their appeal rights (See Appeal Section).
~4~CDCS EXPENDITURES BY SERVICE CATEGORY
All requested expenditures must be specified in the CSP and approved by Wright County. Everything
purchased must be related to the participant’s disability or condition, meet an assessed need, and be
outside of what is typical parenting or spousal responsibility.
There are four expense categories:
Personal Assistance
Treatment and Training
Environmental Modifications and Provisions
Self-Direction Support Activities
PERSONAL ASSISTANCE – Allowable Expenses
This service category allows for supports and services when the participant needs someone to do things
for him/her or needs reminders to do things. The following are examples of this category:
Assistance with things participants do every day such as dressing, grooming, bathing, eating or
assistance in getting around
(For Adults) Assistance with shopping, meals, cleaning, managing finances, communicating by
phone or other means, getting around and participating in community activities
Paying a parent of a minor or spouse to provide personal assistance services to you
o See specific information under “Support by Parent/Guardian of a Minor Child OR
Spouse” for specific rules and considerations
It is important to include staff responsibilities, qualifications and training in your explanation. The
number of hours of approved staffing is not based on the allocation amount but rather on the need
for services and must be clearly explained in the CSP.
IMPORTANT! All services and items should be the least costly alternative or may have
suggested limits. Limits are included as a guide to what is considered “customary” and
fiscally responsible. Requested amounts beyond what is suggested will require
additional written explanation in the CSP and/or an evaluation.
Services/Supports funded under this category may include the following:
Camp (as Caregiver Relief/Respite): Camp providing supervision to a disabled participant in order to
give a primary caregiver a needed break
Camp must be able to maintain participant’s health and safety and meet identified needs.
Disability and non-disability specific (e.g., YMCA camp, church camp) day and overnight camps
are allowed.
~5~ Camp outside of MN is only allowed in the bordering states of Wisconsin, Iowa, South Dakota,
and North Dakota.
Camps that are more about skill building than caregiver relief/respite should be listed in the
Treatment and Training service category.
CSP must identify the need for caregiver relief/respite.
Caregiver Relief/Respite – IN or OUT of Home: Costs associated with the need for rest for the primary
caregiver due to the participant’s disability
Staff hired are considered “unlicensed.”
Family members who reside in the participant’s home may NOT provide caregiver relief, unless
the family member is NOT the primary caregiver AND the primary caregiver is away overnight
(e.g., older sibling).
Unlicensed individuals providing in home caregiver relief do not qualify as independent
contractors and must be paid hourly through the Financial Management Service (FMS) provider.
Staff working overnights and/or weekends: Individual staff is paid hourly for ALL hours
worked. There are no longer daily rates.
If caregiver relief requires staff to work overtime, this will need prior approval from the CST. For
paid parent of minor or paid spouse, overtime is never allowed.
Childcare: Consider the following for approval:
When a parent is working, day care costs are typical parental responsibility for children ages 10
and under.
Costs above and beyond typical parental responsibility are fundable. Example: Additional costs
may be associated with utilizing a person with specific skills that are necessary to provide
adequate care to the participant in a child care setting.
For children 10 and under, the difference between the cost of regular day care and specialized
day care due to the disability is fundable.
Day care is not considered typical parental responsibility for children ages 11 and over and is
fundable.
Respite Services (Licensed): Respite services through a licensed agency and 245D provider
Support Staff: Unlicensed, hired staff to assist participant with dressing, grooming, bathing, eating,
shopping, meals, cleaning, managing finances, communicating by phone or other means, getting around
and participating in community activities
All staff must meet the qualifications as described in the CSP including pass a background study
and have a UMPI number. (See Other – Criminal Background Study and Other – UMPI Number)
Hourly wages need to be at least minimum wage as determined by the union. Rates may vary
depending upon the qualifications and training of the person to be employed, which is
necessary to meet the unique needs and preference of the participant.
Any wages above $15/hour needs an explanation in the CSP about why this wage is necessary
to meet the unique needs of the participant.
All Department of Labor Regulations must be followed. Specific staff job descriptions may be
requested by Wright County as an attachment to the plan.
Occasional overtime is allowed if planned for and approved in the CSP prior to use.
~6~ Holiday pay at a higher rate is allowed per union regulations and must be built into the CSP.
Double staffing (2 staff to 1 participant) is allowed if prior approved and specified when
appropriate in the CSP (e.g., staff training or parent out of town for weekend).
Shared Care Staffing (1 staff to 2 consumer-directed participants) is allowed if case manager
assesses this to be a safe situation.
Staff will automatically accrue paid time off (PTO) according to the union contract.
Paying staff outside of the country is not allowed.
The following Support Staffing situations have specific rules and considerations
to follow:
Support by Family Member (e.g., sibling):
Support is limited to 40 hours a week per family member who lives in the household. Family
member MUST meet the staff qualifications described in the CSP and have a job description on
file with FMS.
Support Staff (Under Age 18): Child labor laws apply. FMS policies may vary. Staff must be
identified in the plan and meet the staff qualifications described in the CSP. Staff must be paid
minimum wage according to the union and follow all other employment guidelines and rules.
Support by Parent/Guardian of an Adult:
A parent/guardian cannot provide caregiver relief/respite if the participant lives with them.
Support is limited to 40 hours a week per parent/guardian.
A parent/guardian cannot receive a bonus.
Support by Parent/Guardian of a Minor Child OR Spouse: Parents are defined as biological, step,
adoptive, legal guardians of minors, and other legally responsible individuals.
For a parent of a minor or spouse to be paid, the participant must have at least one dependency
in activities of daily living indicated on the MnCHOICES assessment.
Support is limited to 40 hours per week regardless of the number of children with disabilities
and/or the number of parents being paid.
The maximum wage is the current PCA wage and must include all taxes, fees and benefits. Check
with your FMS for their maximum gross wage.
Parent/guardian or spouse cannot receive a bonus or mileage.
Payment is only for disability related services beyond typical age appropriate parenting or
spousal role.
Paid Time Off (PTO) will accrue and can be used after meeting the initial threshold.
Parent/guardian or spouse must complete a job description for the FMS and meet qualifications
described in the CSP. Tasks that a parent or spouse is performing must be beyond typical age-
appropriate parenting/role and specified in the CSP.
Work schedule needs to identify days of week AND a.m./p.m. hours (such as 2 hours in the
morning on Mondays). Exact hours on time sheets may vary due to unforeseen situations.
However, the total hours per pay week cannot exceed approved hours. Work hours cannot be
during school hours unless the reason is clearly defined in the CSP.
~7~ If you are a foster parent, ask your case manager about whether you qualify. Parents of minors
that receive payment to care for relative children in their licensed foster home can be a paid staff
for their biological/adoptive minor child up to 25 hours per week.
A CDCS Notice of Technical Assistance will be issued if approved weekly hours are exceeded (See
Notice of Technical Assistance Section)
NOTE: See Section entitled “Exclusion Rule/IRS Notice 2014-7” for information regarding
possible tax exclusions.
Support Staff Bonus: A bonus must relate to an overall compensation package and outcomes achieved
by staff.
The CSP must include:
o The timeframe the bonus is to be given;
o Amount given; and
o Outcomes achieved (e.g., punctual, longevity, specialized training, etc.).
A bonus must be pre-approved at least two months prior to usage.
A bonus cannot be paid to use up remaining funds in the budget or attached as a holiday bonus.
Parents, legal guardians, spouses, and siblings cannot be paid a bonus.
TREATMENT AND TRAINING – Allowable Expenses
This expense category includes services that promote the participant’s ability to live in and participate
in the community.
Assistance with learning a new skill, improving a skill, or relearning a skill in such areas of self-
care, communication, interpersonal skills, home and community living, sensory/motor
development, reduction/elimination of challenging behavior and mobility
Training for staff to help meet the participant’s needs
Licensed staffing services
Most often these services need to be provided by someone who meets the certification or licensing
requirements in the state law related to that service (e.g., music therapist certification), and it needs to
be documented in the CSP.
For any therapies or behavioral supports, the CDCS Alternative Treatment Form for MHCP-
Enrolled Physicians (DHS-5788-ENG) must be completed and signed by an MHCP provider. Ask
participant’s case manager for the most up to date version of this form (see Forms section).
Staff time and mileage are fundable when working on skill acquisition, but no other staff costs
are allowed, such as tickets, food, going to restaurants, etc. even if they are used for skill
acquisition purposes.
Activities solely for social, recreation, leisure, diversionary, or distraction purposes are not
allowed (e.g., redirection using an iPad). See CDCS Lead Agency Manual 8.1.
Participants on the DD waiver MUST have at least one skill acquisition service/habilitative
service or activity clearly detailed in their plan. Do NOT list these activities in the CSP as staff
goals or tasks but rather what the participant will try to accomplish.
~8~IMPORTANT! All services and items should be the least costly alternative or may have
suggested limits. Limits are included as a guide to what is considered “customary” and
fiscally responsible. Requested amounts beyond what is suggested will require
additional written explanation in the CSP and/or an evaluation.
Services funded under this category may include the following:
Adapted Community Activities: Activities that are specifically for individuals with disabilities (such as
Special Olympics, Miracle League Baseball, adapted sports, Opening Doors, etc.) are fundable when
specific outcomes (other than recreation/leisure) are detailed in the CSP.
Adapted equipment is fundable, only if needed to participate in the activity.
Other equipment that is not adapted will be considered by the CST on case-by-case basis.
Related staff time and mileage is fundable, however, paid parent of minor and paid spouses are
not allowed to bill for mileage.
Adaptive Swim Lessons: Swim lessons that are adapted to meet the individual needs of the participant
due to their disability are fundable. A clear goal related to safety ONLY and a way to measure it is
needed in the CSP for approval of this item.
Swim lessons listed as adapted for a child with disabilities is allowable.
1:1, instead of group lessons, are considered adapted and allowable.
Alternative or Specialized Therapy/Treatment: Non-experimental therapies or treatments not currently
available through insurance must be prescribed by an MHCP physician or nurse practitioner (APRN
certified). Complete the CDCS Alternative or Specialized Therapy/Treatment Form annually (See Forms
section or ask your case manager for a copy).
Examples: music therapy, hippotherapy, aromatherapy, therapeutic listening program, aquatic
therapy, cognitive/educational therapy, behavioral therapy, feeding therapy, essential oils,
biofeedback, other approved therapies, etc.
The prescribed therapy/treatment must be provided by a therapist licensed or certified
according to the Provider Qualifications requirements in the Lead Agency Manual Section 7.2.
Related equipment and supplies to the therapy/treatment (e.g., noise canceling headphones,
diffusers, etc.) are allowed and do not require a separate physician’s statement and are
specifically required for the therapy equipment.
Note: CDCS funds cannot be used to purchase experimental treatments. According to MN Rule
9525.3015, subpart 16, an experimental treatment means: drugs, therapies or treatments that
are unproven, have been confined largely to laboratory use, or have progressed to limited
human application and trials, and lack wide recognition from the scientific community as a
proven and effective measure of treatment.
Camp (As Skill Acquisition Service): Because CDCS can be used to purchase services or supports that
develop or maintain life skills or community integration, camps (mainstream or specialty) could be
purchased using CDCS funds. Camp used as a skill acquisition service must clearly define the skill building
that is occurring during the camp experience. The camp must be able to maintain health and safety and
~9~meet identified needs.
Disability and non-disability specific (e.g., YMCA, church camp) day and overnight camps are
allowable when specifically working on a formal outcome in the CSP as related to a specific area
of need identified in the MnCHOICES assessment.
The participant’s CSP must identify the participant’s assessed needs, the treatment/training
goals and objectives tied to this activity, along with measures to know if the methods identified
achieve the goals. If the criteria are met, this expenditure would be listed under the Treatment
and Training category on the CSP.
Supports and services categorized under Treatment and Training are those typically performed
or provided by people with specialized skill, certification or licenses. Residential camps are
required to be licensed and are regulated by MN Dept. of Health, Environmental Health Division.
Camp outside of MN is only allowed in the bordering states of WI, IA, SD, and ND.
Camps that are more about providing a break to the primary caregiver should be listed in the
Personal Assistance service category.
Community Classes: Community classes held in a community-based setting may be fundable when
specific formal outcomes for skill development related to the disability/condition are detailed in the
CSP/CSSP.
Related staff time and mileage is allowable, however, paid parent of minor and paid spouses are
not allowed to bill for mileage.
Classes NOT related to the disability or that are typically paid by parents of non-disabled
children are not allowed.
Classes should be for the direct benefit of the participant.
Non-disability classes related to fitness and exercise for minors are not allowed. This is
considered parental responsibility.
Adults should try to seek funding through SNBC plan.
Day and Employment Services and Activities (For Adults): Formal and informal day support services
options or vocational/employment related services
Examples include licensed day support services and employment services.
Creative vocational activities are welcome (e.g., volunteer activities).
Formal or informal waiver services need to bill the FMS for payment.
Waiver Rate Management rules apply for licensed 245D providers.
Extended Therapy: Extended therapies beyond what insurance will cover (e.g., physical therapy,
including pool therapy, occupational therapy, speech therapy, etc.)
Fitness and Exercise Activities (for Adults ONLY): Allowable when it is recommended and monitored by
participant’s primary MHCP physician/nurse practitioner to improve or maintain the participant’s
physical condition or behavioral health
The CSP must clearly define how this is related to the participant’s disability/condition and
specific outcomes.
Expenses may include fitness club memberships, personal training sessions, or nutrition classes.
~ 10 ~ Primary MHCP MD or nurse practitioner must complete CDCS Alternative or Specialized
Therapy/Treatment Form and outline fitness program/equipment/classes needed to treat the
health condition related to the disability annually.
Adaptations to equipment are allowed if needed to treat medical condition and it is more cost
effective or necessary to exercise in the home instead of in the community.
The payment structure must be the most cost-effective payment option (consider daily/monthly
rates vs. annual membership) depending on the individual’s actual and projected use.
Licensed Waiver Services/Non-Home Care Services: Non-MA Home Care services should be listed in this
section.
Examples include individualized home supports (with training, without training, or with family
training), behavior specialist services, etc.
Rates are set by the State of MN.
The staff person(s) or program must meet the state requirements from the identified agency
(e.g., 245D provider) and meet the qualifications described in the CSP/CSSP.
Licensed waiver services must be billed through the FMS.
These services that include the training component count as a skill acquisition service for those
on DD waiver.
Support Staff for Skill Acquisition:
All staff must meet the qualifications as described in the CSP including pass a background study
and have a UMPI number (See Background Study and UMPI number section for more details)
Hourly wages need to be at least minimum wage as determined by the union. Rates may vary
depending upon the qualifications and training of the person to be employed, which is
necessary to meet the unique needs and preference of the participant.
Any wages above $15/hour needs an explanation in the CSP about why this wage is necessary
to meet the unique needs of the participant.
All Department of Labor Regulations must be followed. Specific staff job descriptions may be
requested by Wright County as an attachment to the plan.
Occasional overtime is allowed if planned for and approved in the CSP prior to use.
Holiday pay at a higher rate is allowed per union regulations and must be built into the CSP.
Double staffing (2 staff to 1 participant) is allowed if prior approved and specified when
appropriate in the CSP (e.g., staff training or parent out of town for weekend).
Shared Care Staffing (1 staff to 2 consumer-directed participants) is allowed if case manager
assesses this to be a safe situation.
Staff will automatically accrue paid time off (PTO) according to the union contract.
Paying staff outside of the country is not allowed.
~ 11 ~The following Support Staffing situations have specific rules and considerations
to follow:
Support by Family Members (e.g., sibling):
Support is limited to 40 hours a week per family member who lives in the household. Family
member MUST meet the staff qualifications described in the CSP and have a job description on
file with FMS.
Support Staff (Under Age 18): Child labor laws apply. FMS policies may vary. Staff must be
identified in the plan and meet the staff qualifications described in the CSP. Staff must be paid
minimum wage according to the union and follow all other employment guidelines and rules.
Support by Parent/Guardian of an Adult:
A parent/guardian cannot provide caregiver relief/respite if the participant lives with them.
Support is limited to 40 hours a week per parent/guardian.
Parent/guardian cannot receive a bonus.
Support by Parent/Guardian of a Minor Child OR Spouse: Parents are defined as biological, step,
adoptive, legal guardians of minors, and other legally responsible individuals.
In order for a parent of a minor or spouse to be paid, they must have at least one dependency
indicated on the MnCHOICES assessment
Support is limited to 40 hours per week regardless of the number of children with disabilities
and/or the number of parents being paid.
The maximum wage is the current PCA wage and must include all taxes, fees and benefits. Check
with your FMS for their maximum gross wage.
Cannot receive a bonus or mileage.
May only be paid for disability related services beyond typical age-appropriate parenting or
spousal role.
Will accrue Paid Time Off (PTO) and can use after meeting the initial threshold.
Must complete a job description for the FMS and meet qualifications described in the CSP. Tasks
that a parent or spouse is performing must be beyond typical age-appropriate parenting/role
and specified in the CSP.
Work schedule needs to identify days of the week AND am or pm hours (such as 2 hours in the
morning on Mondays). Exact hours on time sheets may vary due to unforeseen situations.
However, the total hours per pay week cannot exceed the approved hours. Cannot work during
school hours unless reason clearly defined in CSP.
If you are a foster parent, ask case manager about whether you qualify.
A CDCS Notice of Technical Assistance will be issued if approved weekly hours are exceeded (See
Notice of Technical Assistance Section)
NOTE: See Section entitled “Exclusion Rule/IRS Notice 2014-7” for information regarding
possible tax exclusions.
Support Staff Bonus: A bonus must relate to an overall compensation package and outcomes achieved
by staff.
~ 12 ~ The CSP must include:
o The timeframe the bonus is to be given,
o Amount given,
o Outcomes achieved (e.g., punctual, longevity, specialized training, etc.)
A bonus must be pre-approved at least two months prior to usage.
A bonus cannot be paid to use up remaining funds in the budget or attached as a holiday bonus
Parents, legal guardians, spouses and siblings cannot be paid a bonus.
Training for Paid or Unpaid Caregivers: Training and education of caregivers to increase their ability to
care for the participant.
Registration fees for conferences, classes and workshops are fundable.
Staff time for attending workshop is allowed.
Materials being provided by the training are allowed.
Expenses for travel, lodging or meals related to training are not fundable.
The name of the training, description, and cost for each training is required in the CSP.
Training outside of MN is only allowed in bordering states of WI, IA, SD, and ND.
Educational books, DVDs, magazines/periodicals related to the person’s disability/condition is
allowable.
Computer based training is allowable, such as webinars.
Training for Participant: Training to increase the participant’s ability to care for themselves, become
more independent, manage their CDCS plan, employees, or resource amount.
Registration fees for conferences, classes and workshops are allowable.
Materials being provided by the training can be included.
Expenses for travel, lodging or meals related to training are not fundable.
The training can be paid for, but the participant cannot pay themselves to attend the training.
Training outside of MN is only allowed in bordering states of WI, IA, SD, and ND.
Educational books, DVDs, magazines/periodicals related to the person’s disability/condition is
allowable.
Computer based training is allowable, such as webinars.
Classes or internships at colleges are allowable if not for college credit or working towards a
degree. All activities must be related to the participant’s disability/condition.
Tutoring: When it is above and beyond what school is required to provide based on student’s IEP/IFSP.
Must not be used as a school or home-schooling substitute.
Can be an individual or through a tutoring agency.
Teachers must be licensed or certified.
ENVIRONMENTAL MODIFICATIONS & PROVISIONS – Allowable Expenses
Allowable Expenses
Environmental modifications and provisions are services, supports, and goods needed for the participant
to help him/her continue to live in their home and have needed support when going out in the
~ 13 ~community. Environmental modifications and provisions also include services, supports, and goods
required to maintain the participant’s health and well-being.
The following are examples under this service category:
Adapted supplies and equipment
Modifications to the participant’s home or vehicle
Prescribed special diets
Assistive technology
Per Wright County Policy, any item over $2,500 requires at least 2 bids to determine cost effectiveness
unless specifically assessed by a professional for most appropriate product and fit. An insurance
denial may be requested on some items prior to approval.
See Separate Wright County Environmental Accessibility Adaptations Guidelines for more specific
information about criteria, guidelines, and procedures. Request from case manager.
IMPORTANT! All services and items should be the most cost effective to meet the
assessed need and must be identified in the CSP.
Services funded under this category may include:
Adapted/Specialized Equipment: This refers to specialized adapted equipment not covered by
insurance and supported in the Community Support Plan with sufficient documentation of need and
related to the disability/condition. Wright County may request insurance denial and/or
consultant/therapist to determine appropriate equipment for identified need.
See the following sections for more specifics:
Durable Medical Equipment or Supplies
Non-Specialized Equipment
Safety Equipment
Sensory Equipment
Skill Acquisition Equipment and Supplies
Adapted Recreation Equipment
Air Conditioner/Air Purifier: Only approved if directly related to a health condition (e.g., congestive
heart failure, severe allergies, temperature regulation issue, etc.).
Must obtain supporting documentation from an MHCP provider that item is needed as a
medical necessity and is a direct benefit to the participant.
Central air conditioning is not allowed.
Air purifier is a standalone device and must be for the direct benefit of the participant.
Alarm System Monthly Monitoring: Only approved if it is the most cost-effective means to notify the
caregiver. The monthly monitoring costs are not subject to the $5,000 home modification procedure.
For information on alarm system installation, see “Home Modifications/Environmental Accessibility
Adaptions” section.
~ 14 ~Assistive Technology: This refers to devices, equipment or a combination of these supports which
improve a person’s ability to communicate in the community, control or access their environment, or
assistance with things participants do every day such as dressing, grooming, bathing, eating or
assistance in getting around.
Common examples include switches, communication devices, monitoring devices.
Communication voice output devices, including tablets and iPads, may be funded through
Medical Assistance and should be pursued prior to requesting waiver funds.
Bed Adaptations:
Adaptations to a bed to improve safety are allowed.
Must have insurance denial and/or a recommendation from an appropriate professional (e.g.,
OT, PT, Live Life Therapies)
Adaptations that restrain or seclude are not funded by the waiver
Bike Adaptations/Adapted Bike: Bike modifications and/or adapted bikes are fundable only if they are
adaptive
In the case of a minor child, the parent/guardian will pay the first $50 for children ages 7 and
under, and $100 for ages 8 and over, toward the cost of the adapted bike; this may include a 3-
wheel bike
Adaptations to a standard bike may include wider tires, fat tire training wheels, wider seat, etc.
Supporting documentation and evaluation by a specialist may be requested.
Books: Are allowed when related to the client’s disability and are needed to support an outcome in the
plan. Books for pleasure reading are not allowed.
Car Cleaning Services (Professional Cleaning): Interior car cleanings due to incontinence or bodily fluids
and related to the participant’s disability/condition are allowed. Not allowed for normal wear and tear
such as food stains and spills.
Carpet Cleaning (Professional Cleaning): Allowed due to incontinence or bodily fluids.
Includes professional cleaning or rental of equipment (including cleaning supplies).
Not allowed for normal wear and tear.
Purchase of carpet cleaner may be considered if cost effective.
Suggested limit is 2 times per year. If needed more often consider flooring adaptation.
Clothing, Adaptive:
Clothing purchased that has adaptations built into the clothes by design.
Alterations due to the disability are fundable.
Specialized footwear – Insurance denial documented in CSP and must be related to the
participant’s disability. Examples include diabetic shoes, therapeutic orthopedic shoes, inserts,
AFO’s, seamless socks, etc.
Clothing, Bedding & Protective Covers, Replacement: Replacement clothing and bedding linens due to
incontinence, excessive wear and tear, or excess bodily secretions related to the disability is fundable.
Must be above and beyond what is typical parental responsibility.
~ 15 ~Computer/Tablet: Computers (including peripheral equipment/accessories such as printer, monitor and
protective cases), laptop, notebook, iPod/iPad/etc., tablet or other portable computer devices are
allowable when it improves a participant’s ability to:
communicate with others in the community,
control or access their environment, or
assist with things participants do every day such as dressing, grooming, bathing, eating or
assistance in getting around perform activities of daily living (e.g., visual schedules for bathing,
organizing their day, etc.).
Funding information for computers/tablets:
iPad/tablets funded through CDCS MUST have other uses beyond just communication (e.g.,
emotional regulation, behavioral, scheduling, etc.) AND NOT be used primarily for
communication purposes. Otherwise, medical assistance should be accessed first and may ask
for table to be “unlocked” per recommendation of case manager.
CDCS does NOT pay for computers for the purpose of enhancing educational experiences.
Schools are responsible to provide the resources needed to meet educational goals. MUST
identify benefits and address a need at home or in the community.
Participant must obtain supporting documentation and/or evaluation by one of the following
specialists (e.g., OT, speech therapist, behavior specialist, Live Life Therapy evaluator) which
includes the most appropriate selection of products from the available options AND
documentation that participant can successfully manipulate the device. Must submit
Computer/Tablet Request Form. See Forms section or request most current form from your case
manager.
May include equipment rental during a trial period, customization, training and technical
assistance to the participant, caregivers, and staff to teach the person how to best use the
device.
A protective case is required and fundable for all tablets.
Adaptations required to enable the participant to use the computer and/or tablet are fundable.
Device replacement is allowed once every three years unless appropriate rationale included
(See Property Destruction for more information).
Multiple devices may be fundable if there is a documented need based on the
disability/condition from a professional.
Computer/Tablet Request Form must be completed and submitted to case manager, and all
necessary information included in the CSP (See Forms Section). Ask case manager for most up
to date version.
Computer/Tablet Applications & Software: Cost of applications and software must have prior approval
AND skill acquisition based on need and disability/condition must be documented in the CSP.
Examples include: Educational software, apps for behavior, time management, etc.
Documentation/recommendation from a professional (e.g., participant’s licensed
OT/Speech/Behavioral Therapist) is required for any apps or software over $75.
Educational software/apps must be non-age appropriate to be considered.
Doors: See “Property Damage” section.
~ 16 ~Durable Medical Equipment or Supplies: Fundable if not covered by insurance. CST may request
insurance denial.
Driver’s Education:
Driver’s Education Assessments (e.g., Courage Center) for vision testing, reaction time,
memory/problem solving, strength and coordination, cognitive processing skills, prescription for
adaptive driving equipment, etc., are fundable.
Driving lessons for the purpose of practicing the use of adapted equipment is allowable.
Driving lessons are allowed above and beyond what’s typical and must be an approved outcome
in the CSP. For example, the participant requires more behind the wheel hours than what is
typically required.
Agencies must be certified in this industry.
The cost of traditional driver’s education is considered parental or consumer responsibility.
Enteral/Nutritional Products: Prescribed products adding nutritional value to participant’s diet through
a tube (enteral) or through the mouth needed because of a specific disability or condition.
Allowed IF prescribed by an MHCP provider and denied by insurance OR when need exceeds
what is covered by insurance.
Not covered: Oral nutritional products (Example: Boost or Ensure) (Exception: allowed for EW
and AC waivers).
Oral nutritional products such as Boost, Ensure are only covered if prescribed by an MHCP
provider as part of a specialized diet. See specifics under Specialized Diet.
Eyeglasses: Must be documented in CSP that insurance will not pay for more durable frames (e.g.,
titanium frames) or an extra pair.
Only pay for lenses if current lenses don’t fit in the more durable frames.
Replacement pair of glasses is allowed with insurance denial and support of need for another
pair in CSP.
“Transition lenses” only allowed if related to specific medical condition (e.g., corneal transplant)
and with recommendation from MHCP.
If glasses are needing replacement due to behavioral issues of the participant or another family
member receiving a waiver, behavioral services may be suggested by the case manager.
Fence: See “Home Modifications/Environmental Accessibility Adaptations” section.
Food/Liquid Thickening Agent: Products such as “Thick It” are allowable with proof of insurance denial
and a doctor’s statement.
Flooring: For accessibility purposes see “Home Modifications/Environmental Accessibility Adaptations”
section. For replacement due to damage see “Property Damage”.
Furniture, Adaptations/Modifications: CDCS funds can be used to adapt or modify a participant’s
furniture. For example, removal of arm rests for easier transfers.
Global Positioning Device (GPS): The device and the monthly monitoring fee are allowable for tracking
~ 17 ~those with elopement issues and/or those who are not able to communicate their whereabouts.
Home Delivered Meals (for Adults): Provided to participants not able to prepare their own meals and
for whom there is no other person available to do so OR when a home delivered meal is more cost-
effective than staff preparation of a nutritional meal.
Examples Include: Meals On Wheels, Mom’s Meals.
Maximum limit of one meal/day.
Home Modifications/Environmental Accessibility Adaptations (EAA):
Speak to participant’s case manager before taking any action on a home modification or environmental
accessibility adaption project and ask case manager for separate EAA guidelines and procedures. As with
all MA services, this must be prior authorized.
Environmental Accessibility Adaptations (EAA) are modifications and physical adaptations (including
equipment) to a person’s home environment necessary to help the participant have greater
independence.
CDCS allows for the modification/adaptation of a participant’s primary residence if the following four
principles are met:
1) Are necessary for the health, welfare and safety of the participant,
2) Enable the participant to function with greater independence,
3) Are of direct and specific benefit due to the participant’s disability,
4) Are the most cost-effective solution.
The modification must be of direct and specific benefit to the participant due to his/her disability. When
an item is covered by insurance, it should be billed first to the extent of the limitations. Non-covered
items may be covered under CDCS if all other criteria are met.
An assessment by a consultant is required to determine/evaluate the need and appropriate
modifications and/or adaptations, and funding for the assessment must be requested from the
Aggregate committee/pool. Projects/equipment over $2,500 require two estimates/bids to submit to
the CDCS Screening Team for approval as set forth by MN Statutes 471.345, Subd. 15 and Wright
County Purchasing Policy (1/27/15)
Adaptations to a participant’s primary residence(s) or construction of new primary residence may include
but are not limited to:
Installation and maintenance of ramps, grab bars, and widening of doorways.
Modification of bathrooms (handheld shower, grab bars) and kitchens.
Widening doorways to access common areas of the home
Installation of electric or plumbing systems to accommodate necessary medical equipment.
Lift equipment (e.g., stair glide, platform lift, ceiling mount lift)
Shatterproof windows or film over windows.
Floor coverings for mobility purposes.
Installation of monitoring or surveillance systems including cameras, motion detectors, GPS
trackers, home security systems, door and window alarms.
~ 18 ~NOTE: In June 2010, the DHS maximum is $40,000 per 365 days for Environmental Accessibility
Adaptations.
NOTE: EW (Elderly Waiver) and Alternative Care Programs (AC) has a limit of $10,000/year.
The waiver is able to reimburse for the purchase, installation, maintenance, and repairs of
environmental modifications and equipment provided that the repairs are cost efficient
compared to the replacement of the item(s).
For DD, CAC, CADI, and BI Waivers: Participants must utilize their individual CDCS budget to
cover up to $5,000 of environmental modifications/equipment in their budget year. If item(s)
cost more than $5,000, the participant may request that Wright County approve further
expenditures outside of their individual budget. The County will approve requests based on the
current status of total waiver expenditures.
For EW and AC: Participants must utilize their individual CDCS budget to cover up to the yearly
maximum amount for environmental modifications. This amount includes all environmental
modifications to be paid for by the waiver per service agreement year. This maximum amount is
set annually by the state fiscal year.
For Modifications OVER $5000: Two estimates/bids are required from two separate providers.
Providers of home modifications must have a current license or certificate, if required by
Minnesota Statutes or administrative rules, to perform their service. The provider of
modification services must be enrolled with MN DHS, have the ability to bill MA and meet all
professional standards and/or training requirements that may be required by Minnesota
Statutes or administrative rules for the services they provide.
For Modifications UNDER $5000: Two estimates/bids are required from two separate providers
with a building contractor license number or certificate. MN DHS enrolled provider not required.
If there are questions from the participant or from supervisor regarding the safety or use, a
home modification consultation may be requested.
Home Modifications/Environmental Accessibility Adaptations are marked with
the house symbol and may include:
Alarm System Installation: Only approved if it is the most cost-effective means to notify the
caregiver. The installation of an alarm system is considered a home modification and will be
subject to the $5,000 minimum that must come from the CDCS budget prior to requesting
waiver/aggregate funding.
If participant exceeds the $5,000 home modification minimum, waiver/aggregate funding
can ONLY be used to install a system but NOT to fund the monthly monitoring fee.
Participant must send bid/estimate to case manager and this must be approved by the CST
prior to installation.
Fence: Customary to enclose an outdoor area that will provide adequate freedom of movement
while ensuring the safety of the participant from elopement.
~ 19 ~ Participant must be 4 years of age or older.
Participant needs to receive prior approval from case manager and needs to obtain two bids
and send these to the case manager.
The fence should not replace supervision needs of the participant.
The homeowner remains responsible for any decorative posts and/or fence tops and for
upgrading to comply with neighborhood covenants.
Any upkeep or maintenance will be the homeowner’s responsibility.
Fence materials should be the least costly material that meets the participant’s health and
safety needs. If an upgraded fencing material is desired, the participant will need to private
pay the amount that exceeds the lowest cost fencing material that meets the participant’s
health and safety needs.
If the project exceeds $5,000, the participant may request waiver/aggregate funds. If
waiver/aggregate funds are available and approved, the participant will need to use an MA
billable provider.
Flooring: For accessibility purposes.
Will only consider common areas and participant’s bedroom (e.g., living room, hallway,
family room).
The hard surface flooring must be the most cost-effective option (e.g., plastic laminate or
vinyl plank/tile).
Carpeting is not allowed.
Refinishing cost to wood floors is not allowed.
For flooring replacement due to participant property damage, see “property damage”.
Ramps: Are fundable. They must be cost effective and be based on need.
Safety Assessment: A consultant/professional safety assessment to determine most reasonable
and cost-effective equipment/modifications is fundable.
Stair Lift/Platform Lift: Lifts are allowable for family inclusion purposes and needed accessibility
to different levels in a home.
Requires 2 bids.
Ask case manager for more specifics about Wright County EAA guidelines and process.
Not allowed if only purpose is getting to the basement for emergencies when natural
disasters occur. There are more cost-effective options.
Vehicle Modifications: Adaptations are based on documented needs as described in the CSP
and are only allowable for vehicle that is the participant’s primary means of transportation. The
request for funds for a vehicle modification must be based on a medical or assessed need.
Required ongoing maintenance for adapted equipment is allowed.
Ask case manager for more details about Vehicle Modification Policies and Procedures.
Waiver funds may not be used to purchase a vehicle.
Waiver may pay for the additional costs that the family would incur for an accessible rental
vehicle if there is a need for a specialized vehicle during this time of vehicle modification.
~ 20 ~The difference between the estimated amount of a non-accessible rental vehicle and the
actual cost to rent the accessible vehicle can be covered using waiver funds.
NOTE: $5000 must come from the annual CDCS budget. Any unallocated funding may also
be used. The remainder of the costs may be approved outside of the CDCS budget if
additional funds allow.
Examples of vehicle modifications may include, but are not limited to:
Door handle replacements (due to physical disability only)
Door widening
Roof extensions
Lifting devices
Wheelchair securing devices
Adapted seat devices
Handrails/Grab bar
Housecleaning/Household Management (Using a Company): A company hired to perform general
household activities or chores. Consider the following:
Services such as lawn mowing, snow removal, and/or housekeeping may be allowed when it
enables the caregiver to support the participant AND the caregiver is unable to do these chores.
If the participant lives in a home where an able-bodied person living in the home can do these
chores/household activities these services are considered typical family responsibility and it
should be expected that the family incur the costs.
Is the primary caregiver or participant unable to manage the home AND care for themselves or
the participant in the home due to significant behavioral or medical diagnosis/condition.
This service must be cost effective and a documented need based on participant’s condition in
CSP.
INDOOR: Vacuum, dust, cleaning, shampooing carpet or furniture. Related supplies such as
chemicals or cleaners are not allowed.
OUTDOOR: Lawn mowing or snow removal ONLY. Prepayment of service plans is allowed if cost
effective. Does NOT include landscaping, leaf pickup, fertilizing.
The CSP must include frequency and hourly/weekly cost.
Incontinence Supplies: Items needed for incontinence.
This could include items such as wipes, gloves, diapers, briefs, waterproof bed sheets,
waterproof mattress covers, etc.
Insurance pays for some of these items and these funds should be exhausted prior to requesting
CDCS funds for these items.
These items will not be considered for children under the age 4 years old.
Internet Access: A participant may use their CDCS funds to purchase Internet access if it is the most
effective way to meet the person’s outcomes and goals based on assessed needs and if it meets waiver
criteria for allowable expenditures (for these criteria, see CDCS – Allowable and unallowable goods and
services). CDCS funds may cover:
Additional costs for set-up and equipment if the person moves
Equipment maintenance and repair
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