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The Ultimate Guide to Consumer Directed Services in Missouri

elderly individual holding the hand of a nurse

Imagine the following scenario. Your elderly aunt lives alone. She manages pretty well on her own, but because of her arthritis, she has some trouble bathing and dressing and struggles with keeping her house clean. You worry about her living alone and have suggested it might be time for her to move to an assisted living facility. However, your aunt values her independence and isn’t ready to make the move. This is where the Consumer Directed Services (CDS) program can help. Consumer-directed services can help people with disabilities receive the daily care they need at home.

Even if you’ve heard of CDS, understanding the ins and outs of the program can be quite daunting. That’s why Integrity Home Care and Hospice has created an all-encompassing overview of CDS that covers the following points.

  1. What is Consumer Directed Care?
  2. What personal care services are covered under CDS?
  3. How much do consumer-directed services cost?
  4. Who is eligible for CDS?
  5. What is the CDS consumer responsible for?
  6. Personal Care Attendant FAQ

What is Consumer Directed Services (CDS)?

Consumer Directed Services (CDS) is a Missouri program that provides personal care assistance to people with physical disabilities as an alternative to nursing homes. People often get to a point in their life where they are no longer able to take care of themselves. This can be due to aging, a serious accident, or illness. When this happens, people often end up moving into a facility in order to receive the care they need. However, CDS provides the option of receiving personal care at home from a personal care aide of their choice. 

The goal of CDS is to allow people with physical disabilities to maximize their independence and autonomy by providing them with greater choice and control over their personal care. CDS officially became a program in Missouri in 2005, but the history of consumer-directed services has a much longer history.

A brief history of consumer-directed care

1960s and 1970s: Independent Living Movement

Consumer-directed care grew out of the larger independent living movement. Taking place during the 1960s and 1970s, during the independent living movement, people with disabilities advocated for greater access to services and mainstream life. Small programs focusing on independent living and disability rights started to pop up throughout the country.

Progress continues

Throughout the last third of the 20th-century, disability activists won gains on the national level. Multiple national laws were passed that expanded rights and access to services for those living with disabilities. Including, the Rehabilitation Act of 1973, which prohibited discrimination at the federal level in programs and jobs. 

Consumer-directed care in Missouri

  • In 1985, Missouri passed the Non-Medicaid Eligible Program, which was the first self-directed care program in Missouri. 
  • In 1993, Missouri enacted the Personal Assistance Services (PAS) Program, which allowed people with disabilities to take more control over their care. It granted them the ability to hire their own care attendant. 
  • In 2000, Missouri instituted the Independent Living Waiver (ILW), which provided funding for a greater number of hours of care, medical equipment, and environmental accessibility adaptations.
  • In 2005, the Missouri Department of Health and Senior Services renamed PAS the Consumer Directed Services (CDS) Program.

Current Day

Today, all 50 states and Washington DC have at least one CDS option. Here in Missouri, there are more than 30,000 people enrolled in CDS. 

As the program’s name suggests, within Consumer Directed Services, the consumer is expected to make decisions about their personal care. Therefore, the consumer is responsible for hiring, training, supervising, and directing their PCA. This means that as a consumer, they can hire someone they know to be their PCA. In the imaginary case above, you could even be providing care to your aunt. 

But what exactly constitutes personal care? Personal care includes a variety of tasks that impact activities of daily living (ADL).

What personal care services are covered under CDS?

According to MO HealthNet, CDS covers a variety of personal care tasks that include, but are not limited to the following services:

  • Bathing, including shampooing hair
  • Dressing/grooming
  • Ostomy or catheter hygiene
  • Bowel and/or bladder routine
  • Assistance with toileting
  • Assistance with mobility
  • Passive range of motion 
  • Manual assistance with medications
  • Turning and positioning
  • Treatments 
  • Cleaning and maintenance of equipment 
  • Clean bath
  • Make bed
  • Change linens
  • Clean floors 
  • Tidy and dust
  • Laundry (home) 
  • Laundry (off-site) 
  • Trash; 
  • Read/write essential correspondence 
  • Meal prep and/or assistance with eating 
  • Wash dishes
  • Clean kitchen 
  • Essential shopping errands

 

  • Bathing, including shampooing hair
  • Dressing/grooming
  • Ostomy or catheter hygiene
  • Bowel and/or bladder routine
  • Assistance with toileting
  • Assistance with mobility
  • Passive range of motion 
  • Manual assistance with medications
  • Turning and positioning
  • Treatments 
  • Cleaning and maintenance of equipment 
  • Clean bath

 

  • Make bed
  • Change linens
  • Clean floors 
  • Tidy and dust
  • Laundry (home) 
  • Laundry (off-site) 
  • Trash; 
  • Read/write essential correspondence 
  • Meal prep and/or assistance with eating 
  • Wash dishes
  • Clean kitchen 
  • Essential shopping errands 

What services are not covered under CDS?

  • Tasks that are performed by licensed professionals (i.e. skilled nursing, therapies ordered by a physician) 
  • Tasks that primarily benefit the household
  • Time spent waiting for doctor appointments

CDS is a Missouri state program that is funded through the Medicaid State Plan and the Independent Living Waiver. Therefore, in order to take advantage of the CDS program, you must meet certain requirements.

How much do consumer-directed services cost?

The Missouri CDS program is funded through the Medicaid State Plan and the Independent Living Waiver. Therefore, Consumer Directed Services are typically free. However, if you are eligible for Medicaid on a spend-down basis, you are responsible for the cost of services you receive during the time you have not met your spend-down liability.

Who is eligible for CDS?

As with most government-sponsored programs, there are several requirements a person must meet in order to receive services. We break down the CDS requirements below. In order to be eligible for CDS, a person must:

  • Be a resident of Missouri 
  • Be physically disabled to the point where you are unable to perform daily activities necessary to care for yourself, such as bathing and meal preparation 
  • Be at least 18 years old 
  • Be enrolled in MO HealthNet
  • Be able to direct their own care and services
  • Be capable of living independently with CDS
  • Meet nursing facility level of care 

We understand the requirements can be confusing. To take the guesswork out of the process, click here to find out if you qualify for CDS services.

How to apply for Consumer Directed Care

1. Check eligibility

  • See the above section to determine if you meet the requirements to enroll in the CDS program.

2. Enroll in MO HealthNet (Missouri’s Medicaid program)

  • If you have not already done so, enroll in MOHealthNet, which is Missouri’s Medicaid program. 

3. Apply for home care through the Division of Health and Social Services (DHSS)

  • Once you have determined you meet the eligibility requirements and are enrolled in MO HealthNet, the next step is to apply for CDS through the Missouri Division of Health and Social Services (DHSS). There are two ways to apply. You can call 866-835-3505 to apply over the phone. Or, you can apply online

4. DHSS home pre-screening and assessment

  • After DHSS has received your application they will conduct a pre-screening over the phone to ensure you meet the requirements. If you meet the requirements, they will then conduct a full assessment.
  • A DHSS representative will conduct the assessment either over the phone or in person. The assessment will certify that you do indeed qualify for CDS and determine your care requirements. They’ll then work with the consumer to create a CDS plan of care. Because a requirement of CDS is that the consumer is able to direct their own care, the consumer will need to answer all questions during the assessment on their own.

5. Contact your preferred CDS vendor/provider

  • Once you’ve completed the assessment, DHSS will provide you with a list of CDS vendors. You will then need to contact your preferred vendor to initiate next steps. 
  • Your vendor will then schedule a home visit with you and your PCA. They will finalize your plan of care and complete the necessary paperwork so you can start receiving consumer-directed services.

Skip the hassle and headache of applying on your own, and give Integrity a call. We will walk you through the process and handle all the necessary paperwork. We’ll ensure you have the right documents, issue payments, and pay and file your state and federal taxes.

What does a CDS vendor/provider do?

Integrity is an approved CDS vendor. Essentially, a vendor is in charge of the paperwork and payments required for CDS. The full responsibilities of a vendor can be found here, but below is an overview of the role:

  • Collect timesheets and certify their accuracy
  • Transmit individual payments to the personal care attendant on behalf of the consumer
  • Ensure all payroll, employment, and other taxes are paid on time 
  • Ensure each attendant is registered, screened, and employable pursuant to the FCSR, EDL, and applicable state laws and regulations 
  • Ensure the attendant is not the consumer’s spouse
  • Perform case management activities with the consumer at least monthly to provide ongoing monitoring of the services 
  • Ensure the consumer is properly trained to properly recruit, employ, instruct, supervise, and maintain the services of the attendant(s). 

What is a CDS plan of care?

A plan of care ensures the consumer receives the amount and type of care required to meet their needs. A plan of care includes: 

  • The number of hours of care a consumer will receive
  • A description of the services and frequency of services that a consumer will receive
  • The date CDS services will start
  • The date CDS services will need to be reassessed
  • Documentation of the consumer’s choice of vendor

Once you are enrolled in the CDS program, you can then start directing your own personal care. Directing your own care provides a lot of freedom, but it also comes with responsibilities.

What is the CDS consumer responsible for?

As a consumer of CDS, they will be responsible for the following duties:

  • Selecting, hiring, training, and supervising the personal care attendant (PCA)
  • Preparing biweekly timesheets, which need to be signed by the consumer and PCA
  • Ensure the number of care hours doesn’t exceed the number of hours they are authorized to receive 
  • Promptly notifying the Division of Senior and Disability Services and/or the provider of any changes that affect the CDS plan of care
  • Promptly notifying the provider regarding any problems with the quality of care they are receiving

How many hours of consumer-directed care can a consumer receive?

Currently, the maximum number of personal care hours a consumer can receive is around 128.5 a month. That works out to about 4 hours and minutes of care a day—depending on how many days are in the month. However, the number of care hours can vary based on the consumer’s personal needs. Some consumers’ level of need will not reach the maximum number of care hours, and therefore the hours they qualify for could be less. 

As stated above, part of the consumer’s responsibility is to find, hire and train their PCA. Read on to learn everything you need to know about PCAs.

Personal Care Attendant FAQ

A personal care attendant (PCA) is the person hired to perform the consumer’s personal care services. Due to the often intimate nature of personal care, consumers should hire someone they trust and feel comfortable around. The consumer-PCA relationship requires solid communication and can be difficult at times. Therefore, many consumers choose to hire family members or close friends to be their PCA.

Personal care attendant qualifications?

Consumers can choose any qualified caregiver to become their PCA, including family members, except for their spouse. Qualified caregivers meet the following criteria: 

  • Be 18 years of age or older
  • Be authorized to work in the U.S. 
  • Have not been convicted of a felony
  • Some misdemeanors may disqualify you
  • Parents can’t be the caregiver for children under the age of 21
  • You can’t be a caregiver of you are your parent’s power of attorney.

How does someone become a CDS personal care attendant?

The process to become a PCA is easy! No certifications or training are required. All you’ll need is to have a current TB shot, sign some paperwork, and show your ID.

How much are personal care attendants paid?

According to Indeed.com the average salary for a personal care attendant is $12.80 per hour.

I’m interested in being a caregiver, can I be a PCA for someone I live with?

Yes! You can be a caregiver for someone you live with.

Can I have a part-time job and be a PCA?

Yes! As long as you can meet the consumer’s weekly hours of care you can work at a second job.

Can I be a caregiver for someone even if I don’t know them?

Yes! Here at Integrity, we’re always looking for quality caregivers. And we work hard to match caregivers to the right clients.  However, due to the nature of CDS care, the consumer will have the final say on whether or not they hire you as their PCA.

Still have questions about Consumer Directed Services in Missouri?

At Integrity Home Care and Hospice, we are experts in Consumer Directed Services. If you or a loved one is interested in applying for the CDS program, give us a call (855-442-4968) or contact us online. We’ll walk you through the whole process and make sure you get the care you need.