2024 Summer Edition
CDCS CHANGES AND UPDATES:
COMING SOON! CDCS Unbundling: There are upcoming changes coming to the CDCS Program. The MN Department of Human Services(DHS), at the direction of the Centers for Medicare and Medicaid Services-CMS(federal agency) have been working on a “CDCS Unbundling Project.” This project will split up 2 of the current CDCS categories and add 2 new categories. According to DHS, the expenses that have been allowed or not allowed should not significantly change, but rather which category to put them in is changing.
CDCS Policy Pages are being updated and a new CDCS Plan is currently in the final stages of development. DHS will notify us through an E-list announcement. The announcement will include updated published policy pages, new forms, online learning modules, and more specific timelines.
Completion of the new form(s) and using the new categories will not take place until after the big announcement at your next renewal. You will not need to make any changes to your current CDCS Plan. Further direction will be provided after the announcement is released.
CDCS Budget Decreases: Some CDCS Budgets are significantly increasing or decreasing after using the mandated MnCHOICES (MnC) 2.0 Revisions Tool:
- All participants will switch to the new assessment tool within the next year.
- DHS has not changed any formulas however did make intentional and clarifying changes regarding scoring causing the budget fluctuations
- If your CDCS budget decreases:
- Work with your case manager to determine what changed from last year to this year’s assessment. The CM may consult with the MnC assessor.
- You may appeal this amount however you will need to prove the assessor did not correctly score an area of need. You cannot simply appeal that your budget went down.
ANOKA County CDCS Guidelines and Expenditures Updated: Following are some highlights of goods and services that have changed in the past several months upon further legislative clarification from DHS and/or various interpretations and considerations from our CDCS Team. This document is updated multiple times a year. It is helpful to review this document prior to submitting a CDCS Renewal Plan each year or completing an Addendum to ensure you are aware of any changes and/or provide required information. Go to the website to see ALL changes.
- Overnight Camp - Added to licensed services under Treatment and Training – Respite (pg. 13). Moved day camps to community activity section (pg. 12, 13).
- Environmental Supports - Split into general information, things to consider and differences between minors and adults (pg. 11, 17)
- Minors and Cleaning Services - Essentially for minors, we only approve cleaning services if it is necessary for medical conditions. Otherwise, it is considered a parental responsibility to maintain a clean home. To consider this for medical reasons, the cleaning must be clearly detailed regarding what the specific cleaning tasks are as related to the medical needs and which common areas are being cleaned. We usually look at home modifications for incontinence issues (e.g. replace carpet with waterproof flooring). We may also request an invoice to verify what is being cleaned (pg. 9, 11,17).
- Paid Parent of Minor(PPOM)/Spouse – updated with new legislative information around no. of hours (pg. 9, 10).
- Driver’s assessment – add info re: VRS potentially paying for this as job acquisition (pg. 22).
- Fitness for minors – added to Unallowed List (pg. 24).
- Fitness for adults – added info. re: SNBC (pg. 12, 13)
- Skilled nursing – added info re: checking if SNBC will cover cost or private options (pg. 23).
New FMS Providers: Minnesota has 4 more FMS providers to choose from when using CDCS. Their information is listed below.
Note: Rates for ALL FMS Providers
Current Federal Mileage Rate:
- Maximum of up to 67 cents/mile. This amount is not updated automatically. An increased rate must be requested and approved by your case manager prior to implementing.
Overtime (OT) & Multiples – When there are multiple participants receiving service in the same household and utilizing or requesting OT; ALL plans must have OT listed in the plans (e.g. incl. CSG/CFSS). You cannot choose one person’s plan to payout all the OT. Work with your FMS and case manager for a better understanding of how this works.
Backdating Hours and Wages – Backdating of hours and wages is not allowed. Waiver/Medical Assistance statutes require prior approval for all goods and services.
- Some FMS’s also will only allow new wages to begin at the start of the next pay period.
- Plan accordingly and allow at least 2 weeks for processing.
Current Support Planner (SP) Certification - Beginning July 1, 2024, case managers need to verify that your Support Planner is current on their certification. To verify this, one of the following must be included when submitting a Renewal CDCS Plan:
- Support Planner certificate OR
- Expiration date added to Worker Agreement and submitted with CDCS Plan OR
- Added Support Planner expiration date in CDCS Plan under Self Direction Category.
Paid Time Off (PTO) vs. Sick and Safe – Sick and Safe benefits for all employees is now a MN state law. Participants must choose to use PTO or Sick and Safe (not BOTH).
- Both benefit options cost the same (currently 4.65% of wages)
- Both accrue hours the same way (1 hour for every 30 hours worked).
- The PTO option through your FMS is more flexible than Sick and Safe.
- PTO will be checked “yes” on ALL CDCS Plans for all Staff as this amount will need to be taken out of your budget regardless of which benefit option you choose.
- Talk to your FMS if you have questions.
Deleted: Anoka County Adapted Swim Form – This form is no longer recommended to renew adapted 1:1 swim lesson. There should be updated progress in the Evaluation Section of the CDCS plan if you are requesting to continue this service.
Upcoming January 2025 Legislative Changes:
- There will be a new minimum wage of $20/hr. for all staff hired by the FMS. Those being paid lower than this amount/hour will automatically be raised to comply with this law. Please plan accordingly.
- CDCS budgets will automatically be increasing by 4.53%. You will be notified of this amount by your case manager and/or an update of a service agreement change through DHS.
Save the Date - Self Direction Connection Conference.
- November 1, 2024, AM and PM Sessions in Mankato, MN
- $40 registration fee for participant. Managing party responsible for own registration fee.
IMPORTANT CDCS REMINDERS:
Check Medical Assistance/Insurance PRIOR To Requesting Goods and Services Using Waiver Funds. Some examples include mobility devices and adaptations, allergen products, seizure detection devices, chiropractic services, etc. It also includes a noncovered goods and services list and much more.
Medical Mileage Reimbursement - Never allowed on any waiver (including Alternative Care Program) for staff to claim mileage reimbursement or other public transportation if it is for medical appointments.
Licensed Services on CDCS:
Staff Schedule Reminders:
- Whole household schedules must be submitted in the following circumstances:
- Multiple people in the home receiving waiver services and or CSG/CFSS.
- Overtime
- Shared Services
- Large Amounts of staffing incl. if both parents are working 40 hours.
- Whole household schedules should include and/or take the following into consideration: :
- Include ALL participants and ALL staff and when they work with each person.
- Consider whether it makes sense to do shared services.
- Consider getting waivers on the same renewal schedule.
- Consider working with one case manager for the entire family (if it is an option)
- Assure the household participants are all using the same FMS.
- Follow Labor Laws.
- Spread your hours out over the week when you are performing personal assistance activities as staff that are beyond usual parental responsibilities or typical spousal duties. This should somewhat match the job duties. E.g. If job duties include bathing, dressing, etc. These activities typically occur in the morning so should be reflected in the morning on the schedule.
- If there is only one minor/spouse receiving services, the schedule may generally indicate when the hours are being worked E.g. 3 hours in the morning and 4 hours intermittently in the afternoon, evening.
- Schedules should not include long shifts that do not account for times spent on activities that are typical parental responsibility based on age.
- The appropriate number of hours should be based on the person’s assessed needs and when these activities are performed. For staff living in the home, the participant needs to be awake in order to perform personal assistance activities with them. There are rare situations that overnight hours would be approved.
- To determine the appropriate number of hours each day, start with the number of extra hours needed to help with activities of daily living (ADL’s)/PCA assessment + instrumental activities of daily living (IADLs) + Behavioral Redirection + Additional Supervision = the no. of hours to be considered for staffing. You could use our Job Description Form to better indicate the time commitment for various assessed needs.
- Do not include unpaid job duties such as performing medical cares in the scheduled number of hours.
- It may be helpful to have a different schedule for the school year vs. summer.
- With electronic visit verification (EVV) time reporting, you must record the time you actually worked on a daily basis.
Switching To a New FMS:
- Some FMS’s are only allowing switches the first of the year and other FMS’s allow it to occur at fiscal quarters.
- When switching, new employee packets and background studies are required to be completed. Often it takes time for workers to clear background studies right away. Sometimes employees have to redo fingerprints.
- Risk: Cannot start working at new FMS until everything clears and all documents are completed. Allow for plenty of time to complete process (4-6 weeks). There could be a lapse in services.
CONTINUED CDCS REMINDERS:
Stipends Still Available For ALL Staff Hired Through FMS:
- $200 Electronic Visit Verification (EVV) Stipend (one time benefit)
- https://fs10.formsite.com/togevents/evvstipend/index
- Designed to offset the potential cost of using individual devices to access EVV systems for time reporting.
- Available to Support Staff that have worked 6 month or more.
- Need 10-digit UMPI number from FMS or check paystub.
Alternative Therapies & Specialized Services Requirements.
- Forms must be signed by MHCP Physician, Physician Assistant, Nurse Practitioner with a MHCP Provider Number
- Gym memberships require monitoring and an annual physician recommendations by MHCP Physician, Physician Assistant, Nurse Practitioner (adults only)
Monitoring Technology Usage and Forms:
- Need to be completed with your case manager annually for any monitoring tech devices being used whether purchased in current plan year or not.
- E.g., 3 years ago cameras were purchased and are still being used but there is no monitoring fee in the CDCS plan. Still need form completed if staff are still using the equipment.
- For minors and camera’s in bedroom: CM’s Supervisor must approve continuation until 18
- For adults, monitoring technology form must be submitted to DHS for initial approval. After approved, CM’s Supervisor must approve annually unless meets 1 of 4 listed situations in CBSM.
Job Descriptions:
- All staff must have a job description included within the CDCS plan or attached separately.
- Include detail of tasks to meet the needs of the participant. Should not be general statements only.
- Only include personal assistance activities that are not typically parental responsibility. For example in a Paid Parent of Minor (PPOM) Schedule, a small child’s job duties should not include transportation, general meal prep, family outings, medical/therapy appointment, etc. These are activities a parent should already be engaging in as a typical “parental responsibility.”
GENERAL INFORMATION LINKS FOR CDCS:
College Tuition Resource for Direct Care Staff
Person Centered Planning
- A person centered planner, helps a person develop/create a life plan to help them reach their goals and achieve their dreams in life. Contact The ARC Minnesota
RECOMMENDED COMMUNITY RESOURCES (suggested by participants, not necessarily endorsed by Anoka County):
- Islands of Brilliance – creative programs for autistic students
- Vera Fitness: (for adults) 1:1 or group, special needs music play, special needs mobility, Zumba, yoga, brain flex fitness, drumming, music play, mobility, power core (non-weight bearing) - 30 min sessions. https://www.verafitnesstc.com
- Toneworks Music Therapy
- Vehicle Barriers - affordable https://infparts.com/product/sneeze-guard-vehicle-safety-partition-2/
- Twin Cities F.I.T. (Fitness Integrated Therapy) - helps individuals reach their health and fitness goals by integrating approaches from: Exercise physiology, Occupational therapy, Physical therapy, Behavioral therapy, Sensory integration.
- Requires Alternative Treatment Form
ENJOY THE REMAINDER OF THE SUMMER!
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