Consumer Directed Services (CD)

It is important to know that anyone requesting services from "Comfort Facilitators" must first be approved for one of the waivers... what is needed for us to get started is an UAI ("Uniform Assessment Instrument") which is prepared by your local DSS ("Department of Social Services") office or a hospital in which the client has been recently discharged. 

To understand more about the Waiver with Consumer Directed Services, click on the Waiver Name to the left.

Fact Sheet 2015 

Overview:  Consumer-directed (CD) is a service delivery model of care. In select waivers, three services are available through the consumer-directed model or the agency-directed model. These services are: personal care, respite care, and companion care. Enrolled individuals with a demonstrated need for these services may elect to receive them through either the CD model of service delivery, the agency-directed (AD) model of service delivery, or a combination of both. The CD model differs from AD services by allowing the individual to assume the employer responsibility for directly hiring, training, scheduling, and firing staff and monitoring the provision of services provided. AD services are provided by a Medicaid enrolled provider agency. To receive CD services, the individual or a designated individual must act as the employer of record (EOR). The EOR hires, trains, and supervises the attendant(s). A minor (under the age of 18) is required to have a designated EOR.

An individual may be found NOT to be eligible for CD services if:

· It is determined that he or she cannot be the EOR, and no one else is able to assume this role.

· The individual wants CD services, but health and safety cannot be assured.

· The individual has medication or skilled nursing needs or medical/behavioral conditions that cannot be met through CD services.

Refer to the program regulations and Medicaid provider manuals for additional information.

Target Population:  Individuals in the Intellectual Disability (ID) Waiver, Individual and Family Developmental Disabilities Support (DD) Waiver, or the Elderly or Disabled with Consumer Direction (EDCD) Waiver, have the option of CD services if criteria are met. The Early, Periodic, Screening Diagnosis and Treatment (EPSDT) program and Children’s Mental Health (CMH) program also have the option of CD services.

Eligibility:  An individual must meet eligibility requirements for the waiver in which he or she is enrolled.

Service Authorization:  The authorization process for CD services is specified in the program regulations and Medicaid provider manuals. The service authorization process for the CD model of service delivery is the same as the AD model, and is based on the specific service need and plan of care that is developed.

Process of CD Services:  Upon waiver enrollment and assessment of need, an individual can choose AD services, CD services, or a combination of both. The individual is the employer-of-record (EOR) and is responsible for hiring, training, supervising, and firing. An individual unable to manage his or her own CD services or individuals less than 18 years of age must have a family member/caregiver serve as the EOR. Specific employer duties include checking of references of employees (assistants/companions), determining that they meet basic qualifications and pass a criminal background check and, if providing services to minor, have no finding in the Child Protective Services Central Registry. The EOR is also responsible for training employees, supervising their performance, and submitting timesheets to the fiscal/employer agent in a consistent and timely basis. When the fiscal/employer agent receives all paperwork from the EOR, determines that the individual is “Good to Serve,” and services are authorized, the attendant may begin providing services. Services facilitation means a service that assists the individual (and the individual’s family or caregiver, as appropriate) in arranging for, directing, and managing services provided through the CD model. Individuals choosing the CD model of service delivery may receive support from a services facilitator (SF). Services facilitation is used in conjunction with CD services. The SF is responsible for assessing the individual’s particular needs for a requested CD service, assisting in the development of the Plan of Care, providing training to the individual/EOR as appropriate, on his or her responsibilities as an employer and providing ongoing support of the CD model of services.

Services Available:  Services may include personal care, respite care, and/or companion services necessary for individuals to remain in the community. CD services do not include nursing services or services provided to other individuals in the household.

Fiscal Agent:  A fiscal/employer agent, Public Partnerships (PPL), is the state’s contractor responsible for all fiscal agent services. PPL is responsible for establishing accounts for the EOR by securing a federal identification number, and establishing the tax accounting process (this can include employment tax and IRS tax). PPL also processes requests for new providers and completes their enrollment enabling them to be compensated for the attendant services they provide individuals. PPL processes timesheets and distributes paychecks for all enrolled providers (employees) while maintaining accountability for the hours each participant has available for use.

Definitions:  (Consumer-Directed Waiver Services Employer of Record Manual, March 2015, at dmas.virginia.gov)

CD personal assistance:  services help individuals with their activities of daily living (ADLs), such as dressing, bathing, toileting, eating, and assistance with self-administration of medication. They may also be used to support individuals with their ADLs at work and other places in their community. This service is available in the EDCD, ID, and DD Waivers and in the EPSDT program.

CD respite:  services provide assistance and support to individuals that provide the unpaid primary caregiver (for example, family members) time to do things that they need to do for themselves or other members of the family. A respite attendant assists the individual at home and in the community with tasks the family/caregiver normally helps with, giving the family/caregiver the needed time away. However, an attendant cannot provide skilled respite services. Skilled respite services available through the EDCD waiver cannot be consumer directed. Skilled respite can only be provided by a registered nurse (RN) or a licensed practical nurse (LPN). General respite services are available in the EDCD, ID, and DD waivers.

CD companion:  services are available only to ID and DD Waiver individuals; must be age 18 or older. Companion services are defined as assisting adult individuals with housekeeping, shopping and community activities. Companion services are not available for individuals in the EDCD waiver.

Quality Management Review:  DMAS conducts quality management reviews of the services provided and interviews individuals for all providers providing services in this waiver to ensure the health and safety of all individuals. Level of care reviews are performed at least annually.

Regulatory Basis:  Refer to the regulations for the specific waiver or program.

Program Contact:  As consumer direction is a service delivery model, contacts should be made to Nicole Scott, Contract Supervisor at 804-786-3228 or nicole.scott@dmas.virginia.gov. The DMAS website is www.dmas.virginia.gov.

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