CDS
Support Advisor Training

Consumer Directed Services

Support Advisor Training

 Texas Capitol

Texas Health and Human Services

7/14/17

Welcome!

Welcome to Consumer Directed Services (CDS) Support Advisor Training.

Navigating this Training

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Tips for Taking WBTs

To maximize the benefit you receive from participating in this web-based training (WBT), please consider each of the following tips:

Training Objectives

Training

After successfully completing this training, you will be able to:

Support Advisor Basics

Before learning about CDS, it is helpful to review the following important facts about support advisors and support consultation:

Support Advisor Training Requirement

 

To meet the HHS support advisor training requirement, you must pass the test at the end of the training with a score of at least 80%

Prerequisite: Background Check

Prerequisite: Know the CDS Rules!

Texas Administrative Code

Before beginning this training, you should be familiar with the CDS regulations (also called rules) found in Texas Administrative Code (TAC) Title 40, Part 1, Chapter 41. If you have not reviewed the CDS rules, then please review them before continuing with this training.

Prerequisite: Support Advisor Applicant Form

In addition to completing this training and submitting background check requirements, all CDS support advisors must complete the CDS Support Advisor Applicant Form (HHS Form 8400) and submit it to the address provided at the end of this training. This form will be available on the CDS Forms page.

Let's Review

Before continuing to the next page, please complete the following learning check. If you fail to get the correct answer on your first try, please try again.

 Learning Check #1

 

Module One:

Introduction/Overview

What is the CDS Option?

Elderly Couple on Bench

On the following pages, you will be asked to watch short videos that introduce the CDS option.

CDS Video #1

Please click the play button below to start the video, and turn on your speakers or headphones.

In CDS, it's important to select employees who are a good fit for the individuals being served, and to create a schedule that fits the individual's needs, as you'll see in the following video.

  

Please note that in the videos of this training, the term "CDSA" (Consumer Directed Services Agency) is used interchangeably with "FMSA."

CDS Video #2

Please click the play button below to start the video, and turn on your speakers or headphones.

In the next video, you'll see that when choosing CDS, individuals have assistance from experienced staff throughout the process.

CDS Overview

Elderly lady with Caregiver

The CDS option provides an opportunity for the individual receiving services, or the individual's legally authorized representative (LAR), to be the employer of service providers who deliver program services through the CDS option. The Employer:

In the CDS option, the CDS employer must be either the:

Note: An employer may appoint a designated representative (DR) and/or hire a support advisor to assist the employer but they cannot be the employer.

What Does the CDS Option Offer?

Caregiver and elderly lady

Factors such as lifestyle, decision-making, time and effort, flexibility, personal control, and peace of mind all contribute to the individual's home care management selection.

 

Some of the reasons individuals select the CDS delivery option are:

  1. CDS allows people to maintain more control of their direct services.
  2. The individual receiving services can train their employee on how THEY need and want support. This direct supervision can result in more training and performance feedback.
  3. Individuals can target advertisements for their specific needs.
  4. Individuals can hire non-traditional employees, such as friends and church members, who may not otherwise ever apply for work in the general field of attendant care.
  5. The ability to adjust pay rates or award bonuses for employees based on performance and/or tenure.
  6. An individual employer may allow their employee to drive during the provision of accompaniment services. The individual employer assumes the liability of the attendant driving.

Personal Perspective of a CDS Employer

A CDS employer made the following personal observation about the CDS option. Please review the 6 pages below before continuing.

  

How Does the CDS Option Work?

 

The CDS Option Basics

Options

CDS Self-Directed Services (June 2017)

Not all services in every program can be self-directed.  Below is a chart listing the services within each program that can be self-directed and who is responsible for service coordination or case management for each program. Just because a service can be self-directed does not mean the individual has to self-direct it. An individual can choose to use the agency option for some services and the consumer directed services option for other services. 

 Please scroll down and carefully review information about each program displayed in the table below. Note the differences between programs.

Program Name

Program offers Support Consultation?

 

Services in program that can be self-directed through the CDS Option:

Case Management/Service Coordination Provider for Program

Community Living Assistance and Support Services (CLASS)

Yes

In-home and out-of-home respite services,transportation (habilitation), nursing, physical therapy, occupational therapy, speech, hearing and language services, cognitive rehabilitation therapy, employment assistance, supported employment and, Community First Choice Personal Assistance Services/Habilitation (CFC PAS/HAB)

Private Case Management Agency (CMA)

Deaf Blind with Multiple Disabilities (DBMD)

Yes

Respite services, transportation (residential habilitation), intervener, supported employment, employment assistance, and CFC PAS/HAB

Direct Service Agency (DSA)

Primary Home Care (PHC); Family Care (FC); Community Attendant Services (CAS)

Yes

Personal assistance services

HHS

Comprehensive Care Program

 

No

Personal care services, CFC, PAS, CFC PAS/HAB

HHS

Consumer Managed Personal Assistance Services (CMPAS)

No

Personal assistance services

CMPAS Provider

Home and Community Based Services (HCS)

Yes

Respite, transportation (supported home living), nursing, cognitive rehabilitation therapy, supported employment, employment assistance, and CFC PAS/HAB

Local Intellectual and Developmental Disability Authority (LIDDA)

Texas Home Living (TxHmL)

Yes

All services, CFC PAS/HAB, and transportation (community support)

LIDDA

STAR Kids

No

Personal care services, CFC PAS, CFC PAS/HAB

Managed Care Organization (MCO)

STAR Kids Medically Dependent Children Program (MDCP)

No

Respite services and flexible family support services delivered by an attendant or a nurse, employment services, and supported employment

MCO

STAR+PLUS

No

Personal assistance services, CFC PAS, CFC PAS/HAB

MCO

STAR+PLUS Home and Community Based Services

Yes

Personal assistance services, respite services, skilled nursing, physical therapy, occupational therapy, speech language therapy, cognitive rehabilitation therapy, employment assistance, supported employment

MCO

What is the Same and What is Different Across Programs?

What is the Same:

 

 What is Different:

The CDS rules (Ch. 41) define the following in all programs:

  • How the CDS option works
  • The responsibilities of:
  • CDS employers (The individual or their legally authorized representative)
  • Designated representatives
  • Financial Management Services Agencies, and
  • case managers or service coordinators
  • The enrollment process
  • Budgeting process
  • Reimbursement

 

 

Program rules define:

  • Which services can be self-directed through the CDS option
  • Service provider qualifications
  • Required training for service providers
  • Required documentation
  • Who provides case management
  • Frequency of program monitoring visits

 

You may also need to look at different programs handbooks which can be found here. 

 

What is the Same and What is Different Across Programs? (Cont.)

Program Specific Addendum to Form 1735

FMSAs are required to provide the program specific addendum at the CDS orientation to each new CDS employer. The addendums outline program specific information about the services that can be self-directed, the provider qualifications, service delivery documentation and training requirements.

 

The 1735 addendums list program specific information, such as:

 

FMSAs are required to provide the program specific addendum at the CDS orientation to each new CDS employer.

Let's Review

Before continuing to the next page, please complete the following learning check. If you fail to get the correct answer on your first try, please try again.

 Learning Check #2

CDS Rules and Information Letters

Rules

CDS: A Service Delivery Option

Delivery Options

REMEMBER: CDS is not a program. It is a service delivery option. Therefore, you will need to understand that the CDS Option functions differently in different programs. Program rules and policy continue to determine:

Each employer must understand the specific requirements of his or her specific program. Form 1735 addendums for each of the programs describe specific requirements the CDS employer must follow for that program. Support advisors must be familiar with the information on each 1735 addendum.

Form 1735 Addendums are found here: https://hhs.texas.gov/laws-regulations/forms/1000-1999/form-1735-employer-financial-management-services-agency-service-agreement.

Let's Review

Before continuing to the next page, please complete the following learning check. If you fail to get the correct answer on your first try, please try again.

 Learning Check #3

Module Two:

Roles and Responsibilities in the CDS Option

Know Your Role

Key Players in CDS

Below are the key players who make up the team and individuals' circle of support in the CDS option. Each have unique roles and responsibilities. Before continuing to the next page, please select each key player icon to review more information.

 

 

Case Manager/Service Coordinator

 

 

 

Informal Support

 

Provider/Employee

 

Contractors/Vendors

Individual/Employer

Designated Representative

 

Direct Service Provider

 

FMSA

 

 

 

Support Advisor

 

 

CDS Employer Roles and Responsibilities

The CDS employer has many responsibilities, listed below. As a support advisor, you may assist the employer with some of these tasks. As you scroll down to read the list below, think about ways you could coach, train, and support an employer to be successful in each responsibility.

CDS Video #3

Please click the play button below to start the video, and turn on your speakers or headphones.

Why do individuals choose CDS?  In the next video you will hear firsthand accounts about why CDS was selected by families.

   

Service Planning Team Roles and Responsibilities

Team

The service planning team (SPT) also plays an integral role in the CDS option. The SPT determines:

Furthermore, the SPT approves:

Program Provider Roles and Responsibilities

The program provider:

Case Manager (CM) or Service Coordinator (SC) Roles and Responsibilities

Caregiver and elderly lady

Case managers and service coordinators are critical partners in the CDS option. They are not only the entry point to the CDS option for many individuals, but they also ensure that services are being coordinated appropriately and assist the employer with changes in their services, FMSA, or service delivery option.

Case manager and service coordinator responsibilities include the following:

FMSA Roles and Responsibilities

The FMSA is the entity that provides financial management services (FMS) and employer support for the individual participating in the CDS option. FMSAs provide a unique service. They provide on-going support for those who use the CDS option and conduct payroll and pay employer federal and state taxes on behalf of CDS employers. 

 

Please review each of the following additional FMSA responsibilities:

Also, it's very important to remember the following information about FMSAs:

List of FMSAs

List of FMSAs

 

 

Designated Representative (DR) Roles and Responsibilities

Definition of Designate

Please scroll down completely on this page and review all content.

 

If an employer (individual or LAR) needs support or assistance to meet employer responsibilities, he or she may choose to appoint a designated representative (DR).

An employer can appoint a DR to assist or to perform employer responsibilities in the CDS option. A DR must:

 

The employer will specify which employer tasks the DR will assist with or assume. The employer maintains responsibility for actions taken by the DR. Some tasks might include approving time sheets or training employees.

 

Appointment of a Designated Representative

An FMSA and the employer must maintain the following documentation regarding an employer's DR:

In the screen shot of the Form 1720 below, the section where an employer must document tasks appointed to the DR is displayed. For example, the employee might write in this field: "The DR will perform the following tasks: approve time sheets and train employees."

Support Advisor Roles and Responsibilities

advisor

Support advisors play an integral role in the CDS option by assisting employees with the following:

(Note that we will discuss more details about the role of the support advisor in Module 3 of this training.)

To see the support advisor choice list that includes support advisors who completed the training requirement, please visit the following webpage: https://www.dads.state.tx.us/providers/CDS/advisors.cfm.

Let's Review

Before continuing to the next page, please complete the following learning check. If you fail to get the correct answer on your first try, please try again.

 Learning Check #4

CDS Sequence of Activities

Sequence

Now that we have explained the roles and responsibilities of each key player in the CDS option, let's look at how the CDS process works. Let's follow Suzie on her journey through each of the CDS option steps.  On the next page you will be asked to put these CDS process steps in the correct order.

1. The Case Manager/Service Coordinator (CM/SC) offers Suzie the CDS option (This can be at the time of program enrollment, on request or annually). Suzie chooses to self-direct services using the CDS option.

 

2. Suzie selects an FMSA for financial management services (FMS) from a list provided by the CM/SC. Next, Suzie meets with her service planning team to determine her services, including the ones she will self-direct (using the CDS option to manage). They also determine "critical services" for which Suzie must develop backup plans.

 

3. Suzie meets with her FMSA representative who explains FMS. Suzie must have her FMSA's written approval of budgets before the services are provided. Suzie recruits and interviews potential employees. Each service provider must be approved in writing by Suzie's FMSA. Suzie submits a Wage and Benefit Plan (Form 1730) for each employee and must receive written approval from her FMSA (Form 1729) before offering an employee's compensation.

 

4. Suzie obtains completed service provider agreements from each newly-hired service provider before the service provider can begin working.

 

5. Suzie trains her service providers on how she would like tasks completed and on recognizing and reporting abuse, neglect and exploitation. She also provides information about the employee misconduct registry. Suzie documents her training activities for each service provider and sends documentation to her FMSA. Service providers must document service delivery as delivered using service logs,time sheets (paper or electronic), receipts, and invoices. Suzie approves documentation of services delivered and submits documentation to the FMSA for processing and payment.

 

6. Suzie's FMSA calculates payments, verifies authorization for payment, and withholds taxes from payroll. Suzie's FMSA issues payroll at least two times per calendar month (or every two weeks) and deposits withholdings with state and federal agencies as required. The FMSA provides FMSA Reports at least quarterly, or more frequently if requested, on the status of funds, services, budget utilization, and notice of concerns, problems, or issues to Suzie and her CM/SC. Suzie reviews her quarterly report to make sure she is within budget.

 

Let's Review

Before continuing to the next page, please complete the following learning check. In this activity, you will be asked to put the CDS events from the preceding page in the correct CDS process order. If you fail to get the correct order on your first try, please try to reorder the items again until you put them in the correct order.

 Learning Check #5

Let's Review

Before continuing to the next page, please complete the following learning check. If you fail to get the correct answer on your first try, please try again.

 Learning Check #6

Module Three:

Support Consultation Services and Support Advisor Responsibilities

Support Consultation Services and Support Advisor Responsibilities

Disability Free

In this section we will learn job responsibilities of support advisors. Specifically, we will identify what types of coaching and support may be expected from a support advisor, including:

 

Overview of Support Consultation Services

Laughter

Let's Review

Before continuing to the next page, please complete the following learning check. If you fail to get the correct answer on your first try, please try again.

 Learning Check #7

Employer Responsibilities

Employer

Next, we will provide more in depth information on employer responsibilities that you, as a support advisor, may support the employer with. Some of these responsibilities include:

Service Backup Plans

What is you Backup Plan?

A service backup plan, is just what it sounds like. It is to ensure an individuals needs are met even if an employee is sick or unable to work. When the lack of provision of the service would place the health and/or welfare of the individual in jeopardy, an employer must have a service backup plan in place. Please scroll down to review the following about backup plans.

 An employer must revise a service backup plan if:

Once approved, the CDS employer has five working days to send a copy of the initial or revised plan to the FMSA.

On the following page, you will be asked to watch a video of a case study.

CDS Video #4

Please click the play button below to start the video, and turn on your speakers or headphones.

In the CDS option, there is often a need for respite backup staff to be available. In this video, you will see how a backup service provider is available when scheduled employees or family members are not available to assist.

  

Let's Review

Before continuing to the next page, please complete the following learning check. If you fail to get the correct answer on your first try, please try again.

 Learning Check #8

Service Backup Plans (cont.)

Service backup plans may include the use of:

 

Some examples of unpaid service providers/informal supports are listed below:

Please scroll down now to view a sample service backup plan.

 


Review the backup plan below. Since suctioning is a task that must be performed for her health and safety, Susie, must have a backup plan in place.

As you can see, she has more than one backup plan strategy listed with adequate details about each option. This helps ensure that her services continue regardless of others' schedules. She uses both formal and informal supports as backup providers.

Let's Review

Before continuing to the next page, please complete the following learning check. If you fail to get the correct answer on your first try, please try again.

 Learning Check #9

Hiring Process

Now Hiring

As a support advisor you may be asked to assist with the recruitment and hiring process. It will be very important that you understand the following, so that you can train the employer and DR to be successful:

CDS Video #5

Please click the play button below to start the video, and turn on your speakers or headphones.

In the following video, you will see that support advisors help individuals to find the right employees who understand their specific needs. In this way, support advisors ensure that the right match is made.

 

Hiring Process (cont.)

Please scroll down to review important information about the CDS hiring process.

 

How to Find a Service Provider (Employee)

There are several ways that one can find a service provider:

 

It is important to think outside of the box and take an individual approach. Different tactics will work better for some employers than others.

 

Tips on Writing an Advertisement

What to include in an advertisement:

What not to include in an advertisement:

 

Interviewing

Setting Up an In-Person Interview

 

Tips for Interviewing

 

Tips for Employer conducting the Interview

Remember, the employer should be in charge. As the support advisor, you are training, coaching and supporting the employer. You are not doing for them.

 

Example Questions to Ask Potential Employees:

 

Checking References

Check references before hiring. Former employers may tell you something that prevents you from hiring someone. (For instance,  the employee frequently did not show up or call.

Sample questions for checking references include the following:

 

CDS Hiring Procedures

At the initial CDS orientation meeting, the FMSA will provide the employer a "new employee packet cover sheet" (Form 1724: https://hhs.texas.gov/sites/default/files//documents/laws-regulations/forms/1724/1724.pdf), a checklist of activities and required forms to be completed. 

 

Form 1724 is a helpful tool for hiring. It can be used as a guide during the hiring process. It will indicate:

 

As a support advisor, you should teach the employer to use tools such as form 1724 to assist them when you are not there (it may be helpful to ask the employer if they need a check list like form 1724 in a different format, such as larger print). Remind the employer, "no one knows everything or remembers every detail - that's why tools like form 1724 exist."

 Please scroll down to review a sample Form 1724.


CDS Hiring Forms

Now that you have had a chance to review form 1724, lets look at each required form in more detail. Although it is tedious to go through each form and its instructions, it will help you better understand the CDS option and employer responsibilities. While reviewing each form, think about ways you can help an employer understand each responsibility and what tools may help them to be successful.

 

Before an individual can be hired, the following forms need to  be completed. One copy should be sent to the FMSA and another copy should be kept by the employer:

 

 


Criminal History and Registry Check–Form 1725

 

 


Applicant Verification-Form 1729

 

Let's Review

Before continuing to the next page, please complete the following learning check. If you fail to get the correct answer on your first try, please try again.

 Learning Check #10

CDS Hiring Forms (cont.)

Service Provider and Employer Certification of Relationship Status for CDS- Form 1734

 

Liability Acknowledgement-Form 1728

 

As outlined in Form 1724, New Employee Packet Cover sheet, the following forms need to be completed when the CDS Employer hires a provider:

 

Wage and Benefit Plan–Form 1730

 

Form 1730 is available here: https://hhs.texas.gov/laws-regulations/forms/1000-1999/form-1730-wage-benefits-plan-employee-compensation

 

Employee Work Schedule and Assigned Tasks-Form 1731

It is the employer's responsibility (not the case manager, service coordinator, or FMSA) to set the schedule for each employee.

 

Employer and Employee Service Agreement- Form 1737

 

Service Provider Agreement Form 1739

Form 1739 documents the service provider agreement between the FMSA and a service provider (employee, contractor, entity, vendor) providing services to one or more individuals through the Consumer Directed Services (CDS) Option.

 

Remember:

 

Management and Training of Service Provider Form 1732

Documents training, evaluations, conflict resolution, warnings and other activities that occur in the process of managing and supervising service providers (service provider or contractor). This form can be completed:

 

Form 1732 is completed upon hire and then ongoing (evaluations, training updates, etc.). Form 1732 is available here: https://hhs.texas.gov/laws-regulations/forms/1000-1999/form-1732-management-training-service-provider

Required Training

Initial training includes:

 

Please note that each program has its own unique training requirements. Make sure you check Form 1735 program addendums and program rules for specific training requirements.

Ongoing Forms: Time Sheets and Service Delivery Logs

Services delivered must be documented by either:

 

Employer Responsibilities: Time Sheets and Service Delivery Logs

Before the employer signs, dates and sends the time sheet or service delivery log to the FMSA for payment, the employer must ensure that:

 

Incomplete time sheets or service delivery logs cannot be paid. It is the employer's responsibility to send time sheets and service delivery logs to the FMSA on time. The employer's signature is a certification that all of the information is true and correct. It is illegal to request payment for services which have not been provided as described on the time sheet.

 

Electronic visit verification (EVV) is optional for CDS. For some individuals, this is the best option. More information about EVV is available here:

https://hhs.texas.gov/doing-business-hhs/provider-portals/resources/electronic-visit-verification/evv-faqs

 

Corrective Action Plans-Form 1741

A support advisor may be asked to assist an employer with a corrective action plan (CAP). A corrective action plan is a tool to assist the employer with improving his or her employer skills. It discusses responsibilities the employer needs to improve on and how they will improve (it may specify that a DR be appointed for a certain tasks).

 

A corrective action plan (CAP) may be required by the FMSA (related to employer responsibilities), the individual's case management provider (related to programmatic issues), or HHS staff (related to CDS or program).

 

Some reasons a CAP may be requested include if an employer:

 

A CAP needs to be specific and focus on what the employer needs to succeed in the CDS option. The goal of a CAP is to appropriately support the employer, not to punish him or her.

Please scroll down to review the sample 1741 below.

 

Employee Misconduct Registry and Nurse Aide Registry

 

Employer Responsibilities Regarding EMR

Abuse Neglect and Exploitation (ANE)

If there is a finding of abuse, neglect, or exploitation, the employee will be listed on the EMR. There are two ways to report allegations of abuse, neglect, or exploitation (ANE):

1. Call 1 (800) 252-5400

2. Report online at www.txabusehotline.org

 

ANE committed against individuals using the CDS option will be investigated by the APS Provider Investigations program.

 

Please scroll down to review the following important information about abuse, neglect and exploitation.

 


What is Abuse?

Physical abuse includes:

Sexual abuse may include:

Verbal/emotional abuse may include the following actions:

  


What is Neglect?

A negligent act or omission by any individual responsible for providing, which caused or may have caused physical or emotional injury or death or which placed a person at risk of physical or emotional injury or death

  


What is Exploitation?

The illegal or improper act or process of using a person or the resources of a person for monetary or personal benefit, profit, or gain

Help Employers to Help Themselves!

Elderly Man with Caregiver

As a support advisor, you can help employers protect themselves with the following:

 

This information can also be found in the CDS Employer Manual http://www.dads.state.tx.us/services/cds/employer/chapter5.html#recognize

 

What to do in Case of ANE

If an allegation of ANE is reported, the following process is followed

  1. The allegation of ANE is assigned to an APS Provider investigator.
  2. The investigator notifies the CDS employer and the FMSA service coordinator/case manager of the allegation.
  3. The FMSA will notify the service coordinator/case manager of the allegation.
  4. The service coordinator/case manager will call a service planning team meeting to discuss how the CDS employer will protect him or herself.
  5. The investigator conducts the investigation.
  6. The investigator provides an investigation report to the CDS employer and the FMSA.  (This report will include the findings of the investigation and possibly recommendations for the individual to stay safe in the future.)
  7. The service coordinator/case manager calls a service planning team meeting to discuss the report and next steps with the CDS employer.

 

Responsibilities of the CDS Employer in relation to ANE include the following:

CDS recipient fraud is reported separately from ANE, but is taken seriously. The Health and Human Services Commission Office of Inspector General (OIG) investigates Medicaid recipient fraud. 

 

It can be helpful to make sure CDS employers know what activities are considered Medicaid recipient fraud. Some examples are if the employer asks the provider to:

It is also Medicaid fraud when an employer falsifies time sheets or other paperwork or hires an ineligible employee.

Email Alerts

Stay informed! Sign up for email alerts at the following link: https://service.govdelivery.com/accounts/TXHHSC/subscriber/new.

Please scroll down to review instructions that will allow you to sign up for email alerts.


Enter your email in the provided field, as illustrated below. After you select the Submit button, you will be asked to confirm your email and provide a password. This is so you may update your preferences at any time.

 


Finally, scroll down and select "Consumer Directed Services (CDS) Resources" under the HHS Long-term Care Provider section.

Future CDS Questions?

If you have any CDS questions in the future, please review the following:

 

 

If you still have questions, please feel free to:

CDS Support Advisor Test

Congratulations! You have completed the CDS Support Advisor training. Please click on the title below to open the final test.

 CDS Support Advisor Test

Once you have successfully completed the test with a score of 80% or higher, please do the following in this order to have your results documented:

1) enter your name in the provided field;

2) select the "email score" button to send your test score to HHSC;

3) request your criminal history record from the Texas Department of Public Safety (DPS) (You must ask DPS to send your criminal history record directly to HHSC at the address below); and

4) mail your completed Support Advisor Applicant Form (HHS Form 8400) with all requested documentation, to the following address:

 

Texas Health and Human Services

CDS Operations

Mail Code: H-600

4900 N. Lamar Blvd.

Austin, TX 78751