How to Apply for Consumer Directed Services in Missouri

1. Who to contact first

Consumer Directed Services is part of Missouri's Home and Community Based Services (HCBS), and every HCBS application starts with a referral to the Division of Senior and Disability Services (DSDS) in the Department of Health and Senior Services. DSDS is responsible for taking referrals, assessing the level of care and authorising services. DHSS publishes two ways to make the referral:

• By phone: the HCBS Intake line, 1-866-835-3505.
• Online: the HCBS Referral form linked from DHSS's Apply for Home and Community-Based Services page.

The referral does not have to come from the participant. DHSS says participants, family, friends or informal supports may submit it, so an adult child can start the process for a parent. Diverse Health Services can explain the steps, but the referral itself goes to the state.

2. The assessment

If the minimum requirements are met at the time of the referral, DHSS says the referral goes to the assessment team, who contact you to schedule a face-to-face visit in the home. The assessor evaluates the participant's level of care and identifies the unmet needs — the help that family or other supports do not already provide. DHSS's HCBS manual requires initial assessments to be scheduled and completed within fifteen business days of the referral being received, and the care plan that follows is written by DSDS staff with the participant.

Two practical points from the state's own page: the assessor will attempt to contact you once, and you have ten days to respond before the referral is closed; and you should be ready to say which model you want — Agency Model or Consumer Directed — and to name a backup plan with specific people and phone numbers.

What to have ready

• The participant's full name, date of birth and MO HealthNet (Missouri Medicaid) number, if they have one.
• A plain description of what the participant needs help with day to day — bathing, dressing, meals, mobility, getting to appointments.
• Which model you want: the Agency Model, where a provider hires the caregivers, or Consumer Directed, where the participant hires them.
• A backup plan: the names and phone numbers of people who can step in when the attendant is unavailable. DHSS asks for this at the assessment.
• The name of the attendant you have in mind, if any, so the vendor can start the registry and screening steps once services are authorised.

3. Who the program is for

Missouri's statute on consumer-directed personal care assistance describes the person the program is designed for: an adult of eighteen or older who is physically disabled, who is able to direct their own care, who can document MO HealthNet (Missouri Medicaid) eligibility, and whose unmet needs can be met safely at home at a cost that does not exceed what MO HealthNet (Missouri Medicaid) would pay for nursing-facility care. DHSS's application page says the same thing in everyday words — your care needs have to be equal to nursing home care, and you need active MO HealthNet (Missouri Medicaid) coverage.

Whether a particular person meets those criteria is established by the assessment, not by a checklist on a website. DHSS/DSDS — not Diverse Health Services — determines eligibility. That is also why we do not publish statements about what the program will or will not provide for you: the answer comes from the state's assessment and care plan.

Questions about MO HealthNet coverage itself — whether the participant has it, or how to apply for it — go to the Department of Social Services, which runs MO HealthNet; its Participant Services line is (800) 392-2161.

4. Choosing a CDS vendor

DHSS's manual states that participants can exercise individual choice in deciding who provides their CDS. Every vendor works under the same state rules, so the useful comparison is how each one does the work. The same five questions we suggest on our find-a-provider page apply to any vendor, including us:

1. 1. How do you handle timesheets and payroll?

   Missouri law makes the vendor responsible for collecting and verifying the timesheets you and your attendant sign, paying the attendant on your behalf and paying the payroll taxes on time. Ask how timesheets are submitted and how quickly questions are answered.

2. 2. What orientation do you give me as the employer of record?

   The participant is the attendant's employer of record, and vendors must provide orientation on employer responsibilities and attendant supervision. Ask what the orientation covers and who you can call afterwards.

3. 3. How do you run registry and background screening for my attendant?

   Vendors must make sure attendants are registered with the Family Care Safety Registry and screened before state funds pay for their work. Ask what the attendant needs to bring and how long the vendor's own steps usually take.

4. 4. Who visits me, and how often?

   Vendors are required to monitor service delivery with at least one face-to-face visit each year. Ask who makes that visit and how to reach them between visits.

5. 5. Where is your office, and who answers the phone?

   A vendor needs a physical business location. Ask whether you will talk to a local coordinator or a call centre, and in what hours.

5. After approval

Once DSDS authorises services and you have chosen a vendor, the work moves to the vendor's side. Missouri statute sets out what that involves, and this is what Diverse Health Services does with each new participant:

• Orientation. The participant is the attendant's employer of record, so the vendor explains the employer's responsibilities and how to supervise the attendant.
• Registry and screening. The attendant is registered with the Family Care Safety Registry and screened; state law does not allow program funds to pay for an attendant's work before the screening is done.
• Paperwork, timesheets and payroll. Employment and tax forms go on file; from then on the participant and attendant sign timesheets, the vendor verifies them, pays the attendant on the participant's behalf and pays the payroll taxes.
• Ongoing contact. The vendor visits at least once a year to see how the services are going, and is the first call for payroll questions in between.

We do not quote how long onboarding takes, because it depends on the attendant's screening and on the state. What we can do is tell you exactly where things stand at each step. If you later want to change something — your hours, your attendant or your vendor — the request goes to DSDS's HCBS Intake and Person-Centered Care Plan team; our page on switching CDS providers describes that process.