Center for Excellence in Consumer Directed Services: Gateways Community Services : Nashua, NH

Center for Excellence in Consumer Directed Services

The Center for Excellence in Consumer Directed Services supports individuals and their families as they determine their own support plans with specific goals. Consumer Directed Services puts people with disabilities and seniors in need of care at the helm, with their families, steering the course of their lives.

How can we help?

Provide proven consulting services to agencies to cost-effectively implement Consumer Directed Services.
Provide technical expertise on an as needed basis. We can help you assess and fill the gaps, so you can better deliver Consumer Directed Services.
Outsource the CDS function to the Center for Excellence to gain immediate results and measurable success.

Consumer Directed Services has emerged nationally as a cost-effective model that provides families with an annual budget and allows them – within broad guidelines – to decide how best to use these funds to benefit their family member. It allows families the flexibility to spend a portion of their budget for professional consultation, equipment and environmental modifications, and parent of provider training. It also enables families to set a wage that will allow them to hire one-on-one providers capable of implementing the program they have chosen. Nationally, the principle funding mechanism for CDS is the Medicaid Home and Community Based Care Program. This model has rapidly gained popularity.

Here to Help Deliver!

Innovative and Accessible
Comprehensive
Choice Driven
Individual and Family Centered
Compassionate

We are committed to increasing the understanding and benefits of Consumer Directed Services. We encourage you to take advantage of our expertise and technical consulting program to learn more. If you feel that you would benefit from meeting with a Consumer Directed Services Specialist or would like to learn more about the Center for Excellence in Consumer Directed Services, please contact Dr. Dotty Treisner at 603-455-6773 or .

Additional Information

Flyer: Are Self-Directed Services for You?

Guide: PDMS Employment Guidebook

Frequently Asked Questions

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What is Consumer Directed Services?

Consumer Directed Services is a method for providing services where the individual or guardian identifies needs, designs the services and supports, selects the supports and service providers, and decides how authorized funding is to be spent.

Participants in Consumer Directed Services have the opportunity and responsibility to design and manage the supports and services that are meaningful to them. Then, working within guidelines, they determine the cost of those supports and services and use the organization as their fiscal agent. It is the participant who provides authorization for the use of Medicaid dollars allocated for the supports and services. It is the organization that provides oversight on federal and state regulations, payroll processing, employer of record and accounts payable functions from the participant’s individual budget.

Is Consumer Directed Services controlled by the participant or the family? Do family members have the right to control services?

Control over services depends on the ability and legality of the participant to self direct. The participant should direct their supports and services; and their wishes are taken into account by the individuals who are closest to him. This is most often the family. Ultimately, a guardian if appointed has the right to say what will or will not happen. If the participant is their own guardian, they have ultimate control. However, no matter who is the guardian, the participant may look to others for guidance.

Many of us look to family members and friends for advice and direction. Many people are in a situation where they can trust their loved ones to help them make the right decisions. In the absence of family and friends, account managers (service coordinators) from organizations can guide the direction of services. The bottom line is that it is up to the individual to determine who he or she would prefer.

Does the consumer have to have a family who will direct the services?

Participants need to be self-directing either individually or with an ally. The ally may be a family member, guardian or friend so they can manage the day-to-day supports and services. Participants direct a range of supports and services. In partnership with the organization, the participant decides how much direction they want to give.

Is consumer directed services appropriate for everyone? What if the consumer has high risk behavioral issues?

Consumer Directed Service is not for everyone. It is a choice. It is not a viable option in situations where there is no one able or willing to perform the responsibility of self-direction. It is a partnership between the organization and the participant. The organization is ultimately responsible for determining whether or not there are adequate supports in place for the individual who is receiving services to manage the services and supports. The organization evaluates the situation and determines if there is the right skill set and capacity to direct one’s own service. If it is determined that the needed support structure is not there, then the organization should work with the participant to establish supports so the individual can choose to self direct.

The organization needs to identify and assess risk to be able to decide what level of risk they are willing to take. This is not always categorical; however, Gateways Community Services has decided that if a consumer has high risk behavioral issues they would not be appropriate for Consumer Directed Services.

Can family members get paid to do the work?

The family supervises and manages the supports and services on a voluntary basis. But for direct service, personal care, family members can get paid. Grandparents, siblings, aunts, and uncles can get paid as family managed employees (staff). If the need arises and the participant is living with their family, families can get difficulty of care payments for direct service.

Who supervises the direct support staff?

Gateways Community Services uses the Agency with Choice Fiscal Intermediary Model. In this model, the organization is the Employer of Record and the participant, or someone they designate, is the Supervisor. The organization takes care of payroll, payroll taxes, workers compensation, and benefits. Typically, the participant recruits, trains, schedules, and supervises the family managed employees (direct support staff).

What happens if the staff quits or doesn't show up one day?

Under the Agency with Choice model, workers (staff) are specifically recruited by the participant and come to work under the organization for that individual. If they quit or don’t show up, it is the responsibility of the participant to find a new worker and arrange for the needed backup.

Worker backup is a key component to service planning. Participants often identify someone in their personal network who can provide the needed back up. This is similar to other situations where someone needs assistance, they call people who they know. The organization assists the participant through the contingency plan, but typically it is the participant who works out the day-to-day details.

What happens when the family gets tired of volunteer management and direct service? Or the family situation alters and they can no longer self direct?

Consumer Directed Services is a voluntary program and adjustments are possible at any time. Consumer Directed Services does not mean that a participant has to have family managed employees. Many participants have chosen to use Vendor agencies for their services, but like to retain the control of an individual budget. They contract with the Vendor directly. However, if the participant decides that Consumer Directed Service is not working for them, the account manager will help them look at different supports and services. This may include a move to traditional contracted services.

What regulations do we follow under Consumer Directed Services?

Consumer Directed Services follows the regulation He-M 525. This regulation is called Participant Managed and Directed Services.

What is paid for through Consumer Directed Services?

Purchases through Consumer Directed Services must align with the intent of the Medicaid Waiver. Goods and services may be purchased but must align with the supports and services outlined in the participant’s individual service agreement. Goods and services must be for the direct benefit for the participant and related to his/her disability.