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Questions and Answers
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How to obtain DD services in Kansas
Person Centered Planning
Duties of Community Developmental Disability Organizations (CDDOs)
Licensing (Limited License)
Intermediate Care Facilities For Mental Retardation (ICF/MR)
Transition from School To Adult Services
How services are paid for
Case Management/Service Coordination
Self-Directed Care
Legal Rights in the Developmental Disabilities System
Where To Go For More Information
See Complete List of Questions
How to obtain DD Services in Kansas
2. Who can receive services which are funded through SRS/HCP?
3. Can a person with developmental disabilities be denied services by the CDDO?
4. What information is a person with developmental disabilities required to provide to a CDDO?
6. Is there an age limit on who must be served?
7. Has eligibility for the HCBS-MR waiver been lowered to birth?
8. Must the CDDO serve children?
9. Is there a right (entitlement) to services under Kansas law?
10. How long should someone who has applied for services have to wait?
11. What community services should be provided as a result of the contract?
12. Is there an age limit for eligibility for Family Support Services?
13. Who monitors the services and how are the services monitored?
Person-Centered Planning
14. Who determines a person's preferred lifestyle?
15. What does it mean to be responsive and how is responsiveness measured?
Duties of Community Developmental Disabilities Organizations (CDDOs)
16. Must CDDOs affiliate with anyone who wants to be an affiliate?
17. Can the CDDO charge for a service they provide? If so, how should the cost be arrived at?
20. Do entities who want to be DD Community Service Providers have to affiliate with CDDOs?
55. Does a CDDO have to provide a specific amount of hours of support based on a person's tier?
56. How is home county established for providing services by the CDDO?
57. How are CDDOs selected to provide services for a county?
Limited License
21. What is a limited license?
22. What HCBS MRDD Waiver services can be provided by the limited license holder?
23. How do I get paid as a limited license provider?
Intermediate Care Facilities for Mental Retardation (ICF/MRs)
27. How are ICF/MR services obtained?
Transition From School To Adult Services
25. What kind of housing options are available?
How Are Services Paid For?
34. In general, how are services paid for?
35. Do persons with developmental disabilities have to pay for some of their services, and if so, how much?
54. Does SRS reimburse CSPs based on severity of disability?
Case Management/Service Coordination
46. How does a person with developmental disabilities get case management?
47. What are the required qualifications of a Case Manager?
49. What kind of fee structure is being established for case management?
50. Can people pick their case management provider?
51. Can parents be case managers for their own children and be reimbursed?
Self-Directed Care
40. What is self-directed care?
41. Who must affiliate with the CDDO when self-directed care is selected?
58. What training is required of direct care staff?
Legal Rights in the Developmental Disabilities System
38. Can a person with developmental disabilities be terminated from service?
59. What are the legal rights of a person with developmental disabilities?
62. Where can all the documents referred to in these questions be obtained?
Where Do I Go For More Information?
63. Where do I go for more information?
1. How does a person with developmental disabilities or a family with a child that is developmentally disabled get services?
The first step is to go to the Community Developmental Disability Organization (CDDO) responsible for the area in which the person lives. Kansas law makes CDDOs the single point of entry to the DD service system. CDDOs carry out that responsibility directly, although they may subcontract this to another entity. Under SRS contract with the CDDOs, the single point of entry must determine who is eligible for developmental disabilities funding and help those seeking services to get needed services within available funds. If funds are available, the CDDO is responsible to serve or arrange to serve anyone who needs services in their designated service area.
There are twenty-eight CDDOs covering all 105 counties in Kansas.
2. Who can receive services which are funded through SRS/HCP?
Eligibility for access to services is determined by CDDO staff using the definitions in state law. Persons must meet the definition of either mental retardation or developmental disability listed there. Denial of eligibility may be appealed to the Office of Administrative Appeals. A copy of the eligibility criteria and appeal process may be obtained from your local CDDO.
Achieving eligibility for services does not mean the person is eligible for the various funding sources which pay for DD services. Because of requirements of different funding sources, additional eligibility thresholds may need to be met.
3. Can a person with developmental disabilities be denied services by the CDDO?
Perhaps. Under the current SRS contract with CDDOs, everyone who is eligible and needs services to successfully remain in the community must receive appropriate services. If the CDDO determines the eligible person does not need services or determines the person does not need the level of services they are seeking they may deny funding to pay for the requested services. If the CDDO denies services, the person or their family/guardian must be afforded an appeal process to the governing board of the CDDO. If the governing board of the CDDO continues to determine the person does not need the services requested, the person or their family/guardian can seek resolution of the issue through a dispute resolution process adopted by the Council of Community Members which is required to be established in each CDDO area.
The Council of Community Members is designated by the DD Reform Act to be the entity which establishes procedures to resolve disputes at the local level whether these are between persons with developmental disabilities or their guardian/family and the CDDO or any other community service provider. The dispute resolution procedures may include the use of an independent professional mediator who can attempt to impartially mediate the dispute. The Division of Health Care Policy/Community Supports & Services (HCP/CSS) can review unresolved disputes.
4. What information is a person with developmental disabilities required to provide to a CDDO?
In order to be considered for services, an eligibility determination must be made by the CDDO. Information concerning the type of disability, severity of the disability, and date of on-set of the disability will be required as well as personal financial information, guardian information and what services are being sought. The CDDO must also collect information concerning the person's medical condition, how well he or she performs activities of daily living such as dressing, eating, etc., and whether the person has behavioral support needs. If the person seeking services is under the age of five, the assessment may be less detailed. Any applicant for services who refuses to release information to the CDDO should be aware they may be determined not eligible for funding of services by DD. Individual information is updated at least annually and is always confidential.
5. Who must be served?
The CDDO must provide or arrange to provide community services to EVERYONE it determines meets the definition of developmental disability and who needs services to successfully remain in the community, within available funds. If funds are not available at the time of the request, the CDDO can place the individual on the Funding Service Access List. This includes children and adults. Successfully remaining in the community can be thought of as a person regularly participating in activities of the community in which he or she lives, and which are typical for persons of his or her age. If natural supports are not able to overcome barriers to enable participation, the person likely needs services to successfully remain in the community
6. Is there an age limit on who must be served?
No. All children and adults with developmental disabilities who need community services as discussed in question number five must receive them.
7. Has eligibility for the HCBS-MR waiver been lowered to birth?
No. Eligibility for the HCBS-MR waiver is limited to persons aged five and above. However, the HCBS-MR waiver is only one of several available funding sources and a person who meets eligibility for services need not also be eligible for the waiver in order to get services.
8. Must the CDDO serve children?
Yes. The CDDO must serve or arrange to serve, within their allocation, all families and children who are eligible and need services. Children's services include a wide array of supports including, but not limited to, such activities as: in-home supports, respite care, residential services, home modifications, and van lifts. Children's services do not include such activities as: educationally related services, medical or therapeutic care, typical child care, or family income.
9. Is there a right (entitlement) to services under Kansas law?
No. The Developmental Disability Reform Act specifically states there is not an entitlement to services. Entitlements generally provide, by law, a specific amount of support to everyone who qualifies. It is by contract that the CDDOs must serve or arrange to serve everyone who needs services and stay within their allocation. If funds are not available, persons will be placed on the CDDO Funding Service Access List.
10. How long should someone who has applied for services have to wait?
There is no single answer to this question that will satisfactorily cover each person's specific situation. If the eligible person or family seeking services is in a crisis situation, such as the sudden loss of natural (family) support, the CDDO must respond immediately giving top priority toward achieving whatever level of support needed to help the person safely remain a part of their community. If there is no crisis, the CDDO may need a period of time to arrange for the needed services or for funding to become available, whether the services are provided directly by the CDDO or by a provider other than the CDDO.
When someone who has applied for services is informed they are eligible to receive services funded by SRS/HCP they should be told when they can expect services to begin. If they are not, they should ask for a starting date. A system wide expectation is that no one should have to wait longer than sixty (60) days for services to begin, after MRDD eligibility has been determined and funds are available. Even if the desired/needed service is not immediately available, some level of support should be provided if requested.
11. What community services should be provided as a result of the contract?
Services funded through HCP/CSS fall into the following five general descriptions:
Adult Day Services - These are services or supports provided away from the person's home, typically during working hours, to increase the person's independence, integration, inclusion and personal accomplishment. To the extent possible and desired by the person and guardian/family, typical work or job related activities are addressed during this time.
Adult Residential Services - These services are provided in the residence of persons who are not living in the family home and are designed to assist individuals to live successfully in a community setting they have chosen and can afford.
Family Support Services - These services are designed to defray the cost and/or stress of supporting a family member with a developmental disability who is living in the family home and may include, but is not limited to: direct subsidy, respite care, in-home supports, and assistance in purchasing durable equipment and supplies.
Children's Residential Services - These services are designed for children to avoid placement in an institution or other congregate residential setting when they cannot remain with their natural families. These services must occur outside the child's family home in a setting licensed by Kansas Department of Health and Environment or approved by SRS/HCP. No more than two children, not related by blood or marriage to the surrogate family, can be living in a residential service setting for children.
Case Management - Case management is fully described later in this paper.
12. Is there an age limit for eligibility for Family Support Services?
Yes - If the individual is receiving funds from the HCBS MRDD Waiver, then the minimum age requirement is five.
If the individual is receiving other CDDO funds, there is no minimum age requirement.
13. Who monitors the services and how are the services monitored?
All CDDOs are required to ensure the services being provided by the CDDO or other community service providers (CSPs) are of good quality, meet individual needs, and are responsive to the preferred lifestyle of the person with developmental disabilities. The CDDO must provide for on-site monitoring of these requirements by a local Quality Assurance (QA) committee made up of persons served, their families, guardians, interested citizens, and providers.
Also, SRS has twelve (12) Quality Enhancement Coordinators for developmental disabilities that visit service sites on an on-going basis to determine that individuals are healthy, safe and life preferences are being responded to; and to ensure that CDDO QA mechanisms are in place and implemented. The Quality Enhancement Coordinators also monitor licensing requirements to determine if the CDDO's QA monitoring ensures that all providers in the area comply with licensing regulations.
14. Who determines a person's preferred lifestyle?
The preferred lifestyle of the person is documented through a person centered support plan which is developed by a CSP in consultation with, and approved in writing by, the person and the person's legal guardian, if one has been appointed. The person and their guardian may involve anyone who knows and cares about the person to assist in describing the person's preferred lifestyle, and supports or services needed to help achieve it.
The description of the person's preferred lifestyle should include:
1. where the person wants to live;
2. with whom the person wants to live;
3. what work or other valued activity the person wants to do;
4. with whom the person wants to socialize; and,
5. in what social, leisure, religious or other activities the person wants to participate.
back to Person Centered Planning List
15. What does it mean to be responsive and how is responsiveness measured?
This question refers to the regulatory requirement that service agencies be responsive to the preferred lifestyle of a person with developmental disabilities. Generally, services will be responsive if they are provided in a manner which contributes to the continuous movement towards achievement of the preferred lifestyle.
Currently, responsiveness is measured in two ways. First, regulation requires the provider to measure its responsiveness to each person's preferred lifestyle, and to ensure all services provided by the CDDO or any affiliate are responsive to the person centered plan which documents the person's preferred lifestyle.
Second, the DD Quality Enhancement Coordinators use the Kansas Lifestyle Outcomes II(KLO II), a tool designed to determine from persons and their guardian/family whether or not their desired lifestyle is being met, and to validate whether health and safety and preferred lifestyle outcomes are being achieved. The KLO measures the following:
I. Opportunities of Choice To Support and Increase Independence, Productivity, Integration and Inclusion;
II. Individual Rights and Responsibilities;
III. Personal Health and Safety;
IV. Use of Psychotropic Medications or Restrictive Practices.
back to Person Centered Planning List
16. Must CDDOs affiliate with anyone who wants to be an affiliate?
No. The general rule is the consumer can choose to get a service which is defined and purchased by HCP/CSS from any licensed CSP or limited license holder which means the CDDO must affiliate under that circumstance. There are situations in which a CDDO may refuse to affiliate with a provider, such as a failure to meet the CDDO area's policies and procedures. Any other circumstance may need to be assessed to see that consumer choice is not being limited by the CDDO refusing to enter into an affiliation.
17. Can the CDDO charge for a service they provide? If so, how should the cost be arrived at?
Yes. The CDDO may charge for the cost of providing a service, whether administrative, case management, or program, as long as the service is unfunded or not reimbursable through a third party. Generally, the charge should reflect actual costs arrived at through generally accepted accounting principles.
18. Must the CDDO affiliate and purchase services on behalf of a consumer outside its designated catchment area if the consumer requests it?
No
19. Are CDDOs required to contract or affiliate with agencies who provide specialized services which are not billable to Developmental Disabilities?
No
20. Do entities who want to be DD Community Service Providers have to affiliate with CDDOs?
Yes
55. Does a CDDO have to provide a specific amount of hours of support based on a person's tier?
No
56. How is home county established for providing services by the CDDO?
Pursuant to K.A.R. 30-64-10, the following list shall be utilized to establish a "home county" for persons. The list is in priority order:
A.) the county of residence of a family member of the person with a developmental disability;
B.) then the county of residence of the person's guardian; or,
C.) the county in which the person is living.
57. How are CDDOs selected to provide services for a county?
A CDDO is established by County Commissioners deciding to fund services for persons with mental retardation and making those funds available to a not-for-profit agency to provide services. By that action, the CDDO has been designated for that county as long as the Secretary of SRS approves.
21. What is a limited license?
A limited license option was developed in September of 1999 for persons, primarily family members, who wanted to obtain a "user friendly" license to provide services to two or fewer individuals (18 years or older). To obtain a limited license, one must:
A.) Contact HCP/CSS for an application; and,
B.) Submit an application to local Quality Enhancement Coordinator along with policies and procedures which demonstrate how the provider will meet the needs of person(s) served and comply with relevant licensing regulations.
This option is ideal for families who do not wish to use "traditional services."
22. What HCBS MRDD Waiver services can be provided by the limited license holder?
A.) Adult Day Services
B.) Adult Residential Services
All HCBS services definitions still apply and need to be followed (such as adults living in the family home are not eligible for residential services).
23. How do I get paid as a limited license provider?
You must obtain a license from SRS, an affiliation agreement with the CDDO in your area, and a method for billing (either apply for a provider number from Blue Cross/Blue Shield or choose a billing agent to bill on your behalf).
26. What is an ICF/MR?
An ICF/MR is an Intermediate Care Facility for persons with Mental Retardation or related conditions which provides twenty-four hour supervision and training and is regulated through requirements established by Medicaid. The Medicaid definition of conditions related to mental retardation means a severe chronic disability which requires treatment or services similar to those for persons with mental retardation. The two State Mental Retardation Hospitals are certified as ICFs/MR. In addition, there are 33 other privately operated ICFs/MR of various sizes throughout the state. The eligibility requirements for placement in an ICF/MR also establish eligibility for the HCBS-MR waiver.
27. How are ICF/MR services obtained?
Application must be made through the CDDO responsible for the area in which the person with developmental disabilities lives. The CDDO is required to complete a screening on every applicant for ICF/MR services to determine eligibility and assure that admission to an ICF/MR is consistent with the person's preferred lifestyle.
28. Is a person's choice a protected choice under the law if they are eligible for, and choose to reside in, a small ICF/MR?
A person's choice is protected under the DD Reform Act as well as the Medicaid "freedom of choice" requirement which allows a person to choose between ICF/MR (large or small) services and services funded by the HCBS-MR waiver if they are eligible and the choice is consistent with their preferred lifestyle. This does not mean there is an entitlement to services in an ICF/MR under either state or federal requirements, only that a choice is available between HCBS-MR funded services and ICFs/MR services.
29. Can a person apply directly to the ICF/MR and begin receiving services without also applying to the single point of entry?
If the services are to be paid for under the ICF/MR reimbursement regulations administered through HCP, they must first be screened by the single point of entry, the CDDO, and meet the eligibility requirements. If the person is a private pay or has other sources to buy the service and if they or the ICF/MR are not concerned with whether or not the services will be paid for by state and federal dollars, there is no enforcement mechanism which will make them apply through the single point of entry.
30. Do the requirements which apply to screening of new applicants for ICF/MR services apply to persons already living there?
From the point of view of offering "choice", yes. The CDDO is required to annually inform the person and the family/guardian regarding all other available service options and to assist them in obtaining these options should they choose to move to better achieve their preferred lifestyle.
31. Do the ICF/MR gatekeeping activities carried out by the CDDOs apply to persons living in or applying to live in State Mental Retardation Hospitals (SMRHs)?
Yes.
32. If a person with developmental disabilities has a job and job coach when they graduate from a secondary school, can they have this specific situation funded through SRS/HCP?
Yes, so long as the job coach can and is willing to meet the expectations for employment or licensure for staff working in the DD system and the person has been determined by the responsible CDDO to meet the eligibility requirements for funding by Developmental Disabilities, and funds are available to pay for this service. However, this can only be accomplished effectively if the responsible CDDO has been involved in transition planning so services can be arranged prior to graduation.
back to School Transition list
33. Should the CDDO or designated Community Service Provider participate in transition planning for persons with developmental disabilities who are graduating from school?
If parents believe their son or daughter will probably need services funded through HCP/CSS, they should take the following steps:
1. Request the CDDO responsible for their area to determine whether or not their child meets the eligibility requirements for funding by Developmental Disabilities;
2. If their child is determined to meet the eligibility requirements, ask for assistance in finding a case manager who can participate in transition planning sessions with the school; and
3. Request the school notify and invite the case manager to all transition planning sessions which occur at age sixteen years or older.
If the CDDO and/or the case manager refuses to perform the above functions, send a written description of the situation to:
Kansas Department of Social & Rehabilitation Services
Health Care Policy
915 SW Harrison Street
Docking State Office Building--10th Floor
Topeka, KS 66612
ATTENTION: Community Supports & Services
If the school refuses to meet the request to have the case manager present, send a written description of the situation to:
Kansas Department of Education
Student Support Services
120 SE 10th
Topeka, KS 66612
ATTENTION: Team Leader
back to School Transition list
24. Can a person with a developmental disability and/or the person's guardian choose their own provider?
Yes, a person may choose any Community Service Provider (CSP) or limited license provider that is willing to affiliate with a CDDO and is in compliance with all applicable licensing requirements for the services being provided.
25. What kind of housing options are available?
The CDDO is required to work in partnership with the individual requesting the service (and/or guardian) and the person's support network to identify and access housing options. These options may be limited by the availability of community housing and/or the individual's financial resources. The choice must be consistent with the individual's preferred lifestyle or the next best option as identified in the person centered plan.
back to School Transition list
34. In general, how are services paid for?
Services are paid for from many different sources generally based on tiered rates which provide a range of reimbursement based on averaged severity of disability. Some services are paid only with State dollars appropriated by the Kansas Legislature, others with a combination of state and federal dollars, some may be funded by County mill levy, and some may have to be funded by the individuals themselves. Depending on how significant a person's disability is and what funding sources a person who is seeking services is eligible for, the agency providing the service will try to meet the person's needs using as few personal, local, and state dollars as they can.
back to how services are paid list
35. Do persons with developmental disabilities have to pay for some of their services, and if so, how much?
SRS/HCP does not participate in the costs of room and board or transportation provided through community providers. Adults who use these services are responsible for their costs, generally paid for with Supplemental Security Income (SSI) or Social Security Disability Income (SSDI), although CSPs sometimes supplement the cost of these services with other state or local funds.
If the person with developmental disabilities has income which exceeds guidelines, but is eligible for Medicaid funded services, he or she will have to contribute toward the cost of his or her services in order to meet the Medicaid eligibility requirements. Parents of children with developmental disabilities may also be required to pay for some services on a reasonable fee basis. When a person applies to the CDDO or CSP for services, ask whether there will be fees charged and, if so, how much.
back to how services are paid list
54. Does SRS reimburse CSPs based on severity of disability?
Yes. The reimbursement system established by HCP/CSS is based on tiers which assign an averaged amount of funds per tier to differing levels of severity of disability. The CSP is expected to use the tiered average to meet the needs of persons on an individualized basis so long as the total of all dollars allocated covers the expected expenditures for all persons.
back to how services are paid list
45. What is case management?
As outlined in Kansas Administrative Regulation (K.A.R.) 30-64-24, case management "shall assist the person and the person's support network to identify, select, obtain, coordinate, and use both paid services and natural supports as may be available to enhance the person's independence, integration, and productivity consistent with the person's capabilities and preferences as outlined in the person's person-centered support plan".
Case Management shall include the following:
1.) Assessment
2.) Support Planning
3.) Support Coordination
4.) Advocacy
5.) Assisting Transition and Portability
46. How does a person with developmental disabilities get case management?
To get case management, tell the CDDO you need case management. A person with developmental disabilities or a family with a child with developmental disabilities may request case management from any qualified person or organization and the CDDO must help arrange for the chosen case manager to provide the service. The provider of case management is required to affiliate with the CDDO.
If the person with developmental disabilities, whether adult or child, has a Kansas Medicaid card, Medicaid will pay for a portion of the costs for case management. If the person does not have a Medicaid card, due to federal requirements, he/she will be billed and may have to pay a reasonable fee for the service. See your CDDO for its current fee schedule.
47. What are the required qualifications of a Case Manager?
Current K.A.R. 30-64-24 regulations specify case managers must meet the following minimum requirements:
1. A minimum of six months experience in the field of developmental disabilities; and
2. A bachelor's degree or additional experience in the field which may be substituted for the degree at the rate of six months of experience for each semester of college education;
3. Complete a training program that:
A. is developed by the provider of case management services;
B. is described to the CDDO Council of Community Members and approved by the CDDO;
C. specifies:
the content of training;
the manner in which and frequency with which training is delivered;
(iii) the way in which competency will be determined and demonstrated to the CDDO in the event of a dispute;
D. includes, but is not limited to, topics:
regarding the various paid services and natural supports that enhance the person's independence, integration and productivity, consistent with the person's person-centered support plan;
regarding health and safety, including behavior management practices, abuse, neglect and exploitation prevention and response, and individual rights and responsibilities; and,
specified by the commissioner; and
4. Carry a caseload of an average of 25 persons.
The case manager may be a qualified individual who affiliates with the CDDO, be employed by the CDDO, or be employed by an agency affiliated with the CDDO.
48. Does a person with developmental disabilities have to have a case manager if they don't want one?
If the person or his or her guardian/family does not hold a CSP or CDDO responsible for uniquely case management activities, and the CSP or CDDO is able to provide the preferred lifestyle within available appropriations and assessment of risk while investing minimal time performing the case management activities, case management can be declined.
49. What kind of fee structure is being established for case management?
Case management is an optional service in the State Medicaid Plan which is available to all persons with developmental disabilities who are Medicaid eligible. The current reimbursement for case management is based on a "certified match" at $40 per hour. Under certified match, local funds are pledged by the CDDOs to match Medicaid dollars because state match dollars are not available. Case management for persons with developmental disabilities who are not Medicaid eligible can be provided based on a private pay fee schedule which meets Medicaid requirements.
50. Can people pick their case management provider?
Yes, as long as the provider of case management that they want, whether an individual or an agency employing individuals, meets the requirements to be a case manager, is willing to provide case management within HCP/CSS regulations, and agrees to affiliate with a CDDO.
51. Can parents be case managers for their own children and be reimbursed?
If Medicaid will be involved in payment, no. Medicaid does not allow payments to parents of minor children. If the child is an adult, all case management requirements apply including case load levels. If Medicaid will not be billed, the parent can substitute for agency case management as a "natural support" to avoid charges under the fee schedule established by the agency providing case management.
52. What should a person with developmental disabilities do if his or her case manager does not meet his or her needs?
1. First, talk with the case manager so they know what the situation is.
2. If the case manager does not change their behavior, talk with the case manager's supervisor to try to improve the situation.
3. If that is not effective, the service agency's internal grievance procedure should be followed.
The DD Reform Act gives each person with developmental disabilities the right to request another case manager or, if necessary, to change the agency which is providing case management.
53. Is a case manager required to make weekly, monthly, quarterly, semi-annually, or annual contacts with a person who is being served.
No. The original HCBS-MR waiver contained a requirement that a monthly visitation occur by a case manager when a person was enrolled in services paid for by the waiver. With the passage of the DD Reform Act, that requirement was eliminated in the latest HCBS-MR waiver. There is still in force an HCBS-MR requirement that a yearly contact occur, not necessarily by a case manager, to assess continued eligibility and appropriateness for the HCBS-MR waiver. The frequency of contact will be determined by the individual's need for the service and identified during the person centered planning process.
40. What is self-directed care?
Individuals receiving in-home supports have the option of self-directing their care. If the individual is not capable of providing self-direction, his/her parent or guardian can act on the individual's behalf, and agree to take responsibility for some or all of the following activities:
a.) Recruit and select in-home support staff;
b.) Refer in-home support staff to appropriate agency for payroll registration;
c.) Pre-screen applicants;
d.) Perform direct supervision of in-home support staff;
e.) Assign and schedule in-home support staff;
f.) Complete periodic evaluations of in-home support staff;
g.) Dismiss in-home support staff and provide back-up when necessary;
h.) Maintain records of work performed and time sheets;
i.) Communicate necessary information to payroll agent.
Under these conditions, the person or his/her parent/guardian is the employer of record and must meet all legal tax and insurance requirements. Additional self-direction requirements are detailed at KAR 30-63-10.
back to Self Directed Care list
41. Who must affiliate with the CDDO when self-directed care is selected?
The answer to this depends upon how many parties are active in the provision of services to the recipient. If, with the family's support, a payroll agent can clearly demonstrate they are acting on behalf of the individual or designee, then the payroll agent is required to affiliate with the CDDO and must meet all legal tax and insurance requirements. If the family is self-directing and billing Blue Cross/Blue Shield directly, they must affiliate with the CDDO.
back to Self Directed Care list
42. Why must taxes, unemployment, and workers compensation be paid for attendants serving in my home?
All employers are, by law, responsible for withholding taxes on wages and unemployment insurance. It has been determined by the federal Internal Revenue Service and the Kansas Department of Human Resources that, when the person or parent/guardian is self-directing, the person or parent/guardian is the employer. Therefore, they must work with the CDDO to agree on an acceptable way to meet these employer obligations. This requirement is a protection for the person or family because, if required withholding is not paid, the person or family may be held responsible for back payments and penalties.
back to Self Directed Care list
43. Is there a liability for overtime if an individual or family who is self-directing employs staff part-time who work for other agencies serving persons with developmental disabilities?
Possibly. It is always a good idea to have a written agreement or contract with whomever the family employs which sets out the conditions of employment including the Department of Labor requirements regarding hours of employment. Each situation is specific and should be reviewed with the appropriate authority to protect the person and family from violating labor laws.
44. If a family or individual has chosen self-direction, are they required by law or regulation to do background checks on the people they hire?
Yes, HCP/CDDO policy requires employment, criminal, and registry checks on all employees.
back to Self Directed Care list
58. What training is required of direct care staff?
Each provider must provide training which ensures staff are competent to meet the needs of the persons they serve. Sufficient numbers of staff trained in first aid and CPR must be available. Direct care staff must have sufficient training before they are left alone to support persons with developmental disabilities, but it is not required that they be completely trained when that occurs. They must know how to identify and report ANE, understand individual rights, and understand how to meet the needs and life goals of the person(s) they support. This includes such issues as person centered support planning, medication/health issues, effective positive behavioral supports, etc.
For people who self-direct their care, K.A.R. 30-63-10 (a)(4)(G)states the following training requirement: "Any person providing services receives at least 15 hours of prescribed training, or the person directing and controlling the services has provided written certification to the CDDO that sufficient training to meet the person's needs has been provided." In addition, they must be able to identify and report ANE.
back to Self Directed Care list
36. What are the appeal rights for a person with developmental disabilities and who does a person appeal to?
If a person with developmental disabilities or their guardian/parent are dissatisfied with any action or inaction by a CSP, they can appeal.
1. Whenever possible, it is best to try to resolve the issue at the local level by following the CSP's internal grievance procedures.
2. If that doesn't work, formally notify the CDDO and request information about the local dispute resolution process, including options for mediation and/or appeals beyond the CDDO.
37. What if the person or guardian/family believes the provider is retaliating as a result of a complaint?
There are a number of different ways this may be addressed.
1. First, persons with developmental disabilities may contact the CDDO and request services from a different provider.
2. Second, if the person or guardian/family wishes to remain with the provider, and the CDDO is not the provider, the CDDO should be notified immediately if it appears retaliation is occurring.
3. Third, if the CDDO does not satisfactorily address the issue or the CDDO is the service provider, the person may access the local dispute resolution process adopted by the Council of Community members.
38. Can a person with developmental disabilities be terminated from service?
A person cannot be terminated from SRS/CDDO Contract-funded services unless at least one of the following occurs:
1. The Secretary of SRS determines a person to be inappropriate for community services based on a finding that the person presents a clear and present danger to self or others in the community. The Secretary's determination needs to be made and shared with the CDDO within 10 working days of receipt of the letter of the Director of CSS.
Criteria to address in the letter to the Secretary requesting service termination:
• Document the nature of the risks ti the person or the community.
• Explain what supports are needed for the person.
• Explain why those supports are not available or reasonable.
• Document the events that led to the CDDO's decision that the person needs to be terminated from services.
• Describe what supports have been used and why they were not successful.
2. A person, who has available private funding, fails to abide by a written service agreement which specifies payment of any amount with private funding. All service agreements should contain a statement that failure to abide by the written service agreement may result in termination of services.
3. A person refuses to apply for Medicaid benefits.
4. Funding for the person is discontinued.
5. The person formally exercises his/her right to withdraw from services.
The CDDO will review all requests for service termination.
39. Can a person with developmental disabilities and/or the person's guardian change service providers or move to another area of the state?
Yes. Persons with developmental disabilities and/or their guardian or family have the right to move and still receive services. This means, with the exception of State Aid and CDDO Administration funding, all funds identified in the Funding and Reimbursement section of the SRS/CDDO Contract must be portable, and the CDDO must provide continuity of service for persons who choose to continue services and who move from one CDDO to another CDDO. Funds must be portable except when a person no longer needs services or voluntarily withdraws from services with no immediate foreseeable need for services.
59. What are the legal rights of a person with developmental disabilities?
Each person is guaranteed the same rights afforded to every citizen of Kansas. Some, but not all, of these rights are specifically mentioned in K.A.R. 30-63-22 summarized below:
1. Being free from abuse, neglect or exploitation;
2. Having control over personal finances;
3. Receiving, purchasing, and using personal property;
4. Participating in meaningful decision making;
5. Privacy;
6. Practicing the religion or faith of your choice;
7. Being free of excessive medication or restrictive procedures without consent;
8. Being paid for work; and,
9. Being treated with dignity and respect.
No right may be restricted unless it could result in imminent and significant danger to a person or is limited by court order.
60. Who should be contacted if the legal rights of a person with developmental disabilities are violated?
Case managers are responsible to advocate on behalf of persons with developmental disabilities and should be made aware of the situation. Also, immediately notify the CDDO in the area the person resides and seek their assistance in resolving the concern. If the concern remains, Kansas Advocacy and Protective Services (KAPS) assists persons with disabilities to exercise their rights and should be notified. KAPS can be reached by calling (785) 232-0889 or 1-800-432-8276 (Voice/TDD).
If these efforts are not satisfactory, contact the SRS/HCP Quality Enhancement Coordinator for the area (contact information for the QE Coordinators can be obtained at HCP/CSS at #(785)296-6140).
61. What action should be taken if it appears a person with developmental disabilities is being mistreated or exploited?
Anyone who suspects that abuse, neglect, or exploitation is or has taken place should immediately report the incident to the Adult Abuse/Neglect Hotline available twenty-four (24) hours a day at 1-800-922-5330.
62. Where can all the documents referred to in these questions be obtained?
All CDDOs can provide copies of the DD Reform Act, the regulations concerning health, safety, and DD Reform, and information contained in the CDDO/SRS contract. There may be a nominal charge for costs of duplication.
63. Where do I go for more information?
You can contact your local Community Developmental Disability Organization (CDDO)
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