How Consumer Directed Services works

From first phone call to first paycheck, here is the whole sequence — including the parts that are out of our hands, so you know what to expect.

Step 1 — Request an assessment

Contact the Department of Health and Senior Services and ask for a Home and Community Based Services assessment. The referral line is 866-835-3505. You, a family member, a friend, a hospital discharge planner or a physician can all make the referral.

We can talk you through this call before you make it, and tell you what information to have ready.

Step 2 — The in-home assessment

A DHSS assessor visits your home. They walk through your day: how you get out of bed, whether you can bathe safely, how meals happen, what you can and cannot reach. They are determining two things — whether you meet a nursing facility level of care, and which specific tasks you need help with.

Step 3 — Your care plan is authorized

DHSS produces a participant-centered care plan listing the authorized tasks and the time allotted for each. This is what your attendant may be paid to do. Tasks outside the plan are not billable, however helpful they might be.

See which tasks are commonly authorized →

Step 4 — Choose your vendor

You select which enrolled CDS vendor will administer your services. This is your choice and nobody else’s — not the assessor’s, not a hospital’s, not a family member’s. If you choose Communicare Elite, tell DHSS and tell us.

Step 5 — Identify and onboard your attendant

You name the person you want to hire. They complete our onboarding: employment paperwork, tax forms, background screening, and orientation on what the job involves and what the program requires. We handle the process; you make the hiring decision.

What attendants must complete →

Step 6 — Work begins, timesheets start

Your attendant works the schedule you set, within your authorized hours. Under RSMo 208.909, you and your attendant both sign timesheets and submit them to the vendor on a biweekly basis. Missouri also requires electronic visit verification for personal care services, so visits are recorded electronically as well.

How timesheets and pay work →

Step 7 — Ongoing responsibilities

RSMo 208.909 sets out what you are responsible for once services begin:

• Supervise your attendant and verify the wages paid to them.
• Prepare and submit dual-signed timesheets biweekly.
• Notify the department within ten days of any change in circumstances affecting your care plan or where you live.
• Report significant health changes that affect your ability to direct your care.
• Report service quality problems to the vendor first, and escalate to the department if they are not resolved.
• Provide the information the vendor needs to establish employer identification, and allow required quality assurance activities including annual home visits.

How long does all this take?

Honestly: it depends on DHSS scheduling and on how quickly your attendant completes their paperwork and screening. We will not quote you a number of days, because the part that usually takes longest is not ours to control. What we can do is start your attendant’s onboarding in parallel with the state process, so nothing waits in sequence that could have run alongside.