6300, Consumer Directed Services

6310 Description

Revision 26-2; Effective June 1, 2026

The Consumer Directed Services (CDS) option gives the person more control over their personal attendant services by making them the attendant's employer. The person hires and manages the attendant(s) and selects a Financial Management Services Agency (FMSA) to do the employee's payroll and federal and state tax payments. The person also sets the wages and benefits for their attendant. Review Appendix XXXI, It's Your Choice: Deciding How to Manage Your Personal Attendant Services, for a comparison of available service delivery options.

Staff will encounter terms that are specific to the CDS option, including the following.

• Agency Option (AO) — A service delivery option where the provider manages all aspects of service delivery with input from the person and caseworker.
• Annual service plan (ASP) — A 12-month plan that identifies:
  • the person's specific needs;
  • the annual cost of meeting those needs; and
  • how those needs will be met by the person's employees and the FMSA.

Review 6332.2, Calculation of the Annual Service Plan. Separate from service plan or service planning, the term ASP is used to determine the amount of service a person will receive.

• Designated representative (DR) — A willing adult appointed by the person to help with or perform the person's required responsibilities to the extent approved by the person. This person is not an employee or the legally authorized representative (LAR) and is not paid for their services. The DR is not the legally recognized employer.
• Employee — Someone employed by the person through a service agreement to deliver program services. This person is paid an hourly wage for those services.
• Employer — The person or the LAR who chooses to participate in the CDS option.
• Financial management services (FMS) — Services delivered by the FMSA to the person or LAR, such as orientation, training, support, help with and approval of budgets, and processing payroll and payables on behalf of the employer.
• Financial Management Services Agency (FMSA) — An agency contracted by the Texas Health and Human Services Commission (HHSC) to provide financial management to support the delivery of services to people who receive CDS.
• Legally authorized representative (LAR) — A person required by law to act on behalf of a person who is:
  • A court-appointed guardian for adults.
  • A parent, adopted parent, stepparent, foster parent or Child Protective Services (CPS) for people younger than 18. If parental rights have been revoked, the court-appointed guardian must be the LAR.
  • The LAR and any mention of them by the person applies to the LAR.
• Service planning team — A term in CDS rules that refers to the interdisciplinary team (IDT). An IDT is a designated group of people who meet when the need arises to discuss service delivery issues. Although other people may be asked to participate when needed, the IDT must include:
  • the person, the person's representative or both, and if there is a LAR, they would be a required participant;
  • a provider representative; and
  • an HHSC representative.
• Support consultation — An optional service available to people who receive CDS that provides a higher level of assistance and training than what is available through FMS. Support consultation helps the person meet the employer responsibilities of the CDS option.

6311 Risks and Advantages of the CDS Option

Revision 25-2; Effective March 31, 2025

Before the person can make an informed choice about service delivery options, make sure they understand the risks and advantages of the Consumer Directed Services (CDS) option.

6311.1 Advantages of CDS Service Delivery

Revision 25-2; Effective March 31, 2025

When using the Consumer Directed Services (CDS) option, the person:

• has control over who provides services and when services are delivered;
• can offer the attendant(s) benefits such as bonuses, vacation pay, sick pay and insurance;
• can control the rate of pay for attendant(s) within the spending limits of the unit rate for the service;
• can hire backup attendants, if necessary;
• can train and supervise the attendant(s);
• can choose a Financial Management Services Agency that pays attendants and file reports with governmental agencies on their behalf;
• may appoint someone to help with employer responsibilities or to perform employer responsibilities for them; and
• may get more training and help from a CDS support advisor to be a successful employer in the CDS option.

6311.2 Potential Risks Associated with CDS

Revision 25-3; Effective June 1, 2025

Some of the risks associated with the Consumer Directed Services (CDS) option include the person:

• controls hiring, training, managing and firing employees. The attendants are not the employees of the:
  • Financial Management Services Agency (FMSA);
  • Texas Health and Human Services Commission (HHSC);
  • any state or federal agency; or
  • other contracted provider; and
• is solely responsible and liable for their own negligent acts or omissions, as well as those of the employee(s), service provider(s) and the designated representative;
• is responsible for handling all conflicts with the attendant and the FMSA or HHSC caseworker is not involved;
• is required to keep certain paperwork, as identified by the FMSA and must safely store the documentation for the length of time specified by the FMSA;
• is ultimately responsible for payroll taxes owed to the Internal Revenue Service and the Texas Workforce Commission and is liable for any taxes the FMSA fails to pay; and
• is responsible for creating a backup plan for services to be delivered if the attendant does not show up for work. There is no home health agency to provide backup services.

6320 Roles and Responsibilities

Revision 25-3; Effective June 1, 2025

Under the Consumer Directed Services option, the roles and responsibilities of the person, caseworker and provider differ from other service delivery options.

6321 Personal Responsibilities

Revision 25-5; Effective Dec. 1, 2025

To participate in the CDS option, the person must be:

• capable of performing all required employer responsibilities upon completion of training and transition planning provided by the FMSA, or
• able to appoint a designated representative (DR) to help with the responsibilities of being an employer in the CDS option.

Required Employer Responsibilities

An employer is responsible for:

• service planning with the person's service planning team;
• budgeting allocated program funds in the person's service plan to deliver services through the CDS option;
• determining compensation for service providers within the service rate and spending limits established by HHSC;
• recruiting, screening, hiring and training qualified service providers;
• managing and terminating service providers; and
• planning and arranging for backup services.

An employer or DR must hire or retain service providers per qualifications and other requirements of the person's program.

People receiving services in the CDS option also have the following responsibilities:

• reviewing, approving and signing timesheets;
• submitting employee timesheets, receipts, invoices and employment forms to the FMSA in a timely manner;
• informing the FMSA of all employees the person hires, fires or otherwise terminates;
• resolving employee concerns and complaints;
• maintaining a personnel file on each employee; and
• finding appropriate out-of-home respite providers and negotiating a payment rate.

Designated Representative

26 Texas Administrative Code (TAC) Section 264.205, Employer Appointment of a Designated Representative

26 TAC Section 264.109, Enrollment in the CDS Option

The DR signs an agreement to perform employer functions for the CDS person. The person remains the employer of record and assumes liability. The FMSA can help the person complete the forms for designation of the DR. The DR may not be hired as the personal attendant or be paid for their duties.

6322 Caseworker Responsibilities

Revision 25-3; Effective June 1, 2025

The caseworker has certain responsibilities about Consumer Directed Services (CDS), which include:

• explaining and offering the CDS option;
• reviewing the self-assessment tool Form 1582, Consumer Directed Services Responsibilities with the person to help determine if the CDS option is right for them;
• assessing service needs;
• coordinating development of the service authorization;
• presenting the list of Financial Management Services Agencies (FMSAs) participating in the area;
• informing the person of their rights, responsibilities and resources;
• redeveloping service authorizations when the person's needs change;
• reviewing each quarterly status report received from the FMSA;
• contacting the FMSA or person as appropriate if there are issues such as 50 percent of funds authorized on the annual service plan are already expended on the first quarterly report;
• being a resource if the person has health, safety or exploitation concerns; and
• monitoring and reviewing the person's satisfaction with the services provided by the FMSA.

6322.1 Casework Procedures

Revision 17-1; Effective March 15, 2017

Consumer Directed Services is not a service; it is a service delivery option. All financial and non-financial eligibility criteria must be met in order to receive personal attendant services. In addition to the procedures specified in the following sections, customary casework procedures apply.

6322.2 Presentation of the CDS Option

Revision 25-5; Effective Dec. 1, 2025

The caseworker is responsible for presenting information about the CDS option to the person. To help the person make their decision, the caseworker must carefully present both the advantages and risks associated with the CDS option.

Caseworkers must follow 26 Texas Administrative Code Section 264.109, Enrollment in the CDS Option, when presenting the CDS option to a person.

The caseworker thoroughly explains all information on Form 1581, Consumer Directed Services Option Overview, to make sure the person understands the differences between the CDS and agency options.

6323 FMSA Responsibilities

Revision 25-5; Effective Dec. 1, 2025

26 Texas Administrative Code (TAC) Section 264.309, Financial Management Services and Employer-Agent Responsibilities

26 TAC Section 264.317, CDSA Reports

6330 Personal Decision

Revision 25-5; Effective Dec. 1, 2025

Caseworkers must follow 26 Texas Administrative Code Section 264.109(c)-(e), Enrollment in the CDS Option, to enroll an applicant or recipient into the CDS option using a Community Care Services Eligibility (CCSE) program. 26 Texas Administrative Code Chapter 264, Consumer Directed Services Option.

To enroll in the CDS option, the applicant or recipient must complete the following forms:

• Form 1582, Consumer Directed Services Responsibilities, including Page 4, Consumer Self-Assessment;
• Form 1583, Employee Qualification Requirements;
• Form 1584, Consumer Participation Choice;
• Form 1586, Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services (CDS) Option, if the service is available in the applicant's or recipient's program; and
• Form 1740, Service Backup Plan. Form 1740 is required when the service planning team determines that a service is critical to the health and safety of the person. This includes people with priority status.

Note: The caseworker must review the service backup plan when services are initiated and annually thereafter. If the backup plan requires no revisions, the caseworker may initial and date the current backup plan. An applicant or recipient who cannot complete the self-assessment portion of Form 1582 must appoint a designated representative (DR) to participate in the CDS option.

Help the applicant or recipient complete the self-assessment. The applicant or recipient must document their ability to meet the following criteria needed to become a CDS employer:

• locate attendants for hire in the community;
• train and supervise attendants to perform each task on the service plan;
• locate and arrange for backup staff and out-of-home respite services, if needed;
• handle conflict with attendants; and
• be willing to accept more training or help with employer responsibilities, if needed.

If the applicant or recipient is not able to meet all the CDS employer criteria, they must appoint a DR to assist with employer responsibilities. Review 6321, Applicant or Recipient Responsibilities, for more information on the requirements of hiring a DR, if needed.

Present Form 1586 and Form 1583 if the applicant or recipient wants to proceed and meets the criteria, or has appointed a DR.

Make sure the person not interested in CDS understand that this option is available at any time. They must call the caseworker to request the CDS option.

6331 FMSA

Revision 25-3; Effective June 1, 2025

The Texas Health and Human Services Commission (HHSC) caseworker or the person may go to the PHC Consumers page on the HHSC website for a choice list of Financial Management Services Agencies (FMSA). The list allows people to search for FMSAs by county.

On the top of the PHC Consumers page is a drop-down list of Texas counties. After selecting the person’s county of residence, click the button labeled Search. This will create a list of FMSAs serving the selected county. The FMSA’s address does not have to be in the person’s county of residence to be able to serve the person. If the FMSA is listed in the program and county list, the person may select the agency as their FMSA. This list can be printed and provided to people choosing an FMSA.

FMSAs are not required to provide services to all referred people. In rare instances, such as anticipation of contract termination or placement on a vendor or individual hold, an FMSA may not accept individual referrals. FMSAs contract with HHSC to provide financial management services (FMS) to people choosing the Consumer Directed Services (CDS) service delivery option. FMS includes employer orientation, help with and approval of budgets, and processing payroll and payables for the employer. An FMSA must make available support consultation services if this service is available in the person's respective program and is requested by the person. Support consultation offers employer training and support beyond the FMS provided by the FMSA.

Applicants and people use Form 1584, Consumer Participation Choice, to identify the choice of service delivery option and choice of Home and Community Support Services Agency (HCSSA) or FMSA, as appropriate. A list of FMSAs in each county is available on the HHSC website to help the applicant or person make this choice. If the applicant or person chooses CDS, the caseworker has five business days from receipt of Form 1584 by a person, or from receipt of Form 1584 and determination of eligibility for an applicant, to provide the required documentation to the selected FMSA. If the selected FMSA is not able to provide services to the applicant or person, the FMSA must send the caseworker written notification stating this, using Form 2067, Case Information. Receipt of written notification prompts the caseworker to offer the applicant or person another choice of FMSA and to provide the newly selected FMSA with the required documentation, following the same procedures outlined above.

6332 Initial Authorization of Services

Revision 26-2; Effective June 1, 2026

Before receiving services under the CDS option, applicants must:

• be determined eligible for services; and
• have a program service plan developed.

Note: People do not have to receive services through the agency option before receiving services through the CDS option – they may go directly to the CDS option.

26 Texas Administrative Code Section 264.111, Service Planning in the CDS Option

Provide applicants who choose CDS with the choice list of available Financial Management Services Agencies (FMSA) for their program and county during the first home visit. After the applicant has decided, they must sign the regional contract list indicating their FMSA selection.

Review 6332.1, Pre-Enrollment Requirements. Authorize services on Form 2101, Authorization for Community Care Services once an eligibility determination is made and pre-enrollment requirements are met. In the comments section, note the total annual hours at the current rate per hour and the total dollar amount for the annual service plan, as detailed in 6332.2, Calculation of the Annual Service Plan. Send Form 2065-A, Notification of Community Care Services, to the applicant as notification of eligibility.

6332.1 Pre-Enrollment Requirements

Revision 26-2; Effective June 1, 2026

Caseworkers must follow 26 Texas Administrative Code Section 264.401, Enrollment Process, to enroll a person into the CDS option.

Form 2101, Authorization for Community Care Service, must include the:

• hours of service being authorized in the period; and
• hourly payment rate for the service as specified in 6332.2, Calculation of the Annual Service Plan.

The caseworker must contact the FMSA to request an initial orientation for the person. They then send Form 1584, Consumer Participation Choice, to the FMSA to notify it that the person has selected the agency. Request the FMSA to advise when the initial orientation is complete with Form 2067, Case Information.

For people who are receiving services using the agency option and have requested transition to the CDS service delivery option, negotiate a CDS begin date with the person and the FMSA once this notification is received. In addition to the Form 2067 that confirms orientation, applicants for PHC or CAS who choose to start services directly using the CDS option must have a valid Form 3052, Practitioner’s Statement of Medical, before negotiating a CDS begin date with the FMSA. Send Form 2101, Authorization for Community Care Services, to the person and the FMSA.

• Authorize the monthly FMS administrative fee using Service Authorization System Service Code 63V. For Community Attendant Services (CAS) and Primary Home Care (PHC) applications and recertifications, the regional nurse must authorize the FMS fee. Request authorization for the FMS fee from the regional nurse.
• Use the appropriate service code below to begin CDS Services:
  • 17 V – Primary Home Care (PHC)
  • 17 CV – Family Care (FC)
  • 17 DV – CAS

6332.2 Calculation of the Annual Service Plan

Revision 26-2; Effective June 1, 2026

CDS is authorized in the Service Authorization System Online (SASO) using an annual service plan (ASP).

Assess the applicant's need for services using Form 2060, Needs Assessment Questionnaire, Task and Hour Guide. The ASP amount is calculated using the required weekly service units determined using Form 2060 and the current CDS hourly provider rate.

Note: A link to the current CDS service rate is on the Primary Home Care (PHC) page, Texas Health and Human Services Commission webpage.

After an applicant is determined eligible for PHC, CAS or FC services and selects the CDS delivery option, use the following steps to calculate the ASP.

Determine the total number of required weekly service units personal attendant services per week.

1. Enter the required weekly service needs in SASO.
   
   SASO automatically calculates the annual services needs amount by multiplying the weekly service needs over a 53-week period. SASO will use the CDS hourly provider rate and the annual service needs amount to calculate the total dollar amount of the ASP.
    
2. Enter the ASP information, the total weekly services hours, the total annual hours, the current CDS hourly rate = the total dollar amount for the ASP, in the comments section for Form 2101, Authorization for Community Care Services. The ASP must be rounded to the nearest cent.
   
   Example: CDS authorized 10.5 hours per week for a total of 556.5 hours of service at $16.33 per hour = $9,087.645 total for the ASP, rounded to nearest cent = $9,087.65. Note: If the digit in the thousandths place is five or greater round up. If less than five, round down. Keep only two decimal places.
    
3. Print Form 2101, Authorization for Community Care Services, showing the CDS ASP.

In addition to the budgeted ASP, a CDS monthly administrative fee must be authorized using Service Code 63V for CAS, PHC and FC cases.

For initial and ongoing CAS and PHC cases, request authorization from the regional nurse before initial and renewal of the services using the CDS option.

Financial Management Services Agency (FMSA) Procedures

To notify the FMSA agency that it was selected to provide CDS administrative services, send:

• Form 2067, Case Information; and
• Form 1584, Consumer Participation Choice.

After receiving notice, the FMSA:

• schedules a face-to-face interview with the applicant;
• provides training to the applicant covering all orientation material;
• helps the applicant develop a budget for program services;
• provides information and helps complete the criminal history and other required registry checks on the potential attendant; and
• completes all required forms to initiate services under the CDS option. 

6332.3 Monitoring CDS Service Initiation

Revision 25-3; Effective June 1, 2025

All Consumer Directed Services (CDS) cases must be monitored either by face-to-face home visit or by phone within 30 calendar days of the CDS service delivery start date. In all other situations, CDS cases are monitored per program guidelines, as described in 2700, Service Monitoring, Changes and Transfers. At all mandated contacts, caseworkers must complete:

• Form 2314, Satisfaction and Service Monitoring; and
• Form 2314-C, Consumer Satisfaction Interview — Consumer Directed Services Addendum.

Any service problems noted must be communicated to the Financial Management Services Agency using Form 2067, Case Information. The caseworker may recommend that the employee complete Form 1741, Corrective Action Plan, and more training if necessary. Concerns about fiscal management must be noted and resolved with the agency. Consult the contract manager if the situation involves contract issues.

6332.4 Responsibility for Responding to Questions

Revision 20-4; Effective December 1, 2020

For questions about the Consumer Directed Services (CDS) option, use the following chart to determine who is responsible for responding to questions from the applicant, recipient or the applicant's or recipient's family.

For questions about the CDS option related to the Financial Management Services Agency (FMSA), refer the recipient to their FMSA. Do not attempt to answer the question or contact the FMSA on behalf of the recipient.

Contact the CDS operations specialist for general non-case specific questions about the CDS option.

CDC Contact Chart

6333 Service Initiation Directly into CDS for PHC or CAS

Revision 24-4; Effective Sept. 1, 2024

Applicants for Personal Attendant Services (PAS) through Primary Home Care (PHC) or Community Attendant Services (CAS) who choose the Consumer Directed Services (CDS) option may start services directly in CDS without going through a Home and Community Support Services Agency (HCSSA).

If a PHC or CAS applicant chooses to start services through the CDS option, the CDS employer's must get the completed Form 3052, Practitioner's Statement of Medical Need, get it to the practitioner and make sure the practitioner signs it. The CDS employer then sends the form to the selected Financial Management Services Agency (FMSA) to complete Part II, Provider's Statement. The FMSA returns the form to the CDS employer, and it is the employer's responsibility to return the form to the caseworker. Services will not be authorized until Form 3052 is signed by both the practitioner, the FMSA, is returned, and the applicant meets all eligibility requirements. The employer may be the applicant or the legally authorized representative (LAR).

The caseworker provides a copy of Form 3052 and form instructions to the applicant with a return envelope and instructions on returning the form to the caseworker within 14 calendar days. The caseworker's must forward Form 3052 to the regional nurse the date it is received in the office. Within two business days of receipt in an HHSC office the regional nurse verifies that the form is complete or requires correction. Refer to Section 4661.1, Review of the Practitioner’s Statement and Section 4661.2, Required Corrections. If correction is required, it is returned to the employer for correction or completion. Allow five business days for the employer to complete all corrections. The authorization must be completed in Service Authorization System Online (SASO) within five business days of receipt of completed Form 3052. The time frame starts when the completed form is received in an HHSC office.

All other requirements remain the same, as outlined in 6300, Consumer Directed Services. These procedures are also applicable to people who are on the CDS option in another program and are transferring to PHC or CAS. This includes people on Family Care or Personal Care Services (PCS) through the Comprehensive Care Program (CCP).

6333.1 Authorizing CDS for Ongoing People

Revision 26-2; Effective June 1, 2026

When the person receiving services selects the AO initially and then selects CDS, they will be transitioned to the CDS service delivery option. The caseworker must present the official list of all FMSAs on the HHSC webpage and the following forms:

• Form 1581, Consumer Directed Services Option Overview;
• Form 1582, Consumer Directed Services Responsibilities;
• Form 1583, Employee Qualification Requirements;
• Form 1584, Consumer Participation Choice; and
• Form 1586, Acknowledgement of Information Regarding Support Consultation Services in the Consumer Directed Services Option.

The official list must be used as the FMSAs routinely cover multiple regions. When the CDS employer selects an FMSA, the employer signs Form 1584, indicating the choice to use the CDS option and the selected FMSA.

Use the appropriate Service Authorization System code(s) created for use with the CDS option, provided in 6332.1, Pre-Enrollment Requirements.

Complete Form 2101, Authorization for Community Care Services, to terminate participation in the AO and create another Form 2101 authorizing the CDS option. The CDS start date is the date negotiated with the person and FMSA. Service through the provider agency must be terminated the day before the start date of CDS. There must be no gap in coverage dates.

Send Form 2065-A, Notification of Community Care Services, using the notification of change section, to advise that participation in the AO is terminating and services will now be delivered using the CDS option. Time frames in Appendix IX, Notification Effective Date of Decision, apply. 

Example: The service you have been receiving, 20 hours of CAS using the AO, is changing to 20 hours of CAS using the CDS Option effective March 15, 2026. 

6333.1.1 Different Program Annual Review and Annual Service Plan Dates

Revision 25-2; Effective March 31, 2025

If a person decides to transition to the Consumer Directed Services (CDS) option after being on the agency option, the dates for the CDS annual service plan (ASP) could be different than the date for the program annual review.

The caseworker must keep the program annual review date the same if the annual review date and the ASP date are within different months. The next annual review date will be 12 months from the date of the previous annual review date.

The caseworker must complete a separate service authorization wizard in the Service Authorization System Online (SASO) at the end of the ASP year to renew the CDS funds for another year. The caseworker should enter a reminder on their scheduler in SASO to ensure there is no gap in CDS services.

The caseworker does not complete a home visit or contact the person when the ASP reauthorization is due or complete a financial or functional wizard in SASO. The caseworker will only complete the authorization wizard in SASO to renew the funds needed for the CDS option. The caseworker must send the updated Form 2101, Authorization for Community Care Services, to the person ’s Financial Management Services Agency (FMSA).

Example:

A person starts Community Care Services Eligibility (CCSE) services with the agency option on Jan. 15, 2024. The person decides in April 2024 to switch to the CDS option. The caseworker negotiates a start date with the selected FMSA of April 25, 2024. The effective dates of the ASP are April 25, 2024, through April 24, 2025. The caseworker completes the authorization for CDS per 6333.1, Authorizing CDS for Ongoing People.

The caseworker also enters a scheduler entry set to a few days before April 24, 2025, to ensure the CDS funds are renewed for another year. The caseworker should already have a scheduler in place to complete the program annual review in January 2025.

In January 2025, the caseworker completes the program annual reassessment as usual. Review, 4447, Reassessment, 4678, Annual Reassessments, 4678.1, Primary Home Care (PHC) Annual Reassessments and 4678.2, Community Attendant Services (CAS) Annual Reassessment.

In April 2025 before April 24, the caseworker completes the ASP by running the SASO authorization wizard with new dates of April 25, 2025, through April 24, 2026, to renew the CDS option funds. The caseworker sends the updated Form 2101 to the FMSA.

6333.2 Transfers and CDS

Revision 26-1; Effective March 1, 2026

The person has the right to:

• transfer to a different FMSA or
• request a transfer back to the AO at any time.

If the person feels that the current FMSA is not fulfilling the expected responsibilities they can:

• address those issues directly with the FMSA;
• contact the caseworker if they cannot resolve issues or concerns with the FMSA; or
• select another FMSA to provide CDS services if concerns and issues are still not resolved.

Review 6333.4, Annual Recertification, for instructions on updating the ASP when transferring to another FMSA.

Transfer to Another FMSA

If issues with the current FMSA cannot be resolved to the person's satisfaction, they have the right to transfer to another FMSA. Follow procedures outlined in 2723, Freedom of Choice.

The person must contact the caseworker if they decide to transfer from one FMSA to another. The caseworker makes all necessary arrangements for the transfer.

Review 6333.3.1, FMSA Transfer, for step-by-step budgeting procedures required when transferring from one FMSA to another.

Transfer to the AO

Caseworkers must follow 26 Texas Administrative Code Section 264.407, Termination of Participation in the CDS Option, to terminate a person from participation in the CDS option. 

Send Form 2065-A, Notification of Community Care Services, using the notification of change section to advise that participation in the CDS option is terminating and services will now be delivered using the AO.

Example: The service you have been receiving, 20 hours of Community Attendant Services (CAS) using the CDS Option is changing to 20 hours of CAS using the Agency Option effective March 15, 2025.

The person may return to CDS after the 90-day transfer period has expired by contacting the caseworker. All pre-assessment procedures must be completed, including a new Individual Self-Assessment, before the person is allowed to return to CDS.

Service Resources Available During the Transfer Process

If the person is without PAS and requires assistance before the transfer can take place, they may be able to contract for PAS through the AO provider using CDS funds. The agency is not required to provide this service. The person must be acquainted with other resources, which are outlined in the training provided by the FMSA.

6333.3 Circumstances That Necessitate a Revised Annual Service Plan

Revision 26-2; Effective June 1, 2026

The Annual Service Plan (ASP) specifies an annualized dollar amount. This is the maximum the person can expend during the year. It is the basis for developing a service budget. The person and the FMSA share responsibility for making sure annual expenditures remain within the authorized amount.

Four situations may necessitate revision of the ASP:

• provider transfers;
• rate changes;
• an increase in service units; and
• a decrease in service units.

Caseworkers must use Form 1589, Consumer Directed Services Revision Worksheet, Page 1, to begin any changes that necessitate a revised ASP. Using the form will help a caseworker get the needed information from an FMSA. The caseworker can use the optional second page of Form 1589, Consumer Directed Services Supplemental Calculation Worksheet, to help complete the rest of the revision calculation. Caseworkers must continue to follow instructions to input ASP authorizations into the Service Authorization System, per 6333.3.1, FMSA Transfer, 6333.3.2, Rate Change, 6333.3.3, Increase in Service Units and 6333.3.4, Decrease in Service Units that follow.

Changes to the ASP must be made in the order of occurrence.  Example: The caseworker cannot enter a rate change effective Sept. 1 in the Service Authorization System before making a change in hours that was effective Aug. 15.

6333.3.1 FMSA Transfer

Revision 25-3; Effective June 1, 2025

When notification of a request to transfer Financial Management Services Agency (FMSA), use the following steps to re-calculate the ASP for the remaining time period.

• Send Form 1589, Consumer Directed Services Revision Worksheet, to the FMSA to request the total hours used.
• Re-calculate the ASP based on the number of units or amount of funds needed to complete the service plan period based on the recipient’s current service plan.
• Update the information in SASO.
• Send Form 2101, Authorization for Community Care Services, to notify the FMSA of the revised ASP information.

Use the following example when processing FMSA transfers.

Note: In this example, the $10.00 amount is a fictitious number used for demonstration purposes only. When transferring FMSA, the current CDS service rate can be accessed at the Primary Home Care (PHC) on the Texas Health and Human Services Commission website.

Example: CDS recipient requests to transfer to a new FMSA. The transfer is effective July 16, 2015. The original ASP was Jan. 1, 2015 through Dec. 31, 2015. The ASP was approved for 1060 hours at $10 per hour.

CCSE staff must also authorize Financial Management Services (FMS) Service Code 63V for the gaining provider. The regional nurse authorizes the FMS fee for Community Attendant Services applications and recertifications.

6333.3.2 Rate Change

Revision 22-2; Effective June 1, 2022

When notified of a change in the CDS service rate, use the following steps to re-calculate the ASP for the remaining time period.

• Send Form 1589, Consumer Directed Services Revision Worksheet, to the Financial Management Services Agency (FMSA), to request the total hours used.
• Re-calculate the ASP based on the time remaining in the ASP period and the new CDS service rate.
• Update the information in SASOW.
• Send Form 2101, Authorization for Community Care Services, to notify the FMSA of the revised ASP information.

Note: The $10.50 and $10.00 amounts in this example are fictitious numbers used for demonstration purposes only. The current rate can be accessed at the following Texas Health and Human Services Commission website: pfd.hhs.texas.gov/long-term-services-supports/primary-home-care-phc.

Example: CCSE staff are notified of a rate increase to $10.50 effective Sept. 1, 2015. The original authorization was for 530 hours of service at $10.00 per hour, for a total of $5,300.00, beginning Feb. 15, 2015 and ending Feb. 16, 2016.

6333.3.3 Increase in Service Units

Revision 22-2; Effective June 1, 2022

Use the following example when processing increases in service units.

Note: In this example, the $9.50 amount is a fictional number used for demonstration purposes only. The current rate can be accessed at the following Texas Health and Human Services Commission website: pfd.hhs.texas.gov/long-term-services-supports/primary-home-care-phc.

6333.3.4 Decrease in Service Units

Revision 22-2; Effective June 1, 2022

Use the following example when processing decreases in service units.

Note: In this example, the $9.75 amount is a fictitious number used for demonstration purposes only. The current rate can be accessed at the following Health and Human Services Commission website: https://pfd.hhs.texas.gov/long-term-services-supports/primary-home-care-phc.

6333.4 Annual Recertification

Revision 22-4; Effective Dec. 1, 2022

Complete functional reassessments for Family Care (FC) and Primary Home Care (PHC) services at least once every 12 months.

Complete financial redeterminations at least once every 24 months.

Complete a home visit for all recipients receiving Family Care (FC) and Primary Home Care (PHC) at least once every 24 months at the same time the financial redetermination is conducted.

Recipient rights requirements apply in CDS the same way they apply to any other service delivery option.

Related Policy 

Reassessments and Recertification Procedures, 2660 
Redetermination of Financial Eligibility, 2662 
Reassessment of Functional Need, 2663 
Annual Home Visit Required for Individuals Receiving PAS, 2663.1 
Determining When a Home Visit is Necessary for Other Services, 2663.2 

6333.4.1 Procedures for the CAS CDS Annual Reassessment

Revision 25-2; Effective March 31, 2025

Per 1929(b) of the Social Security Act and the State Plan under Title XIX of the Social Security Act Medical Assistance Program, in the Community Attendant Services (CAS) program, the Consumer Directed Services (CDS) employer can be considered the supervisor for the purpose of completing the CAS annual reassessment.

CAS annual reassessment procedures for a person using the agency option require the caseworker complete the functional assessment, the Home and Community Support Services Agency (HCSSA) supervisor to document agreement or disagreement with the service plan, and the HHSC regional nurse to authorize services within 12 months of the last authorization. Under the state plan, the CDS employer may fulfill the role of the HCSSA supervisor in signing the agreement or presenting information when in disagreement with the proposed service plan.

When the caseworker conducts the home visit for the annual functional reassessment, the role of the CDS employer for the annual reassessment must be explained to the CDS employer. The caseworker advises them of the following:

• The proposed service plan, Form 2101, Authorization for Community Care Services, for the next year is faxed or mailed to the CDS employer.
• The CDS employer must review the plan, sign Form 1596, Consumer Directed Services Agreement for the Community Attendant Services Annual Reauthorization, indicating their agreement or disagreement with the proposed plan, and return the form to the caseworker within 14 calendar days of receipt to prevent delay in services.

The caseworker must schedule the annual reassessment home visit to allow time for all the required steps to be completed within the time frames.

Caseworker Procedures

Within five business days after the functional assessment visit, the caseworker faxes or sends the CDS employer a copy of the following forms:

• Referral Form 2101, with the proposed annualized service plan.
• Form 1596, to be completed and signed by the CDS employer with the following information:
  • A statement showing that the proposed annualized service plan has been reviewed and the CDS employer agrees; or
  • A statement showing that the proposed annualized service plan has been reviewed and the CDS employer disagrees with the tasks or hours shown on the annualized service plan for the reasons listed on Form 1596.

The CDS employer must sign Form 1596 and return it to the caseworker within 14 calendar days of receipt. If the CDS employer signs agreement with the annualized service plan, the caseworker, within five business days, sends a copy of Form 1596 and Form 2101 to the HHSC regional nurse for the annual authorization.

Disagreement with the Service Plan

If the CDS employer does not agree with the proposed annualized service plan, the reasons must be documented on Form 1596. The caseworker must contact the CDS employer to try to resolve the issues and agree upon a plan. If an agreement is reached, the caseworker sends Form 1596 and Form 2101 to the HHSC regional nurse for the annual authorization.

If an agreement cannot be reached, the caseworker forwards Form 2101 and Form 1596 to the HHSC regional nurse. Within five business days of receipt of Form 2101 and Form 1596, the HHSC regional nurse contacts the CDS employer and caseworker to determine if agreement can be reached on the service plan.

The HHSC regional nurse makes the final decision on the service plan. If the negotiation results in a decrease in services for the person, the effective date must allow time for the person to receive a 12-day advance notice of the adverse action. The CDS employer has the right to request a fair hearing and appeal the decision.

The HHSC regional nurse makes any necessary changes to Form 2101, noting any negotiated changes in the comments and completes the authorization in the Service Authorization System Online (SASO). The nurse sends Form 2067, Case Information, notifying the CDS employer and the caseworker of the outcome of the negotiation and sends a copy of the authorization Form 2101 to the caseworker by mail or electronic mail.

The caseworker sends a copy of Form 2101 to the Financial Management Services Agency and the CDS employer. Form 2065-A, Notification of Community Care Services, is sent to the person within two business days.

Note: If the CDS annual service plan (ASP) dates are different than the CAS annual review dates per 6333.1.1, Different Program Annual Review and Annual Service Plan Dates, the caseworker must ensure the CDS ASP dates remain unchanged after a CAS annual review is completed.

6333.5 Ongoing CDS Monitoring

Revision 25-3; Effective June 1, 2025

All monitoring of Consumer Directed Services (CDS) people is done per the mandated schedule for their specific services. Review 2700, Service Monitoring, Changes and Transfers, for details. Because the person is now responsible for their own service delivery, the caseworker's function is to:

• monitor the person's satisfaction with the Financial Management Services Agency (FMSA) services; and
• evaluate the person's ongoing ability to comply with CDS option requirements.

If it is evident the person is having difficulty in the management of services under the CDS option, the caseworker may consult with the FMSA.

Examples of the person's inability to manage services include:

• lack of adequate supervision of the attendant so that necessary services are not being delivered; or
• misuse of funds so that the annual authorized amount will be expended before the year is over.

The FMSA must provide the budget status report at least quarterly to the person or designated representative and caseworker. If the caseworker does not receive the quarterly report, or the person reports they have not received the quarterly report the caseworker must follow-up with the FMSA.

6333.6 Ensuring Personal Health and Safety

Revision 25-3; Effective June 1, 2025

The Financial Management Services Agency (FMSA) and caseworker share responsibility for assessing the person's ability to manage the demands of the Consumer Directed Services (CDS) option. Careful evaluation is necessary to ensure the person's health and safety are maintained.

As soon as they become aware of a potential problem, the caseworker must:

• notify the FMSA of any concerns about the person's circumstances or ability to comply with CDS option requirements; and
• provide supporting documentation about the circumstances or problems noted to the FMSA.

The person is responsible for informing the FMSA of the assessment date in time for the FMSA to send the caseworker a copy of the person's annual budget.

Review 6323, FMSA Responsibilities, for FMSA responsibilities.

6333.6.1 Responsibilities for HHSC Caseworkers in Association with Abuse, Neglect and Exploitation (ANE) Allegations

Revision 25-3; Effective June 1, 2025

Responsibilities for HHSC Caseworkers

Responsibilities for HHSC caseworkers in association with ANE investigation procedures are specifically for the Consumer Directed Services (CDS) option when a CDS employee, designated representative, or representative of a Financial Management Service Agency (FMSA) is the alleged perpetrator are as follows.

Initial Intake Actions When a CDS Employee or Designated Representative is the Alleged Perpetrator

When the Department of Family and Protective Services (DFPS) receives an allegation of ANE for a person using the CDS option, Adult Protective Services (APS) provides the initial intake report to the CDS employer and the person’s caseworker. The caseworker must notify the person’s FMSA of the initial allegation. The caseworker is required to hold an interdisciplinary team (IDT) meeting in person or by phone, within four business days of receipt of the initial report, with the CDS employer to:

• discuss the actions the CDS employer has taken or will take to protect the person during the APS investigation, which may include implementing the service backup plan to allow someone other than the CDS employee who is the alleged perpetrator to provide services;
• inform CDS employers of their responsibilities to protect evidence, such as timesheets and other employee-related documentation; and
• if appropriate, recommend termination of the CDS option, per 26 Texas Administrative Code (TAC) 264.407(e), Termination of Participation in the CDS Option.

The caseworker documents in writing the responses provided by the CDS employer during the IDT and any actions that have been or will be taken because of the allegation pending the outcome of the final investigative report.

Final Report Actions

After the investigation is complete, APS will release a final investigatory report, including findings, to the CDS employer and the caseworker. The caseworker convenes an IDT meeting in person or by phone, within four business days after receipt of the final report, if there is a confirmed or inconclusive finding of ANE or if concerns and recommendations are included in the report, in which:

• the IDT discusses the findings or concerns and recommendations;
• the caseworker documents, in writing, any actions that have been or will be taken by the CDS employer as a result of the findings or concerns and recommendations. Form 1741, Corrective Action Plan, may be used for this purpose; and
• if appropriate, the caseworker may recommend termination of the CDS option, per 26 TAC 267.407(e), Termination of Participation in the CDS Option.

Initial Intake Actions if an FMSA Representative is the Alleged Perpetrator

When DFPS receives an allegation of ANE related to services delivered through the CDS option and an FMSA representative is the alleged perpetrator, APS provides the initial intake report to the CDS employer and the FMSA of the initial allegation. The FMSA must provide a copy of the initial intake report to the person’s HHSC regional office within one business day. The HHSC regional director or designee ensures that the person’s caseworker receives the intake report and a copy of Information Letter 15-83, ANE Investigation Procedures for the CDS Option in the PHC Program, as soon as possible.

The caseworker convenes an IDT meeting in person or by phone within four business days after receipt of the initial intake report, in which:

• the IDT discusses the actions the CDS employer has taken or will take to protect the person during the APS investigation, including transferring to a different FMSA; and
• the caseworker documents in writing any actions that have been or will be taken as a result of the allegation, pending the outcome of the final investigative report.

Final Investigation Report

After the investigation is complete, APS sends a final investigation report, including findings, to the CDS employer and to the person’s FMSA. The FMSA must provide a copy of the final investigation report, within one business day after receipt of the report, to the person’s HHSC regional office. The HHSC regional director or designee ensures the final investigative report is given to the caseworker as soon as possible.

The caseworker convenes an IDT meeting in person or by phone, within four business days after receipt of the final report, if there is a confirmed or inconclusive finding of ANE or if concerns and recommendations are included in the report, in which:

• the IDT discusses the findings or concerns and recommendations;
• the caseworker documents, in writing, any actions that have been or will be taken by the CDS employer as a result of the findings or concerns and recommendations. Form 1741 may be used for this purpose; and

if appropriate, the caseworker may recommend termination of the CDS option in accordance with 26 TAC 267.407(e), Termination of Participation in the CDS Option.

6333.6.2 Voluntary Suspension of the CDS Option

Revision 25-3; Effective June 1, 2025

26 Texas Administrative Code Section 264.405, Suspension of Participation in the CDS Option.

Voluntary suspensions are rare. Examples include but are not limited to a person:

• has turned 18 and no guardian was appointed so there is no employer; or
• lacks back-up service delivery options.

For the caseworker, a voluntary suspension is handled exactly the way a transfer to another service delivery option would be handled. Review 6333.2, Transfers and Consumer Directed Services (CDS), for detailed instructions. But, for the Financial Management Services Agency(FMSA), the provider tasks as described in 6323, FMSA Responsibilities. They do not have to be repeated when the person transfers back to CDS at the end of the 90-day voluntary suspension period. That is not true when the person simply transfers from, and then back to, CDS.

6333.6.3 Involuntary Termination of the CDS Option

Revision 26-1; Effective March 1, 2026

26 Texas Administrative Code Section 264.407, Termination of Participation in the CDS Option.

The caseworker or FMSA representative may observe that a person is unprepared to meet the demands of managing the details of service delivery. With supporting documents from the monitoring visit or from the FMSA, the caseworker recommends to the person that they voluntarily request to return to the AO. If they do not agree, the caseworker, in counsel with the supervisor, schedules an interdisciplinary team (IDT) meeting to discuss  transferring the person back to the agency option. The IDT meeting must include the person, the person’s representative, LAR, FMSA representative and HHSC caseworker.

The caseworker must carefully document the findings of the IDT on Form 2066-IDT, Interdisciplinary Team (IDT) Meeting Letter, including:

6333.6.4 Re-Enrollment in the CDS Option

Revision 25-3; Effective June 1, 2025

26 Texas Administrative Code Section 264.409, Re-enrollment for Participation in the CDS Option.

The person may request to re-enroll in the Consumer Directed Services option at any time following the mandatory 90-day suspension period.