Some states have authorize home care models where the care is directed by the consumer receiving services. These models are often referred to as Consumer Directed Services (CDS) and sometimes referred to as registry models or Employee of Record models. In many cases these programs are administered by home care agencies, but the caregivers are not employees of the home care agency.  For agencies who are not participating in these models of care it can be very confusing, and even agencies who do participate in these care delivery models often have trouble complying with their expectations.

This article seeks to demystify CDS and Registry Models:

The "Rules" of CDS and Registry Models

• The first "rule" is that the rules vary. These programs are generally Medicaid-driven and Medicaid rules are defined by each state.

• Since the consumer directs the care, it is often the case that the home care agency isn't allowed to "schedule" the caregiver. Having said that, the consumers and caregivers aren't generally good at keeping track of where they stand against their authorization. One approach agencies take is to "earmark" schedules with duration only and not specific times in order to give the caregivers a guideline.

• When caregivers are employees of the home care agency, the agency is generally required to pay for all time worked, even if the caregiver wworks beyond the authorized units. In the case of CDS programs, this is generally not the case. Since the consumer is directing the care, any payments above the authorization would be the responsibility of the consumer to pay.

• This is an area where the rules vary by state, but many of these programs allow relatives to provide the care (but sometimes with restrictions such as that the care provider can not be the spouse).

• There is often a requirement for the consumer to be able to approve their hours. This is tricky given that clients are generally elderly and not very tech savvy.

• In this model, it is generally the consumer receiving care who is the employer of their caregiver(s) and as such, the home care agency performing the admin role needs to submit tax forms on behalf of the consumer.

• Often your state Medicaid program administrators will provide legal guidelines so that you can avoid behaviors that would make your agency the employer.

Can we help you automate your CDS Program?

Ankota has strong expertise with CDS programs in multiple states. If we can help you automate your program, please ask.