Title of Rule:	Consumer Directed Attendant Support Services, Section 8.510	
Rule Number:	MSB 07-07-30-A	
Division / Contact / Phone:	Long Term Care Benefits / Aggie Berens / 303-866-3358	

SECRETARY OF STATE
RULES ACTION SUMMARY AND FILING INSTRUCTIONS

SUMMARY OF ACTION ON RULE(S)

1.	Department / Agency Name:	Health Care Policy and Financing / Medical Services Board	
2.	Title of Rule:	MSB 07-07-30-A, Consumer Directed Attendant Support Services, Section 8.510	
3.	This action is an adoption of:	new rules	
4.	Rule sections affected in this action (if existing rule, also give Code of Regulations number and page numbers affected): 	
Sections(s) 8.485.31 (page 1) 8.485.40 (page 2) 8.509.12 A (page 1) and 8.509.13 (page 2) , Colorado Department of Health Care Policy and Financing, Staff Manual Volume 8, Medical Assistance (10 CCR 2505-10).	
5.	Does this action involve any temporary or emergency rule(s)?	No	
If yes, state effective date:		
Is rule to be made permanent? (If yes, please attach notice of hearing).	Yes	

PUBLICATION INSTRUCTIONS*

Please replace existing text beginning at §8.485.30 through §8.485.40.J with new text attached from §8.485.30 through §8.485.40.K.  
Please replace existing text beginning at 8.509.12 through 8.509.13.H with new text attached beginning at 8.509.12 through 8.509.13.I.
Please insert new text provided (8.510 through 8.510.15.A CONSUMER DIRECTED ATTENDANT SUPPORT SERVICES) immediately after 8.509.40  HCBS-MI PROVIDERS and just preceding 8.515 HOME AND COMMUNITY BASED SERVICES FOR PEOPLE WITH BRAIN INJURY (HCBS-BI).  This change is effective 12/30/2007.

Title of Rule:	Consumer Directed Attendant Support Services, Section 8.510	
Rule Number:	MSB 07-07-30-A	
Division / Contact / Phone:	Long Term Care Benefits / Aggie Berens / 303-866-3358	

STATEMENT OF BASIS AND PURPOSE

1.	Summary of the basis and purpose for the rule or rule change.  (State what the rule says or does and explain why the rule or rule change is necessary).	
This rule provides regulations for the Consumer Directed Attendant Support Services, a consumer directed service model authorized by 25.5-6-1100, C.R.S.  The proposed new components of the Rule define eligible clients, the consumer directed benefits, client responsibilities and rights, case management responsibilities and reimbursement.       	
2.	An emergency rule-making is imperatively necessary	
	to comply with state or federal regulation and/or	
	for the preservation of public health, safety and welfare.	
Explain:	
    	
3.	Federal authority for the Rule, if any:	
42 U.S.C. Section 1315 	
4.	State Authority for the Rule:	
25.5-1-301 through 25.5-1-303, C.R.S. (2006);
25.5-6-1100 et seq. : consumer directed services model, 25.5-6-307 (j) and 25.5-6-606.  	

Title of Rule:	Consumer Directed Attendant Support Services, Section 8.510	
Rule Number:	MSB 07-07-30-A	
Division / Contact / Phone:	Long Term Care Benefits / Aggie Berens / 303-866-3358	
REGULATORY ANALYSIS

1.	Describe the classes of persons who will be affected by the proposed rule, including classes that will bear the costs of the proposed rule and classes that will benefit from the proposed rule.
Individuals who are eligible for the Home and Community Based Services for the Elderly, Blind and Disabled (HCBS- EBD) and Home and Community Based Services for Persons  with Major Mental Illness (HCBS- MI) waivers and are interested in directing their attendant support services or having an authorized representative direct the care on their behalf will benefit from this rule.    
2.	To the extent practicable, describe the probable quantitative and qualitative impact of the proposed rule, economic or otherwise, upon affected classes of persons.
Clients will have the ability to control the quality of care they receive by selecting, training, and supervising their attendants and setting wages for those attendants.  This ability may enhance clients' ability to have their care needs met either through a wider array of caregivers or in a manner more desirable to the client.      

3.	Discuss the probable costs to the Department and to any other agency of the implementation and enforcement of the proposed rule and any anticipated effect on state revenues.
The service is designed to be cost neutral relative to either the historical costs of providing care through an agency model or if the client's care needs as reflected by the Service Plan were provided by an enrolled Medicaid Provider agency.   
4.	Compare the probable costs and benefits of the proposed rule to the probable costs and benefits of inaction.
Inaction would result in failure to comply with state law.  
5.	Determine whether there are less costly methods or less intrusive methods for achieving the purpose of the proposed rule.
None
6.	Describe any alternative methods for achieving the purpose for the proposed rule that were seriously considered by the Department and the reasons why they were rejected in favor of the proposed rule.
None

8.485.30  SERVICES PROVIDED
.31  HCBS EBD services provided as an alternative to nursing facility placement include:
A.  Adult day services; and
B.  Alternative care facility services, including homemaker and personal care services in a residential setting; and
C.  Electronic monitoring; and
D.  Home modification; and
E.  Homemaker services; and
F.  Non-medical transportation; and
G.  Personal care; and
H.  Respite care.
I.  In-Home Support Services.
J.  Community Transition Services
K. Consumer Directed Attendant Support Services 
.32  Case management is not a service of the HCBS-EBD waiver program, but shall be provided as an administrative activity through Single Entry Point Agencies.
.33  HCBS-EBD clients are eligible for all other Medicaid state plan benefits, including the Home Health program.
8.485.40  DEFINITIONS OF SERVICES
A.   Adult day services  shall be as defined at Section 8.491.
B.   Alternative care facility services  shall be as defined at Section 8.495.
C.   Electronic monitoring  shall be as defined at Section 8.488.
D.   Home modification  shall be as defined at Section 8.493.
E.   Homemaker services  shall be as defined at Section 8.490.
F.   Non-medical transportation  shall be as defined at Section 8.494.
G.   Personal care  shall be as defined at Section 8.489.
H.   Respite  shall be as defined at Section 8.492.
I.   In-Home Support Services  shall be as defined at Section 8.552.
J.   Community Transition Services (CTS)  shall be as defined at Section 8.553.
K. Consumer Directed Attendant Support Services (CDASS) shall be defined at Section 8.510.

8.509.12  SERVICES PROVIDED
A.  HCBS-MI services provided as an alternative to nursing facility placement include:
1.  Adult day services, and
2.  Alternative care facility services, including homemaker and personal care services in a residential setting, and
3.  Electronic monitoring, and
4.  Home, modification, and
5.  Homemaker services, and
6.  Non-medical transportation, and
7.  Personal care; and
8.  Respite care; and 
9.  Consumer Directed Attendant Support Services; and   
B.  Case management is not a service, of the HCBS-MI program, but shall be provided as an administrative activity through case management agencies.
C.  HCBS-MI clients are eligible, for all other Medicaid State plan benefits.
8.509.13  DEFINITIONS OF SERVICES
A.   Adult Day Services  shall be as defined at Section 8.491, ADULT DAY SERVICES.
B.   Alternative Care Facility  services means, services as defined at Section 8.495, ALTERNATIVE CARE FACILITY.
C.   Electronic Monitoring services  shall be as defined at Section 8.488, ELECTRONIC MONITORING.
D.   Home Modification  shall be as defined at Section 8.493.
E.   Homemaker Services  shall be as defined at Section 8.490.
F.   Non-Medical Transportation  shall be as defined at Section 8.494.
G.   Personal Care  shall be as defined at Section 8.489.
H.   Respite  shall be as defined at Section 8.492.
I.    Consumer Directed Attendant Support Services shall be defined at Section 8.510.

8.510	CONSUMER DIRECTED ATTENDANT SUPPORT SERVICES 
8.510.1	DEFINITIONS 
Attendant means the individual who provides Consumer Directed Attendant Support Services as set forth in § 8.510.3.  
Attendant Support Services Management Training means the required training, including a final, comprehensive assessment, provided by the Department or its designee to a client and/or Authorized Representative who is interested in directing CDASS. 
Authorized Representative means an individual designated by the client or the legal guardian, if appropriate, who has the judgment and ability to assist the client in acquiring and utilizing Consumer Directed Consumer Directed Attendant Support Services. 
Case Manager is defined at 10 C.C.R. 2505-10. § 8.390.1 C. 
Consumer Directed Attendant Support Services (CDASS) means services that assist an individual in accomplishing activities of daily living including Health Maintenance Activities, Personal Care, Homemaker activities and Protective Oversight.     

Financial Management Services organization (FMS) is the entity or entities under contract with the
Department, which entity  is the employer of attendants, and which provides personnel management services, fiscal management and skills training to a client receiving CDASS and/or Authorized Representative.       
Health Maintenance Activities is defined at 10 C.C.R. 2505-10, § 8.552.1.  
Homemaker services is defined at 10 C.C.R. 2505-10, §8.490.
Inappropriate Behavior means offensive behavior which includes, documented verbal, sexual and/or physical abuse. Verbal abuse is defined as consistent verbal threats, insults or offensive language from the client and/or Authorized Representative over a period of time.
Individual Allocation means the funds made available by the Department to clients receiving CDASS and administered by the FMS.  
Personal Care services is defined at 10 C.C.R. 2505-10, §8.489.
Protective Oversight is supervision of the client to prevent at risk behavior that may result in harm to the client.  
8.510.2	ELIGIBILITY 
8.510.2.A.	To be eligible for CDASS, an individual shall:
1.	Meet medical assistance eligibility requirements.
2.	Be eligible for the Consumer Directed Care model as defined at 25.5-6-1101 C.R.S et seq.
3.	Demonstrate a current need for Attendant support.
4.	Document a pattern of stable health, which is a condition of health that necessitates a predictable pattern of Attendant support, allowing for variation that is consistent with medically predictable progression or variation of disability or illness.  The documentation may include the individual’s history of utilization of Medicaid funded Attendant support.  
5.	Provide a statement from his or her primary care physician that indicates the client has sound judgment and the ability to direct his or her care or has an Authorized Representative who has the ability to direct the care on the client’s behalf.  
6.	Demonstrate the ability to handle the financial aspects of CDASS, through completion of Attendant Support Services Management Training or have an Authorized Representative who is able to handle the financial aspects of CDASS.  Ability to handle the financial aspects of CDASS means: 
a.	The ability to determine how the Individual Allocation should be spent to ensure that the individual receives necessary Attendant support, both in quantity and quality, and to ensure that Attendants receive appropriate compensation; and
b.	The ability to verify the accuracy of financial and personnel records as provided by the FMS. 
7.	Demonstrate the ability to manage the health aspects of his or her care, through completion of Attendant Support Services Management Training or have an Authorized Representative who is able to manage the health aspects of his or her care.  Managing the health aspects of one’s care includes the ability to understand principles and monitor conditions of basic health and the knowledge of how, when, and where to seek medical help of an appropriate nature.  
8.	Demonstrate the ability to supervise Attendants, through completion of Attendant Support Services Management Training or have an Authorized Representative who is able to supervise Attendants.  Ability to supervise Attendants means the knowledge and ability:
a.	To recruit and hire Attendants;
b.	To communicate expectations;
c.	To provide training, guidance and review for accomplishment of the Attendant tasks;
d.	To manage necessary paperwork; and
e.	To dismiss Attendants when necessary.       
9.	Complete the Attendant Support Services Management Training and pass the post training assessment.
8.510.3	BENEFITS
Covered benefits shall be for the benefit of the client and not for the benefit of other persons living in the home.
8.510.3.A.	Benefits include: 
1.	Personal Care Tasks, as provided under the Long Term Care Program at 10 C.C.R.2505-10, §8.489.30, including Protective Oversight.
2.	Homemaker  Services, as provided under the Long Term Care Program at 10 C.C.R.2505-10, §8.490.3 (B).
3.	Health Maintenance Activities as defined under the Long Term Care Program at 10 C.C.R. 2505-10, §8.552.1.
8.510.4	CONSUMER DIRECTED ATTENDANT SUPPORT SERVICES MANAGEMENT PLAN
8.510.4.A.	The client and/or Authorized Representative shall develop a written CDASS management plan which shall be reviewed and approved by the Case Manager.  The plan shall describe the individual’s:  
1.	Current status;
2.	Needs and requirements for CDASS;
3.	Plans for securing CDASS; 
4.	Plans for handling emergencies;
5.	Assurances and plans regarding direction of Health maintenance Activities, as described at 10 CCR 2505 -10, §8.510.5, if applicable; 	
6.	Plans for using the Individual Allocation.
8.510.5	DIRECTION OF HEALTH MAINTENANCE ACTIVIITES 
8.510.5.A.	A client, who needs Consumer Directed Attendant Support Services for Health Maintenance Activities, shall direct or have an Authorized Representative direct the Attendant in such activities under each the following conditions:
1.	The client and/or Authorized Representative indicates on the CDASS management plan that he or she has received adequate instruction from health professionals, and is therefore qualified and able to train Attendants in specified Health Maintenance Activities.
2.	The client and/or Authorized Representative list the specific Health Maintenance Activities on his or her CDASS management plan for which he or she will be providing training.
3.	The client and/or Authorized Representative verifies on the CDASS management plan the Attendants who will perform Health Maintenance Activities have had or will receive necessary training, either from the client and/or Authorized Representative or from appropriate health professionals.   
8.510.6	CLIENT AND/OR AUTHORIZED REPRESENTATIVES RESPONSIBILITES 
8.510.6.A.	As a supervisor of Attendants, a client and/or Authorized Representative shall:
1.	Determine wages for each Attendant;
2.	Determine what credentials, if any, individuals must have to be employed as Attendants;
3.	Train Attendants to meet his or her own particular needs;
4.	Dismiss Attendants who are not meeting his or her needs;
5.	Establish hiring agreements, in the form provided by the FMS with each Attendant, outlining wages, services to be provided (limited to Personal Care, Homemaker or Health Maintenance Activities), schedules and working conditions;
6.	Follow all relevant laws and regulations applicable to client’s supervision of Attendants with the exception of those responsibilities set out at § 8.510.13.D as the responsibility of the FMS;
7.	Explain the role of the FMS to the Attendant;
8.	Budget for Attendant care within the established monthly allocation.  
9.	Communicate with the FMS regarding the hiring of Attendants, including wage, services to be provided and scheduling information for each Attendant; 
10.	Review all Attendant timesheets for accuracy and completeness;
11.	Submit completed timesheets to FMS by the timelines established by the FMS;
12.	Ensure that timesheets are signed by the client and/or Authorized Representative and the Attendant in order for the FMS to issue paycheck to the Attendant; and
13.	Authorize the FMS to make any changes in the Attendant wages. 
8.510.6.B.	To receive CDASS each client and/or Authorized Representative shall sign a responsibilities form acknowledging full responsibility for:
1.	Completing training.
2.	Developing a CDASS management plan.
3.	Budgeting for CDASS within the established monthly allocation.
4.	Recruiting, hiring, firing and managing Attendants.
5.	Completing reference checks on Attendants.  
6.	Reviewing background checks on Attendants, if applicable.
7.	Determining wages for Attendants, within the range established by the FMS.
8.	Determining work schedules.
9.	Training and supervising Attendants.
10.	Following all applicable laws and rules applicable to client’s supervision of Attendants with the exception of those responsibilities set out at § 8.510.13.D as the responsibility of the FMS.
11.	Completing and managing all paperwork.
8.510.7	START DATE FOR SERVICES
8.510.7.A.	The start date shall not occur until all of the requirements defined at 10 C.C.R. 2505-10, § 8.510.2 and 8.510.6 have been met. 
8.510.7.B.	The Case Manager shall approve the management plan and establish a start date before a client can begin CDASS. 
8.510.8	SERVICE SUBSTITUTION 
8.510.8.A.	Once a start date has been established for CDASS, the Case Manager shall disenroll the individual from any other Medicaid-funded Attendant support effective as of the start date of CDASS.  
8.510.8.B.	In accordance with 25.5-6-1101 (4), C.R.S., while a client is participating in the Consumer Directed Care model, that client shall be ineligible to receive Home Care Allowance as provided in § 8.484. Once an individual has a start date for CDASS, the Case Manager shall disenroll him or her from Home Care Allowance program prior to the start date for CDASS.  
8.510.8. C.	Case Managers shall not authorize payments for CDASS and Personal Care services, Homemaker services, and Health Maintenance Activities for the same individual.  
8.510.9	CLIENT AND AUTHORIZED REPRESENTATIVE RIGHTS 
8.510.9.A.	A client receiving or requesting CDASS whose Attendant Support Services management plan is disapproved by the Case Manager has the right to review that disapproval.  The client shall submit a written request to the SEP stating the reasons for requesting the review and justifying the proposed management plan.  The client’s most recently approved Attendant Support Services management plan shall remain in effect while the review is in process.
8.510.9. B.	Clients receiving CDASS have the right to transition back to Personal Care, Homemaker, and Home Health Aide and Nursing services provided by an agency at any time.  A client who wishes to transition back to an agency-provided services shall contact the Case Manager.  The Case Manager shall coordinate arrangements for the services.
8.510.9.C.	A client and/or Authorized Representative may request a re-assessment, as described at §8.390.1 (N), if he or she believes that his or her level of service needs to be adjusted. 
8.510.9.D.	A client and/or Authorized Representative may revise his or her CDASS management plan at any time, as long as the Case Manager approves the revised plan.  
8.510.10	INVOLUNTARY TERMINATION
8.510.10.A.	A client may be terminated from CDASS for any one of the following reasons:
1.	The client and/or Authorized Representative fail to comply with CDASS program requirements; 
2.	The client and/or Authorized Representative demonstrates an inability to manage Attendant support; 
3.	A client’s and/or Authorized Representative’s physical or cognitive condition deteriorates to the point that he or she no longer meet program criteria and the client refuses to designate an Authorized Representative to direct services on his/her behalf; 
4.	The client and/or Authorized Representative continue to spend the monthly allocation in a manner indicating premature depletion of funds;  
5.	The client and/or Authorized Representative exhibits Inappropriate Behavior toward Attendants, and the Department has determined that the FMS has made adequate attempts to assist the client and/ or Authorized Representative to resolve the Inappropriate Behavior, and resolution has failed.  
6.	The client’s medical condition that causes an unsafe situation for the client, as determined by the treating physician; and/or
7.	Documented misuse of the monthly allocation by client and/or Authorized Representative as documented by the Case Manager or FMS.   
8.510.11	DISCONTINUATION OF CONSUMER DIRECTED ATTENDANT SUPPORT SERVICES   
8.510.11.A.	A client may be discontinued from CDASS when the Case Manager has secured equivalent care in the community.  
8.510.11.B.	The Case Manager shall notify the client and/or Authorized Representative in writing at least twenty (20) calendar days prior to the termination, that he or she is no longer eligible for CDASS, and that the client and/or Authorized Representative should contact his or her Case Manager for assistance in obtaining other home care services.  The notice shall provide the client and/or Authorized Representative with the reasons for termination and with information about the client’s rights to fair hearing and appeal procedures, in accordance with 10 C.C.R. 2505-10, § 8.057.  Exceptions may be made to the twenty (20) day advance notice requirement when the Department has documented that there is danger to the client or to the Attendant(s), the Case Manager shall notify the FMS of the date on which the client is being terminated from CDASS.  
8.510.12	CASE MANAGEMENT FUNCTIONS
8.510.12.A.	The Case Manager shall review and approve the CDASS management plan completed by the client and/or Authorized Representative.  The Case Manager shall notify the client and/or Authorized Representative of the approval and establish a start date.  
8.510.12.B.	If the Case Manager determines that the CDASS management plan is inadequate to meet the client’s CDASS needs, the Case Manager shall assist the client and/or Authorized Representative with further development of the CDASS management plan.
8.510.12.C.	The Case Manager shall calculate the initial Individual Allocation for each client who chooses CDASS as follows:
1.	Calculate an average monthly payment using prior utilization expenditures for Personal Care, Homemaker, and Home Health Aide and Nursing services, or
2.	Calculate the number of Personal Care, Homemaker, and Health Maintenance Activities hours needed on a monthly basis as defined on the Care Plan and multiply by the Departments established rate for Personal Care, Homemaker, and Health Maintenance Activities services for clients who have insufficient utilization history.  
8.510.12.D.	The Case Manager shall provide written notification of the Individual Allocation to each client. 
8.510.12.E.	A client and/or Authorized Representative who believes that he or she needs more CDASS than the existing Individual Allocation will cover, may request the Case Manager to perform a reassessment.  If the reassessment indicates that more CDASS are justified, the client and/or Authorized Representative shall amend the Attendant Support Services management plan and the Case Manager shall complete a Prior Authorization Request (PAR) revision indicating the increase and submit it to the Department’s fiscal agent.
8.510.12.F.	In approving an increase in the Individual Allocation, the Case Manager shall consider:
1.	Any change in the client’s condition.
2.	Discrepancies between the client’s utilization history and current needs for CDASS. 
3.	The appropriateness of Attendant wages.
4.	The quality and quantity of services provided by Attendants for the wages they receive.  
5.	Revisions in the client’s budgeting of the current Individual Allocation to more effectively pay for needed services.
8.510.12.G.	In reducing an Individual Allocation, the Case Manager shall consider:
1.	Improvement or changes in the condition.
2.	Reasons for unspent allocated funds.
8.510.12.H.	Case Managers shall notify the state fiscal agent to cease payments for all existing Medicaid-funded Personal Care, Homemaker, Health Maintenance Activities and/or Long Term Home Health as defined under the Home Health Program at 10 C.C.R. 2505-10, § 8.520 et seq. as of the clients CDASS start date.     
8.510.12.I.	For effective coordination, monitoring and evaluation of clients receiving CDASS, the Case Manager shall:
1.	Contact the client receiving CDASS and/or Authorized Representative twice a month during the first three months to assess their CDASS management, their satisfaction with care providers and the quality of services received.
2.	Contact the client quarterly, after the first three months to assess their implementation of service plans, CDASS management issues, and quality of care, CDASS expenditures and general satisfaction. 
3.	Conduct a face-to-face visit with the client and/or Authorized Representative when a change in Authorized Representative occurs and contact the client and/or Authorized Representative twice a month for three months after the change takes place.
4.	Review monthly reports to monitor client spending patterns and service utilization to ensure appropriate budgeting and follow up with the client and/or Authorized Representative when discrepancies occur.  
5.	Contact the FMS quarterly to determine the status of each client’s financial management activities.
8.510.12.J.	Reassessment:
	For clients receiving CDASS, the Case Manager shall conduct a face-to-face interview with each client and/or Authorized Representative every six months.  The interview shall include review of the CDASS management plan and documentation from the physician that the client and/or Authorized Representative have the ability to direct the care.  
8.510.13	ATTENDANTS
8.510.13.A.	Attendants shall be at least 16 years of age and demonstrate competency in caring for the client to the satisfaction of the client and/or Authorized Representative.
8.510.13.B.	Attendants shall not represent himself or herself to the public as a licensed nurse, a certified nurse’s aide, a licensed practical or professional nurse, a registered nurse or a registered professional nurse.  
8.510.13.C.	Attendants shall not have had his or her license as a nurse or certification as a nurse aide suspended or revoked or his application for such license or certification denied.  
8.510.13.D.	The FMS shall be the employer of record for all Attendants.  The FMS shall be responsible for worker’s compensation insurance, unemployment compensation insurance, withholding of all federal and state taxes, compliance with federal and state laws regarding overtime pay and minimum wage requirements and compliance with any other relevant federal, state, or local laws.
8.510.13.E.	Attendants shall receive an hourly wage based on the rate negotiated between the Attendant and the client and/or Authorized Representative.  The FMS shall make all payments from the client’s Individual Allocation under the direction of the client and/or Authorized Representative. 
8.510.14	LIMITATIONS ON PAYMENT TO FAMILY AND/ OR LEGAL GUARDIANS
8.510.14.A.	Family members and/ or legal guardians may be employed by the FMS to provide CDASS, subject to the conditions below.  For the purposes of this section, family shall be defined as all persons related to the client by virtue of blood, marriage, adoption, or common law.
1.	The family member and/or legal guardian shall be employed by the FMS and be supervised by the client and/or Authorized Representative if providing CDASS.
2.	The family member and/ or legal guardian providing Personal Care, Homemaker, and/or Health Maintenance Activities shall be reimbursed at an hourly rate by the FMS which employs the family member and/or legal guardian, with the following restrictions:
a.	A family member and/or legal guardian shall not be reimbursed for more than forty (40) hours of CDASS in a seven day period.
b.	A spouse may only be paid to furnish extraordinary care as determined by the Case Manager.  Extraordinary care is determined by assessing whether the care to be provided exceeds the range of care that a spouse would ordinarily perform in the household on behalf of a person without a disability or chronic illness of the same age, and which are necessary to assure the health and welfare of the client and avoid institutionalization.  Extraordinary care shall be documented on the service plan.  
3.	A client and/or Authorized Representative must provide a planned work schedule to the FMS a minimum of two weeks in advance of beginning CDASS, and variations to the schedule shall be noted and supplied to the FMS when billing.
4.	A client and/or Authorized Representative who choose a spouse as a care provider, shall document the choice on the Attendant Support Services management plan.    
8.510.15	ATTENDANT REIMBURSEMENT
8.510.15.A.	Attendants shall receive an hourly wage based on the rate negotiated between the Attendant and the client and/or Authorized Representative hiring the Attendant.  The Fiscal Management Services organization shall make all payments from the client’s Individual Allocation under the direction of the client and/or Authorized Representative.