Dakota CountyConsumer Directed Community Support

Support Planning Agreement

The Consumer Directed Community Supports (CDCS) waivered service defines two types of services: Required Case Management and Support Planning. Dakota County must provide Required Case Management services to all CDCS clients. Clients may also choose to purchase Support Planning services from Dakota County or any DHS Certified Support Planner ( Type in support planner under ‘Start a Search’ and a list of current providers will be listed.

Please indicate your decision about the use of Dakota County Support Planning.

I choose to purchase Support Planning from Dakota County.

I understand that the cost of this service is $300.00 and that I must budget for this service within the Self Direction Support Activity category of my Community Support Plan.

I understand that I will receive the following Support Planning services from my social worker/public health nurse:

Assisting developing and completing the community support plan and assisting client in revising the CSP and exploring new ideas of how to use CDCS services to meet the needs of the client and incorporating those changes into the plan.

I choose not to purchase Support Planning from Dakota County or any Certified Support Planned.

I understand that I will be provided Required Case Management services only.

I understand that it is my responsibility to complete my Community Support Plan (CSP), and to submit any requests for plan changes to my social worker/public health nurse in a timely manner. I understand that any changes requested must be approved before I can implement them.

I understand that I will need to amend my CSP and add Dakota County Support Planning in order to receive the following services from my social worker/public health nurse:

Assistance developing and completing my annual Community Support Plan (CSP).

Assistance revising my CSP.

I choose to purchase Support Planning from a DHS Certified Support Planner.

I understand that I will be provided Required Case Management Services only from Dakota County.

I have chosen to use (name & telephone number) / as my support planner to:

Assistance developing and completing my annual Community Support Plan (CSP).

Assistance revising my CSP. (Plan changes cannot be implemented until they are approved by Dakota County.)

I understand that the support planner I have chosen must have the plan submitted and approved before Dakota County will authorize any FSE payments. The plan should be submitted and approved one (1) month prior to start of plan in order for Dakota County to guarantee uninterrupted services. If the services are not authorized, I will contact my Support Planner. Dakota County will authorize services within 5 days of receipt of an approved CSP and all signed documents that are required as part of the CSP. The support Planner is responsible to bill the FSE or family for payment.

DHS Certification attached

CLIENT NAME:
Signature of Client or Legal Representative / Date

CLS/DD&LTC – DAK 7119.13 – CDCS (02/2014)