Consumer Directed Community Supports Forms
 Any County, health plan coordinator or tribal nation in Minnesota can use these forms to meet the CDCS requirements - typically nothing more is required by DHS:
 
CDCS Community Support Plan Form
Health and Safety Plan
Participation Agreement
Annual Review
Consumer Calculation Spreadsheet *Contributed By Consumer Directions
. *Support Plans must be based upon Assessed Needs (LTCC or DD Screening Document)
*The lead agency (county, health plan, tribe) may have a preferred form, but they are required to accept a plan in any format, as long as it contains the necessary information.
Example of completed CDCS Community Support Plan Form

 Example goals:
*Your goals, as long as they increase your independence, help you to participate in community activities, to develop or maintain personal skills, to maintain your health and safety and to maintain living in the best place for you, are what you choose.  You can only spend your CDCS budget on allowable costs to help you achieve your goals, but how you spend your budget is your choice.
Improved Health My evaluation of my health is fair now and will be good in 6 months.  I will have no emergency room visits for one year.  The public health nurse will assess my health in 1 year.
Increased Independence I will be able to create a menu and prepare a grocery list by myself at six months.  I will  receive assistance and training from CILNM for the first six months, I will shop, cook and clean with assistance from my PCA as needed.
Improved Nutrition My daughter will prepare meals for me five days a week.  I will gain five pounds this year.
Improve Medication Compliance My daughter will set up medication and give me reminders to take my medication.  I will have no medication related emergency room visits.

Example Provider Qualifications:
Unlicensed Provider of Yard Work:  John Doe lives next door and has agreed to remove snow from my sidewalk and driveway each time it snows from October through April and mow my lawn twice per month from May through September. I agree to Pay John Doe $75 per month for Yard Work.  He does not need a license and meets the qualifications in the community support plan as determined by myself.

Example Allowable and Unallowable Expenditures:
Allowable Expenditures Unallowable
Goods and Services that allow the consumer to be more independent and live in the community, enhance community inclusion and family involvement, develop personal skills and decrease dependency.  Costs related to: Personal Assistance, Assistive Technology, Environmental Modifications, Self Direction Support Activities, Therapies, Flexible Case Management, Fiscal Support Entity Costs. Services to people living in foster care or licensed DHS facilities.  Items that benefit people other than the consumer, home modifications that add square footage, travel expenses for the training of caregivers, membership dues, vacation expenses, vehicle maintenance, tickets to recreational events, pets and their related costs, Internet access.

See Manuals Below for a complete description of the above examples.

Manuals

MN DHS CDCS Consumer Handbook (PDF)

MN DHS CDCD Lead Agency Manual (PDF)