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Texas Department of CMPAS CDS Budget
Aging and Disability Services August 2008
Consumer Managed Personal Attendant Services
Consumer Directed Services Budget
General Information and Instructions for Use of Workbook
THIS PAGE IS NOT CONSIDERED PART OF THE BUDGET
Enter the appropriate information in the "Blue" cells (the cells with "dashed" lines around
* them). Be sure the information you enter is accurate, as the budget calculations are based
on the entries made in these cells.
* Use the "TAB" key to move between the "Blue" cells. Entries may only be made in the
"Blue" cells; all other cells are locked.
You can use the keyboard to move between the pages in the workbook. Press "CTRL" and
* "Page Down" at the same time to move to the next worksheet; Press "CTRL" and "Page Up"
at the same time to move to the previous worksheet.
* Watch for "Pop-Up" information windows for many of the cells. If the "Pop-Up" windows are
covering the body of the budget, you may "drag and drop" them to a different area.
* Be sure to read any error messages carefully. They give you instructions on how to correct
data entry errors.
* Complete the entire Workbook for each Consumer at the following times (and when required
by program policy):
Initially and at Annual Reassessment
Termination of Services
Change in Employee
Change in Number of Hours Employee Works, Rate of Pay, Bonus, or Benefits
Change in Employee Pay Rate or Benefits
Change in Reimbursement Rate
Change in Administrative Costs
Change in Payment Option back to Agency Option
Change in Number of Authorized Units for Hourly Services
Use of Respite Services
Anytime Other Time Required by Program Policy
Complete the Quarterly Report at least Quarterly (more frequently if required by Program
Policy)
* Be sure both the Employer (Consumer or Legal Guardian), Designated Representative (if
applicable), and the CDS Agency Representative sign Consumer Information & Budget
Approval Page of the workbook, and that the budget Calculations are listed as "VALID".
* Submit a copy of the current Budget Workbook to the appropriate Case Manager/Service
Coordinator initially, annually, and as required by program policy.
Date and Time Created
12/12/2011 2:33 AM
Texas Department of CMPAS CDS Budget
Aging and Disability Services August 2008
Consumer Managed Personal Attendant Services
Consumer Directed Services Budget
Consumer Information & Budget Approval
Consumer Name:
Consumer Medicaid Number:
Consumer's Address:
Consumer's City, State, Zip Code:
Consumer's Telephone Number:
Region:
Does the Consumer Have a Designated Representative (DR) or
Legally Authorized Representative (LAR)?
LAR's Name:
DR's Name:
Effective / Coverage Period (This does not guarantee
eligibility for the entire period):
Budget Calculations are: VALID
CERTIFICATION: By signature below I acknowledge that all calculations must fall within the allowable budget, and that all budget
calculations are VALID, as indicated above. I acknowledge these budget calculations are not exact, and may need adjustment
throughout the budget period. I also acknowledge receipt of a copy of the CDS Budget. I agree to remain within the boundaries of the
budget set forth. I understand that failure to follow this budget may result in removal from the CDS Option and I accept personal
liability for expenses that may be incurred due to my failure to follow the budget or program requirements. The budget does not imply
eligibility for the entire budget period.
Employer (Consumer or Legally Authorized Representative) Date
Designated Representative (If Applicable) Date
CDS Agency Representative Date
Date and Time Created:
12/12/2011 2:33 AM
Texas Department of CMPAS CDS Budget
Aging and Disability Services August 2008
Consumer Managed Personal Attendant Services
Consumer Directed Services Budget
Notes
0 0
Consumer Name Medicaid Number
Coverage Period From: 1/0/1900 To: 1/0/1900
Date and Time Created
12/12/2011 2:33 AM
Texas Department of CMPAS CDS Budget
Aging and Disability Services August 2008
Consumer Managed Personal Attendant Services
Consumer Directed Services Budget
Authorized Units and Budget Calculations
0 0
Consumer Name Medicaid Number
Coverage Period From: 1/0/1900 To: 1/0/1900
Total Annual CDS Budget $0.00
Service Priority
Weekly Authorized PAS Hours
Rate
Total PAS Dollars $0.00
Date and Time Created
12/12/2011 2:33 AM
Texas Department of CMPAS CDS Budget
Aging and Disability Services August 2008
Consumer Managed Personal Attendant Services
Consumer Directed Services Budget
Employer Support Services & Non-Taxable Costs
0 0
Consumer Name Medicaid Number
Coverage Period From: 1/0/1900 To: 1/0/1900
Total Annual CDS Budget: $0.00
Estimated Employer Support Services Costs
Maximum Amount Available for Employer Support Services Costs: $0.00
Amount: Comments:
Advertising
Equipment & Supplies
Copies & Mailing
Criminal History Check
Other - Specify
Other - Specify
Total Estimated Employer Support Services Costs: $0.00
Non-Taxable Employee Compensation Costs
Amount Available for Employee Compensation Costs: $0.00
Amount: Comments:
Health Insurance Premium(s)
Worker's comp or liability insurance
Other - Specify
Other - Specify
Total Estimated Non-Taxable Compensation Costs: $0.00
Funds Available for Taxable Compensation Costs $0.00
Date and Time Created
12/12/2011 2:33 AM
Texas Department of CMPAS CDS Budget
Aging and Disability Services August 2008
Consumer Managed Personal Attendant Services
Consumer Directed Services Budget
Taxable Wage and Compensation Costs
0 0
Consumer Name Medicaid Number
Coverage Period From: 1/0/1900 To: 1/0/1900
Available Amounts
Total Available for Taxable Compensation: $0.00 Dollars Needed to Meet Minimum Compensation: $0.00
Total Taxable Compensation: $0.00 Dollars Left in Budget: $0.00
Taxable Wage and Compensation Validation
Minimum Amount for Employee
Yes
Do the Total Employee Compensation Costs Fall Within the Required Parameters Compensation Costs met?
for Employee Compensation?
Within Total Budget for Consumer? Yes
Employee Hours, Pay Rates and Other Compensation
1 Weeks S.U.T.A. Total Annual
Employee Name Begin Date End Date Employed Rate Wages Annual Taxes Annual Total
1.00 $0.00 $0.00 $0.00
Hours per
Hourly Pay Week Pay Rate Weeks OT Pay Rate Wages
Priority 1.00 $0.00
Overtime 1.00 $0.00 $0.00
NOTE - The consumer must not develop a regular employee schedule that contains fewer than or
more than the weekly authorized units.
Number of
Other Compensation Amount Payments Wages
Bonuses $0.00
Paid Holidays $0.00
Vacation Pay $0.00
Sick Leave $0.00
Other -Specify $0.00
2 Weeks S.U.T.A. Total Annual
Employee Name Begin Date End Date Employed Rate Wages Annual Taxes Annual Total
1.00 $0.00 $0.00 $0.00
Hours per
Hourly Pay Week Pay Rate Weeks OT Pay Rate Wages
Priority 1.00 $0.00
Overtime 1.00 $0.00 $0.00
NOTE - The consumer must not develop a regular employee schedule that contains fewer than or
more than the weekly authorized units.
Number of
Other Compensation Amount Payments Wages
Bonuses $0.00
Paid Holidays $0.00
Vacation Pay $0.00
Sick Leave $0.00
Other -Specify $0.00
Date and Time Created
12/12/2011 2:33 AM
Texas Department of CMPAS CDS Budget
Aging and Disability Services August 2008
Consumer Managed Personal Attendant Services
Consumer Directed Services Budget
Taxable Wage and Compensation Costs
0 0
Consumer Name Medicaid Number
Coverage Period From: 1/0/1900 To: 1/0/1900
3 Amounts S.U.T.A.
AvailableWeeks Total Annual
Employee Name Begin Date End Date Employed Rate Wages Annual Taxes Annual Total
1.00 $0.00 $0.00 $0.00
Hours per
Hourly Pay Week Pay Rate Weeks OT Pay Rate Wages
Priority 1.00 $0.00
Overtime 1.00 $0.00 $0.00
NOTE - The consumer must not develop a regular employee schedule that contains fewer than or
more than the weekly authorized units.
Number of
Other Compensation Amount Payments Wages
Bonuses $0.00
Paid Holidays $0.00
Vacation Pay $0.00
Sick Leave $0.00
Other -Specify $0.00
4 Weeks S.U.T.A. Total Annual
Employee Name Begin Date End Date Employed Rate Wages Annual Taxes Annual Total
1.00 $0.00 $0.00 $0.00
Hours per
Hourly Pay Week Pay Rate Weeks OT Pay Rate Wages
Priority 1.00 $0.00
Overtime 1.00 $0.00 $0.00
NOTE - The consumer must not develop a regular employee schedule that contains fewer than or
more than the weekly authorized units.
Number of
Other Compensation Amount Payments Wages
Bonuses $0.00
Paid Holidays $0.00
Vacation Pay $0.00
Sick Leave $0.00
Other -Specify $0.00
5 Weeks S.U.T.A. Total Annual
Employee Name Begin Date End Date Employed Rate Wages Annual Taxes Annual Total
1.00 $0.00 $0.00 $0.00
Hours per
Hourly Pay Week Pay Rate Weeks OT Pay Rate Wages
Priority 1.00 $0.00
Overtime 1.00 $0.00 $0.00
NOTE - The consumer must not develop a regular employee schedule that contains fewer than or
more than the weekly authorized units.
Number of
Other Compensation Amount Payments Wages
Date and Time Created
12/12/2011 2:33 AM
5
Texas Department of CMPAS CDS Budget
Aging and Disability Services August 2008
Consumer Managed Personal Attendant Services
Consumer Directed Services Budget
Taxable Wage and Compensation Costs
0 0
Consumer Name Medicaid Number
Coverage Period From: 1/0/1900 To: 1/0/1900
BonusesAvailable Amounts $0.00
Paid Holidays $0.00
Vacation Pay $0.00
Sick Leave $0.00
Other -Specify $0.00
6 Weeks S.U.T.A. Total Annual
Employee Name Begin Date End Date Employed Rate Wages Annual Taxes Annual Total
1.00 $0.00 $0.00 $0.00
Hours per
Hourly Pay Week Pay Rate Weeks OT Pay Rate Wages
Priority 1.00 $0.00
Overtime 1.00 $0.00 $0.00
NOTE - The consumer must not develop a regular employee schedule that contains fewer than or
more than the weekly authorized units.
Number of
Other Compensation Amount Payments Wages
Bonuses $0.00
Paid Holidays $0.00
Vacation Pay $0.00
Sick Leave $0.00
Other -Specify $0.00
7 Weeks S.U.T.A. Total Annual
Employee Name Begin Date End Date Employed Rate Wages Annual Taxes Annual Total
1.00 $0.00 $0.00 $0.00
Hours per
Hourly Pay Week Pay Rate Weeks OT Pay Rate Wages
Priority 1.00 $0.00
Overtime 1.00 $0.00 $0.00
NOTE - The consumer must not develop a regular employee schedule that contains fewer than or
more than the weekly authorized units.
Number of
Other Compensation Amount Payments Wages
Bonuses $0.00
Paid Holidays $0.00
Vacation Pay $0.00
Sick Leave $0.00
Other -Specify $0.00
8 Weeks S.U.T.A. Total Annual
Employee Name Begin Date End Date Employed Rate Wages Annual Taxes Annual Total
1.00 $0.00 $0.00 $0.00
Hours per
Hourly Pay Week Pay Rate Weeks OT Pay Rate Wages
Priority 1.00 $0.00
Date and Time Created
12/12/2011 2:33 AM
Texas Department of CMPAS CDS Budget
Aging and Disability Services August 2008
Consumer Managed Personal Attendant Services
8 Consumer Directed Services Budget
Taxable Wage and Compensation Costs
0 0
Consumer Name Medicaid Number
Coverage Period From: 1/0/1900 To: 1/0/1900
OvertimeAvailable Amounts 1.00 $0.00 $0.00
NOTE - The consumer must not develop a regular employee schedule that contains fewer than or
more than the weekly authorized units.
Number of
Other Compensation Amount Payments Wages
Bonuses $0.00
Paid Holidays $0.00
Vacation Pay $0.00
Sick Leave $0.00
Other -Specify $0.00
9 Weeks S.U.T.A. Total Annual
Employee Name Begin Date End Date Employed Rate Wages Annual Taxes Annual Total
1.00 $0.00 $0.00 $0.00
Hours per
Hourly Pay Week Pay Rate Weeks OT Pay Rate Wages
Priority 1.00 $0.00
Overtime 1.00 $0.00 $0.00
NOTE - The consumer must not develop a regular employee schedule that contains fewer than or
more than the weekly authorized units.
Number of
Other Compensation Amount Payments Wages
Bonuses $0.00
Paid Holidays $0.00
Vacation Pay $0.00
Sick Leave $0.00
Other -Specify $0.00
10 Weeks S.U.T.A. Total Annual
Employee Name Begin Date End Date Employed Rate Wages Annual Taxes Annual Total
1.00 $0.00 $0.00 $0.00
Hours per
Hourly Pay Week Pay Rate Weeks OT Pay Rate Wages
Priority 1.00 $0.00
Overtime 1.00 $0.00 $0.00
NOTE - The consumer must not develop a regular employee schedule that contains fewer than or
more than the weekly authorized units.
Number of
Other Compensation Amount Payments Wages
Bonuses $0.00
Paid Holidays $0.00
Vacation Pay $0.00
Sick Leave $0.00
Other -Specify $0.00
Date and Time Created
12/12/2011 2:33 AM
Texas Department of CMPAS CDS Budget
Aging and Disability Services Quarterly Report
August 2008
Consumer Managed Personal Attendant Services
Consumer Directed Services Budget
Quarterly Report
0 0
Consumer Name Medicaid Number
Quarterly Report Coverage Period From: To:
Quarter Number:
NOTE - All Budgeted Amounts on the Quarterly Report are Estimates
Employer Support Services
Budgeted Actual
Quarter 1 Dollars $0.00
Quarter 2 Dollars $0.00
Quarter 3 Dollars $0.00
Quarter 4 Dollars $0.00
Employee Compensation Totals (Dollars): $0.00 $0.00
Employee Compensation
Annual Dollars Budgeted for Employee Compensation: $0.00
Minimum Dollars Required for Employee Compensation: $0.00
Dollars
Budgeted Actual
Quarter 1 Dollars $0.00
Quarter 2 Dollars $0.00
Quarter 3 Dollars $0.00
Quarter 4 Dollars $0.00
Employee Compensation Totals (Dollars): $0.00 $0.00
Priority
Authorized Actual
Quarter 1 Units 0.00
Quarter 2 Units 0.00
Quarter 3 Units 0.00
Quarter 4 Units 0.00
Employee Compensation Totals (Units): 0.00 0.00
Remaining Units 0.00
Dollars Remaining (negative indicates the consumer has
overspent): $0.00
Percent of Budgeted Dollars Spent (negative amount
indicates the consumer has overspent): #DIV/0!
NOTE - The consumer must not develop a regular employee schedule that contains fewer than
or more than the weekly authorized units.
CERTIFICATION: By signature below I certify that the numbers entered into this quarterly report are
accurate as reported to me.
CDS Agency Representative Printed Name Phone Number
(with Area Code)
CDS Agency Representative Signature Date
Date and Time Created
12/12/2011 2:33 AM
Texas Department of CMPAS CDS Budget
Aging and Disability Services August 2008
Consumer Managed Personal Attendant Services
Consumer Directed Services Budget
Taxable and Non-Taxable Employee Compensation
THIS PAGE IS NOT CONSIDERED PART OF CLIENT BUDGET
TAXABLE EMPLOYEE COMPENSATION
SALARIES/WAGES MILEAGE (MAXIMUM IS 48.5¢ PER MILE)
(Includes Employee-Paid Payroll Taxes:) (Not Directly Related to Client Care)
Regular Time Communiting Costs & Assistance
Overtime
Bonus
Paid Vacation Leave
Paid Sick Leave
Paid Other Leave (Jury Duty, Funeral, etc.)
NON-TAXABLE EMPLOYEE COMPENSATION
EMPLOYEE BENEFITS/INSURANCE MILEAGE (MAXIMUM IS 48.5¢ PER MILE)
Insurance Premiums and Paid Claims, (Use of Employee's Personal Car Directly Related
Including Health/Medical/Dental/Disability Related to Client Care)
Life Insurance Premiums Client Appointments
Employer-Paid Contributions to: Shopping
Deferred Compensation Plans Escort
Retirement & Pension Plans
Child Day Care WORKERS' COMPENSATION COSTS
Accrued Leave Premium Costs
Paid Claims
PAYROLL TAXES (EMPLOYER-PAID) Other Premium/Claims for Employee
FICA Work-Related Injury/Illness Coverage
MEDICARE
SUTA CONTRACTED SERVICE FEE
FUTA (When Contracted With an Agency)
Other as applicable Back-Up PAS
In-Home Respite
Date and Time Created
12/12/2011 2:33 AM
