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					                  Consumer Notebook
                                 Release 1.0 April, 2004




CDC+ Consumer Notebook 4/26/04                i
                  CDC+ Consumer Notebook: Table of Contents


SECTION 1: GETTING STARTED……………………………………………………….1
A. Introduction: Getting the Best out of Your CDC+ Plan and Your
    Consumer Notebook………………………………………………………………………2
    What is CDC+ and how does it work?……………………………………………………2
    How does the CDC+ budget work?……………………………………………………….3
    How does CDC+ differ from the way things work now?…………………………………3
    Is help available if I NEED it?…………………………………………………………….3
    What is the first step in directing my own care?…………………………………………..4
    Summary…………………………………………………………………………………..5
B. Roles and Responsibilities………………………………………………………………...6
    Consumer and Representative roles………………………………………………………6
    Consumer rights and responsibilities……………………………………………………..7
    The roles of the consultant……………………………………………………………….12
    The roles of the bookkeeper……………………………………………………………...13
    The roles of the state……………………………………………………………………..14
    Summary…………………………………………………………………………………15
C. Your Consumer-Directed Care Plus Notebook & Start Up Training…………………….16
    This notebook…………………………………………………………………………….16
    Getting started with your notebook………………………………………………………16
    Getting started: The five keys to success…………...……………………………………16
    How long before I am really on top of what I need to do?……………………………….17
    Your training………………………………………………………………………..……17
SECTION 2: BUDGETS AND PURCHASING PLANS…………………………………18
D. Using Your CDC+ Budget………………………………………………………………..18
    Thinking about your opinions……………………………………………………………18
    You choose………………………………………………………………………………18
    Saving for special items………………………………………………………………….19
    Job skills…………………………………………………………………………………19
    Things you may buy……………………………………………………………….……..19
    Things you may not buy (Prohibited Purchases)…………………………………………20
    Grey areas? If in doubt, ask your consultant……………………………………………..21
    Get the best out of CDC+………………………………………………………………..21
E. Budget Responsibilities…………………………………………………………………..23
    Writing a purchasing plan……………………………………………………………….23
    Making purchases consistent with your purchasing plan………………………………..24
    Keep track of monthly spending…………………………………………………………24
    Track the hours your employees work………………………………………………..….25
    Reports you will receive………………………………………………………………….25
    Keeping track of cash purchases…………………………………………………………25
    Updating your purchasing plan………………………………………………………..…26
    Annual reassessment……………………………………………………………………..27



CDC+ Consumer Notebook 4/26/04        ii
    Summary…………………………………………………………………………………27
F. Getting Started as a CDC+ Consumer…………………………………………………….29
    Deciding what is the most important for you…………………………………………….29
    How to get your needs met……………………………………………………………….29
    Purchasing plan instructions.……………………………………………………..……...31
G. Working with the Program Bookkeeper…………………………………………………..33
    What you can expect from the Bookkeeper……………………………………………...33
SECTION 3: GETTING WHAT YOU NEED AND BEING THE BOSS………………34
H. Finding and Choosing Someone to Work for You………………………………………..34
    Getting services from an individual……………………………………………………...34
    Writing a job description………………………………………………………………...35
    Finding workers………………………………………………………………………….36
    Hiring friends and family………………………………………………………………...36
    Hiring in the open market………………………………………………………………..37
    How to advertise…………………………………………………………………………37
I. Screening, Interviewing, and Background Checks………………………………………...39
    Screening…………………………………………………………………………………39
    Telephone screening……………………………………………………………………..39
    Face-to-face interview……………………………………………………………………40
    Be safe at interview………………………………………………………………………40
    Interviewing- be well prepared…………………………………………………………..41
    Background checks and references………………………………………………………41
J. Deciding How Much to Pay Your Workers, Offering Benefits, and Using
   Employer/Employee Agreements…………………………………………………………44
    Deciding how much to pay………………………………………………………………44
    Setting the level………………………………………………………………………….44
    Pay raises…………………………………………………………………………………45
    Offering benefits…………………………………………………………………………46
    Written employer/employee agreements…………………………………………………46
    Getting services from an agency…………………………………………………………47
    Being a successful employer……………………………………………………………..47
K. Workers’ Compensation Insurance……………………………………………………….49
    Workers’ compensation laws…………………………………………………………….49
    Summary…………………………………………………………………………………50
L. Payroll, Taxes, Labor Laws……………………………………………………………….51
    Introduction………………………………………………………………………………51
    Things the bookkeeper should do for you………………………………………………..51
    Things the bookkeeper will do for you but you need to watch…………………………..52
    Things you must do yourself……………………………………………………………..54
    Child labor provisions……………………………………………………………………55
    Record keeping…………………………………………………………………………..56
    Terms used in FLSA……………………………………………………………………..57
    Computing overtime pay…………………………………………………………………57
    Enforcement……………………………………………………………………………...58




CDC+ Consumer Notebook 4/26/04       iii
    Conclusion……………………………………………………………………………….58
SECTION 4: GET THE QUALITY YOU DESERVE…………………………………...59
M. Ensuring Quality Services………………………………………………………………..59
    Invest your time in training………………………………………………………………59
    Choosing a qualified person for the job………………………………………………….60
    Skilled Nursing Care……………………………………………………………………..60
    Certified Nursing Assistant and Home Health Aides……………………………………60
    Companions, Sitters, and Homemakers………………………………………………….63
    Private Contractors……………………………………………………………………….64
    Training your workers……………………………………………………………………64
    Providing feedback to your workers……………………………………………………..66
N. Working with your Consultants…………………………………………………………..67
    Consumer/Consultant agreement………………………………………………………...67
    How to contact your consultant………………………………………………………….67
    When to contact your consultant…………………………………………………………68
SECTION 5: MAKING CHANGES AND TROUBLESHOOTING……………………70
O. Problem Solving and Making Changes…………………………………………………...70
    Firing a worker…………………………………………………………………………...70
    Making changes………………………………………………………………………….71
P. Fraud, Abuse, Neglect, and Exploitation………………………………………………….72
    Why you need to know what these words mean…………………………………………72
    Understanding what fraud, abuse, neglect, and exploitation mean………………………72
    Who to tell if you suspect fraud, abuse, neglect, or exploitation………………………...73
SECTION 6: EMERGENCY BACKUP PLANS…………………………………………74
    Planning for emergencies…………………………………………………………….…..74
    Keeping safe: Understanding Universal Precautions…………………………………….74
SECTION 7: OTHER INFORMATION………………………………………………….77
    Where to find additional help and information…………………………………………..77
    Glossary………………………………………………………………………………….78
    Forms…………………………………………………………………….………………81




CDC+ Consumer Notebook 4/26/04          iv
SECTION 1: GETTING STARTED

Welcome to the Consumer-Directed Care Plus Program (CDC+)! This
Section helps you get started as a CDC+ Consumer. There are three
main parts:

    A. Introduction
    B. Roles and Responsibilities
    C. The Notebook and Training

This Consumer Notebook will provide you with the basic information you
need to manage your own services. We have intentionally not put
information in it that is for any specific city or county area because it is
not practical to do so. As you find information and resources where you
live, write them down in your Notebook and share them with your
Consultant and other Consumers. The more experience you have, the
better you will get at being a "Consumer" of home and community-
based services. Before you know it, you will be an expert at finding ways
to meet your own needs.

As you begin on this exciting goal of directing your own care, do not be
afraid to ask for help. Surround yourself with people who support your
independence and want to see you succeed at directing your own
services. No matter what choices you make, we are sure your
participation in the Consumer-Directed Care Plus program will be
satisfying and rewarding for you and those you love.




CDC+ Consumer Notebook 4/26/04       1
A. Introduction: Getting the Best out of Your CDC+ Plan
and Your Consumer Notebook
What is CDC+ and how does it Work?
Consumer-Directed Care Plus is a new type of Medicaid waiver funded
long-term care program. It puts you, the Consumer, in charge of
directing services and managing a monthly budget that is based on your
existing Care Plan or Support Plan. You use this budget to meet your
long-term care needs.

You make your own choices about who you want to help you with things
like personal care, homemaking or chores. This is what is meant by
“Consumer-Directed”. You direct your own care. Whenever a
Representative is appointed, the Representative assumes all consumer
responsibilities. Therefore, references to the reader and to “Consumer”
throughout this notebook also refer to the Representative.

To help you understand the program, and then get the best out of it day
to day, you have a Consultant and a fiscal/employer agent (a
Bookkeeper). The Consultant’s job is to assist you, not to make choices
and decisions for you. The Bookkeeper handles your CDC+ accounting
and pays your employees, purchases and taxes.

There are four Medicaid waiver program populations participating in
CDC+: Developmental Disabilities (adults and children, Department of
Children and Families), Aged and Disabled (elders, Department of Elder
Affairs), Aged and Disabled (physically disabled adults, Adult Services,
Department of Children and Families) and Traumatic Brain and Spinal
Cord Injury (Department of Health).

Consumer needs and specific policies vary by Medicaid waiver program.
This consumer notebook is intended to provide information and
guidance applicable to all consumers. Your individual Medicaid waiver
program may provide additional information about policies, procedures
and guidelines.




CDC+ Consumer Notebook 4/26/04     2
How Does the CDC+ Budget Work?
You will be given control of a monthly CDC+ budget – based on your
current Medicaid waiver care plan cost - to purchase services,
equipment and supplies for your long-term care needs. The monthly
budget amount is used to develop a Purchasing Plan, which sets out
what, how much and from whom you obtain supplies and services.

You decide who you want to provide services – perhaps a neighbor, or a
member of your family. You will manage workers and tell them how you
want the job done.

Within limits, you can buy services, supplies and equipment from
whomever, and wherever, you choose.

How does CDC+ Differ from the Way Things Work Now?
In the past, your Case Manager or Support Coordinator explained the
services available, scheduled services for you, and checked to make
sure you were satisfied with those services. If you had any problems –
for example, a worker did not show up - you called your Case Manager
or Support Coordinator.

Now, you are in charge. You choose the services, set the schedule and
judge the results. You hire and fire. You develop a back up plan for no
show workers

Is Help Available if I Need It?
Yes, you may get help from your Consultant and the Bookkeeper.

Your Consultant will first train you on how to plan for the services you
want. He/she will also train you on how to select and supervise your
workers. Your Consultant will then provide ongoing advice and
information about managing your services.

Your Consultant will also give you information and support when you
need it for both routine matters and for special or one-time needs. Your
Consultant will be available to answer questions, discuss your plans for
using your budget, and give you information about other resources. You
can also plan special purchases, such as a special piece of equipment,



CDC+ Consumer Notebook 4/26/04      3
by saving part of your budget each month for that purpose.

Your Consultant will give you tips on how other Consumers have
learned to do things well, and also tell you about peer support activities
in your community.

Consultants take the place of Case Managers and Support
Coordinators. Instead of you being told by your Case Manager or
Support Coordinator what is available to you, you get to decide how you
want to tailor your budget to suit your needs. (In some cases your
Consultant may be the same person as your former Case Manager or
Support Coordinator, but the role is still different.)

Regional program offices (District Office, Area Agency on Aging) review
and approve budgets and purchasing plans. Approval standards vary
by program; not all purchases are appropriate for all consumers.

The CDC+ Fiscal/Employer Agent (that is, the Bookkeeper) keeps
track of the money in your budget, pays your employer taxes, processes
payroll for your workers and pays your vendors. The Bookkeeper will
also hold any CDC+ savings you have.

The Bookkeeper will send you monthly reports showing you what
purchases you made and how much you spent. And, if you have access
to the Internet, you can see your balance and other account information
24/7 on the CDC+ website: www.cdcplus.org

What is the First Step in Directing My Own Care?
The first step you need to take is learning: learn, through the training
offered you, to understand your role as Consumer. To be a success,
you need to know what your own role is, but also the role of those who
help you.

When you enrolled in CDC+, you chose to have more choice, flexibility
and control over your care; that choice meant your role would change
as well. You now have the freedom to make choices that were not
available to you before; but you also have the responsibility to choose
well and get good value from the funds provided for your care.




CDC+ Consumer Notebook 4/26/04       4
Summary
In CDC+, you have more choice, flexibility, control, and responsibility:

     You decide what services and purchases you need.
     You schedule services.
     You train workers how you want things done.
     You decide if you are happy with the quality of what is done.
     You resolve any problems you may have with your workers and
      even replace them, if necessary.
     Your Program, Consultant and Bookkeeper help keep you on
      track.




CDC+ Consumer Notebook 4/26/04       5
B. Roles and Responsibilities
To make a success of your CDC+ program, you need to have a good
understanding of what is expected of you as a Consumer. You also
need to understand the roles and responsibilities of people around you
who are there to help you succeed.

Consumer and Representative Roles

As Consumer, you have a number of roles:

You are a Consumer: Your role as Consumer is to make decisions
about the best way to meet your needs, receive and use goods and
services, and then judge how well they worked for you – making
changes as needed.

As a Consumer, you have choices about what to buy with your CDC+
budget, where you buy, and from whom you buy.

You are an Employer: Your role is to find and hire people to work for
you. You will train your workers and schedule when you want the work
done. You will also decide how much to pay your employees.

You will let your workers know if they are doing things the way you want.

You will authorize your workers’ paychecks.

You are a Custodian of Public Money: As a Custodian, your role is to
use your budget responsibly. The Medicaid waiver budget must be used
to meet your long-term care needs.

You will write a Purchasing Plan to describe how you intend to purchase
goods and services. You will have the freedom to be creative and you
can change your mind along the way. However, you must make
purchases that help you remain at home and keep you out of a nursing
home or other institution.




CDC+ Consumer Notebook 4/26/04      6
You are a Pioneer: Your role is to pioneer this self-directing approach.
Your experiences, and your success, will help decide whether others in
Florida and the nation will have the opportunity to manage their own
services in the future.

The Role of the Representative
The Representative is the Consumer’s agent: the Representative’s
overall role is to make the best decisions and choices on behalf of the
Consumer and to manage all CDC+ care and financial responsibilities.
The Representative takes the place of the consumer for all program
administration and financial matters. So, the role of the Representative
is the role of the Consumer.

The Representative’s Relationship with the Consumer
It is essential that the Representative involve the Consumer as much as
possible in decisions about needs, services, budget and satisfaction
with services. Whenever practical, the consumer should be involved in
writing the purchasing plan, hiring workers and setting their work
schedules. The Representative cannot also be the Consumer’s
employee.

Consumer Rights and Responsibilities
Basic Rights and Responsibilities
As a CDC+ Consumer you have some basic rights and responsibilities.
For example, you have the right to purchase services, but you share in
the responsibility to make sure the services you get are meeting your
needs.


You have the right to:
      Be safe
      Be treated with courtesy, consideration, and respect
      Trust your instincts
      Agree or disagree with others
      Make decisions about your services
      Ask questions until you understand
      Have the right to privacy



CDC+ Consumer Notebook 4/26/04      7
             Have the right to personal dignity
             Be free from mental and physical abuse
             Voice complaints
             Know about all Bookkeeper service fees
             Receive a report of how you have spent your monthly budget
             Return to your previous way of getting services if you prefer
             Make a written complaint at any time about Consultant or
              Bookkeeper services, and expect a prompt response.

Along with your rights come responsibilities.

You have the responsibility to:
      Communicate clearly and openly with your Consultant and
       your workers
      Keep track of the balance of your monthly budget so you do
       not over-spend
      Send all required paperwork to the Bookkeeper on time
      Comply with all tax and labor laws
      Notify your Consultant of admission to a hospital, nursing
       facility, rehabilitation facility, or intermediate care facility
      Be considerate and respect the limits of others
      Follow CDC+ rules.


Appeal Rights
When you started getting Medicaid Waiver services you were told about
your appeal rights (that is, to a fair hearing, as described in 42 Code of
Federal Regulations (CFR), Part 431, subpart E.). As a CDC+
participant you have those same rights. You also have some special
appeal rights because you are part of CDC+. You may appeal:

     A CDC+ disenrollment recommendation;

     Consultant recommendation that a
      representative be appointed for a consumer to
      participate in CDC+;

        Consultant recommended terms of a corrective action plan.



CDC+ Consumer Notebook 4/26/04          8
Consumers or representatives may file CDC+ appeals by completing the
Consumer Appeal Form. These forms are then submitted to the
consultant provider agency or District Office. The Consumer Appeal
Form must contain a summary of the recommendation or action which is
being appealed, the consumer’s objection to the recommendation or
action, and any proposed solution or compromise. The Consumer
Appeal Form must be submitted to the consultant agency or District
Office within fourteen (14) days of the contested action. An appeal form
is included in the Forms section of this notebook.

If you do not know your Consultant's address, call your Consultant and
ask for the address. If you are not able to get the address, you can mail
the Appeal Form to the local Area Agency on Aging (AAA) for
Department of Elder Affairs Consumers, or to the Department of
Children and Families' (DCF) local District Office for Adult Services and
Developmental Services Consumers. Brain and Spinal Cord Injury
Program Consumers should send their Appeal Form to the state
program office at the Department of Health.

The local AAA or DCF District Office will review the appeal. If the AAA
or DCF District Office agrees with the Consultant's recommendation,
they will notify the Program manager. The state Program manager will
review the AAA or DCF District Office decision. The state Program
manager may suggest alternatives or compromises that are consistent
with CDC+ Guidelines. Your Consultant will contact you within fourteen
(14) days after your appeal has been reviewed.


Complaint Process

You have the right to tell the state about the quality of your Bookkeeping
and Consultant services.

Consultant Services:

         Step 1
         If you are not happy with the Consultant services you are getting,
         you may want to talk with your Consultant about it first.



CDC+ Consumer Notebook 4/26/04         9
         Your Consultant may not be aware of the problem. It is a good
         idea to tell people if you are not satisfied with the quality of a
         service they are giving you. This gives you the chance to tell the
         other person what is most important to you. It also gives the other
         person a chance to improve.

         Your Consultant is not allowed to do anything to penalize you for
         making a complaint. In fact, if you talk to your Consultant, chances
         are very good that you will be more satisfied with services in the
         future. Your Consultant is there to help you. The more your
         Consultant knows about what you want and need, the better your
         Consultant service will be.

         Step 2
         If you do not think you can talk to your Consultant, you may
         want to contact your Consultant's supervisor.

         Your Consultant may work for an agency. If you do not have the
         name and phone number of the agency already, simply ask your
         Consultant for the information. You do not have to explain why
         you want the name and phone number of the agency. Just tell
         your Consultant you would like to have it. Then call the agency
         and ask to speak with the person who is your Consultant’s
         supervisor (boss). Simply tell the supervisor why you are not
         happy with the consultant services you are getting.

         Some Consultants may not work for an agency. Only Consultants
         who serve Consumers in the Developmental Services waiver
         program may work independently. In this case, ask your
         Consultant for the name and telephone number of the Department
         of Children and Families' local district office. Then call the district
         office and ask to speak to the contact person for CDC+. Tell the
         contact person why are not happy with the consultant services you
         are receiving.

         Do not worry about hurting anyone's feelings or causing trouble for
         your Consultant. Your satisfaction with the quality of consulting



CDC+ Consumer Notebook 4/26/04          10
         services is very important. One way to improve things is to be
         honest about what you like and do not like.

         Step 3
         You also have the choice of making a written complaint
         directly to the state Program Office in Tallahassee.

         You may want to try Steps 1 and 2 first. However, you do not have
         to try Steps 1 and 2 if you would rather talk directly to the state
         Program staff. There is a form to use for reporting your complaint.
         The form is called the Complaint Form. A copy of the form is in the
         back of this Notebook in the section called FORMS.

         Please feel free to use the complaint form any time you like. You
         will not be disenrolled or penalized in any way for making a
         complaint.

         There are three copies of the Complaint Form in the back of this
         Notebook. If you need more Complaint Forms, you can make
         copies. Usually, the public library has a copy machine. Some
         grocery stores and banks have copy machines. Or, ask your
         Consultant for more copies.

Bookkeeper Services:

         Step 1
         Use the toll free telephone number to call the bookkeeper.

         Talk with your account manager about the problem. Be direct
         about what you do not like. Ask the account manager what he or
         she will do to correct the problem. Then give the Program
         Bookkeeper a chance to improve. In fact, if you talk to the
         Bookkeeper about the problem, chances are very good that you
         will be more satisfied with your bookkeeping services in the future.

         If you are uncomfortable with calling your account manager about
         the problem, talk to your Consultant. Your Consultant can help you
         prepare for the call by talking with you about the problem.



CDC+ Consumer Notebook 4/26/04         11
         Together, you and your Consultant can make a list of things you
         want to say to the account manager. If you still do not feel
         comfortable calling, your Consultant may be able to arrange to be
         on the phone with you when you call the account manager.

         Step 2
         Use the Consumer Complaint Form to tell the state program
         office about a problem you are having with the program
         Bookkeeper.

         Use the Consumer Complaint Form. The Complaint Form can be
         found at the back of this Notebook in the section called FORMS.
         Fill out the entire form and mail it to the address on the bottom of
         the form.


A CDC+ staff member will call you to discuss your complaint. Your
experiences with the Program Bookkeeper are very important to us. We
want to hear from you. Please feel free to use the Complaint Form as
often as you like. You will not be disenrolled or penalized in any way for
making a complaint. We will work with you and the Program Bookkeeper
to correct the problem.

The Roles of the Consultant

The Consultant is a Trainer: The Consultant makes sure you have the
skills and knowledge you will need to manage your services. The
Consultant will train you before you write your first Purchasing Plan. The
Consultant will teach you how to select, train, and supervise your
workers. The Consultant will also discuss your emergency back up
plan.

The Consultant is an Advisor: The Consultant is highly experienced in
matching consumers to the services they need. He/she will also discuss
and plan for future needs, such as a large purchase you may want to
make. You can decide together how much you can save each month
from your budget to make the purchase.




CDC+ Consumer Notebook 4/26/04         12
The Consultant is a Coach: The Consultant answers your questions,
provides information, and offers suggestions. The Consultant is
available to discuss your ideas and help you solve any problems you
may experience.

The Consultant is a Resource Person: The Consultant can let you
know about the resources that are available to you in your community,
such as peer supports.

The Consultant is a Custodian of Public Money: The Consultant is
obliged to see that you spend your Consumer-Directed Care budget on
meeting your long-term care needs. The Consultant will review the bi-
weekly report from the Bookkeeper and compare it to your Purchasing
Plan. The Consultant will call you if he/she has questions about how you
are spending your budget.


The Roles of the Bookkeeper

The Bookkeeper for CDC+ is [GovConnect/ Acumen].

The Bookkeeper is a Fiscal/Employer Agent: Acumen will hold your
CDC+ budget funds (like a bank). They will create payroll checks and
pay invoices at your request (like a payroll company). They will track
how much of your budget you spend and send you a report of the
balance after each payroll period (like a bank statement). The report will
list how you have spent your budget funds and how much you have
saved for future expenses or emergencies. They will deduct your payroll
and bills from your budget, complete and file the tax forms with the
federal and state governments and pay the employer taxes for you (like
an accountant).

You can see all these services online, if you have access to the Internet.

The Bookkeeper is a Resource: The role of the Bookkeeper is to
answer your questions and provide explanations for things you do not
understand about your account. You pay a monthly fee and a
transaction charge based on the number of payments made to you or on



CDC+ Consumer Notebook 4/26/04      13
your behalf by the Bookkeeper. The fee includes a toll-free customer
service line. You can talk to the Bookkeeper during regular business
hours.

You can call Acumen to make sure the completed forms package for
your workers has been received to enroll them in the payroll system.

You can also call to verify that Acumen has received your workers' time
sheets and to get the balance of your account.

The Bookkeeper is a Custodian of Public Money: The Bookkeeper
will send a monthly Budget Report that describes how you are spending
your budget to you and to your Consultant. The Bookkeeper will call
your Consultant if it appears you are mis-using your budget or that
someone is taking advantage of you financially.


The Roles of the State

The State is a Contractor of Services: The role of the State is to
contract with the Bookkeeper on your behalf.

The State is a Trainer: The role of the state is to make sure your
Consultant has the skills and knowledge to train you and answer your
questions. The State provides training to all CDC+ Consultants; before
they can participate in the CDC+ program they have to complete this
training.

The State is a Resource: The role of the state is to share information,
experiences and best practices between Consumers, Consultants, and
the Bookkeeper. The CDC+ Newsletter and the CDC+ website will be
the main way such information will be shared.

The State is a Monitor: The role of the state is to monitor the quality of
the Consultant and Bookkeeper services provided to CDC+ Consumers,
through formal quality assurance.




CDC+ Consumer Notebook 4/26/04      14
The Quality Management Plan includes feedback from you about the
quality of Consultant services and bookkeeping services. The Quality
Management Plan includes feedback on complaint forms from
Consumers, and feedback from Consultants about Consumer
challenges and Consultant activities.


Summary
Now that you are in CDC+, your role is very different than it has been in
the past. It is important that you understand your own and everyone
else's roles.

     You are a Consumer, an employer, a custodian of public money,
      and a leader in Florida.

     Your Representative (if you have one) is your agent and will
      assume your Consumer roles.

     Your Consultant is a trainer, a coach, a resource person, and a
      custodian of public money.

     The Bookkeeper is a fiscal agent, a resource, and a custodian of
      public money.

     The State is a contractor of services, a trainer, a resource, and a
      monitor.

If you have any questions about the roles of CDC+ participants, talk with
your Consultant.




CDC+ Consumer Notebook 4/26/04       15
C. Your Consumer-Directed Care Plus Notebook & Start Up
Training

This Notebook
This Notebook is yours to keep. Feel free to write in it if you like. Before
you write on any form in this Notebook (the forms are all at the back),
make sure you make an extra blank copy in case you need it in the
future.

If any of the information in the Notebook changes, you will be sent
replacement pages. To be sure you always have correct information,
add any new pages to your Notebook as soon as you receive them. If
you have access to the CDC+ website, you can also download and print
new pages as they are published.

Getting Started with Your Notebook
Your Consultant will use this Notebook during your initial training to
explain to you how CDC+ works. It also will be a resource for you later
on, after the training. You will be able to go back and read the
Notebook any time you need it.

Getting Started: The Five Keys to Success
Before you can get going, directing your own decisions about your long-
term care needs, we want to make sure you understand fully how CDC+
works. There are five keys to your success, each with its own rules and
skills:

1. There are rules about how you can spend your budget. Community
resources and natural supports/caregivers must be used whenever
available. Most important, you must not overspend your budget, or go
beyond what your Purchasing Plan allows.

2. You need to know how to hire workers and contract with vendors
to get the services you need.

3. You will want to get the best quality that you can afford for your
services, so you will need to oversee people who work for you.




CDC+ Consumer Notebook 4/26/04       16
4. You may need to make changes in your Plan, or make special
requests.

5. And, in your own interest, you need a back-up plan for what happens
if a critical employee is absent, or if there is an emergency.

How long before I am really on top of what I need to do?
Based on our experience to date with new Consumers, getting to the
point where you feel really confident may take you between three and
six months. But the effort is well worth it; and you are not expected to do
this on your own.

Your Consultant is there to help you, from start to finish, beginning with
teaching you how to get going.

Your Training
It is a condition of joining CDC+ that you complete training; and it is part
of your Consultant’s job to provide you this training, and make sure you
have understood it.

There is a lot of information to cover. Take things a step at a time; do
not try to learn everything in one day. You do not have to memorize
anything, though in time you will find you have more and more
knowledge.

Everything your Consultant covers during the training (and more) can be
found in this Notebook, or on the website. The most important thing is
that you learn how to find the information later.

After the training, using this Notebook as a resource will be much
easier. Each information section is listed at the front in the Table of
Contents. The sections are organized to help you deal with the five
points that are keys to your success. There is a Glossary of Terms at
the back of the Notebook. Your Consultant will also be available to
answer your questions and help you find the information you need.




CDC+ Consumer Notebook 4/26/04       17
SECTION 2: BUDGETS AND PURCHASING PLANS
This Section focuses on your budget, how to write your Purchasing Plan
and how to keep track of your spending. There are four main parts:

    D. Using your CDC+ Budget
    E. Budget Responsibilities
    F. Getting Started as Consumer
    G. Working with the Bookkeeper

The Section relates to key skill 1.

D. Using Your CDC+ Budget

Thinking About Your Options
How you use your CDC+ budget is largely up to you. You decide which
services and other purchases to make. You decide how much you want
to pay for a service. You can buy different services from what you have
had in the past.

You find out where you can get the best price for other things you would
need to buy, such as supplies. You may also buy special equipment
such as transfer boards, dressing sticks, special eating utensils or
kitchen aids, wheelchair accessories, and other adaptive devices. You
can be very creative in choosing what kinds of purchases will best meet
your needs, even if those purchases would not be available in traditional
Medicaid programs.

You Choose
For example, you could decide to buy home delivered meals - if this is
something you need. Or, you might find a neighbor who is willing to
cook extra food and bring you a dinner a certain number of times each
week. You and your neighbor could decide on a fair price for this
service.




CDC+ Consumer Notebook 4/26/04        18
Maybe you need help with bathing and washing your hair. You could
hire a worker to come to your house and help you with bathing and
shampooing your hair a few times each week. Or, you could use your
monthly Consumer-Directed Care budget to buy a shower chair, a hand
held showerhead or maybe even install grab bars in your bathroom.
These adaptive devices could make it possible for you to get in and out
of the bathtub safely, wash your own hair and bathe without assistance.

Savings for Special Items
You might need to save a portion of your budget for several months to
have enough funds to pay for the grab bars. You might know someone
who would install the grab bars for you free or you might have to pay
someone to do the installation. Simple adaptive devices are often less
expensive than you might think. Buying adaptive devices could actually
be cheaper in the long run because you would not have to keep paying
a worker every week. You could use the money you save for another
need.

Job Skills
If you are going to a day program to learn job skills you could continue
to buy that service. Or, you might decide to hire someone to help you
find a job in your community. The person you hire could also provide job
coaching while you are working at your job and earning a paycheck.
This is one of the advantages of CDC+. You get to decide what works
best for you!

However, there are some rules you must follow for using your CDC+
funds. The most basic rule is that everything you buy must be related to
your long-term care needs or your need for community supports. Your
Consultant is available for guidance in using the budget according to
CDC+.

Things you MAY buy:
The CDC+ budget MAY be used for things such as:

     Help with cleaning, laundry, meal preparation and other household
      chores




CDC+ Consumer Notebook 4/26/04     19
     Help with personal care like bathing, hair washing, bladder and
      bowel care, care of your teeth
     Home repairs and maintenance
     Installing ramps or grab bars
     Independent living supports or coaching errands or shopping
     Non-medical transportation
     Adaptive equipment such as mobility aids, communications
      devices, hygiene equipment
     Repairs to adaptive equipment
     Consumable medical supplies such as pads, diapers, or nutritional
      supplements
     Emergency alert response installation
     Emergency alert response maintenance
     Companionship services
     Supported employment services and job coaching
     Day training
     Pest control
     Yard work
     Savings for your emergency back-up plan
     Savings for a special purchase which you cannot afford to make
      from one monthly budget
     Services or purchases which support your ability to live as
      independently as possible and avoid the need for admission to a
      nursing home or other long-term care facility
     Other purchases approved by your Consultant.

The Regional Office first approves the purchasing plan The final
approval of purchases rests with each state program office. For
example, yard work would not be approved for a developmentally
disabled child, but might be approved for a physically disabled adult.

Things you MAY NOT buy (Prohibited Purchases)

The Consumer-Directed Care budget MAY NOT be used for:
   Gifts for workers, family or friends
   Loans to your workers
   Rent or mortgage payments



CDC+ Consumer Notebook 4/26/04      20
     Payments to someone to be your representative
     Clothing
     Groceries (with the exception of special foods required to maintain
      nutritional status)
     Lottery tickets
     Alcoholic beverages
     Entertainment activities
     Televisions, stereos, radios, or VCRs
     Tobacco products
     Utility payments (electric, gas, sewer, garbage services)
     Services which will meet your needs and are available, without
      charge, from community organizations

Do not use your CDC+ budget to purchase services or items which are
available through another source in a way that already meets your
needs.

For example, the Medicaid state plan will pay for a wheelchair for some
people so they should not use their Consumer-Directed Care budget for
that wheelchair.

Grey Areas? If in doubt, ask your Consultant
Some of the rules as to what you can and cannot buy may not be clear
to you. If in doubt, ask your Consultant.

If needed upgrades or repairs to the wheelchair are not funded by the
Medicaid state plan, the purchase could be made with the CDC+
budget. Your Consultant can assist you in identifying community
resources, which are available.

Get the best out of CDC+
Continue to take advantage of the services, equipment, and supplies
available to you from community organizations, Medicare, and the
Medicaid state plan - your "regular" Medicaid.

Likewise, many religious groups or community organizations offer
special services, such as respite. (Respite is when someone comes to
the home to provide care giving so family members can have a little time



CDC+ Consumer Notebook 4/26/04      21
off.) It is a good idea to see what kind of special services are available
through a faith-based group or community organization before buying
these services with your monthly budget.




CDC+ Consumer Notebook 4/26/04       22
E. Budget Responsibilities

You have several responsibilities for using your CDC+ budget. These
include:
    Writing an approved Purchasing Plan
    Making purchases that are consistent with your Purchasing Plan
    Keeping track of what you are spending each month so you do not
      overspend
    Keeping a log and receipts for cash purchases
    Updating your Purchasing Plan when your spending needs
      change.

Let's discuss each of these responsibilities.

Writing a Purchasing Plan
Your Purchasing Plan serves several purposes.

    1. It describes how you plan to spend your CDC+ budget.
    2. Writing the Purchasing Plan will make sure you understand how
       much money you have to spend each month.
    3. Purchasing only what is on your Purchasing Plan will prevent you
       from overspending.
    4. The Purchasing Plan gives your Consultant an understanding of
       your skills in managing your monthly budget.
    5. It also tells your Consultant your plans for when a worker is not
       available and you must have services (Emergency Back Up Plan).

You need to know the cost of the different services you plan to buy
before completing your Purchasing Plan. You will also need to find
workers at the rate of pay you are offering.

Use a copy of the Purchasing Plan to practice while you are still
deciding what you will buy and from whom you are going to buy it. You
will probably need to practice writing several Purchasing Plans. A copy
of the Purchasing Plan form and the instructions for filling it out can be
found at the back of this Notebook in the FORMS section.



CDC+ Consumer Notebook 4/26/04      23
Check out at least three vendors (if you can find three) when you plan to
make a large purchase. And of course, make sure you have enough
savings to cover the item before you order. Some vendors will allow you
to make staged payments.

When your decisions are final and you are ready to commit to a plan for
how you will spend your budget each month, arrange for your
Consultant to review it.

While reviewing your Purchasing Plan, your Consultant may call or visit
you to get a better understanding of your plans. Your Consultant will tell
you if your plans for using the monthly budget do not agree with CDC+
rules.

After your Consultant approves your final plan, it is transferred onto the
original Purchasing Plan form. Both you and your Consultant will sign
the original form; you will keep a copy, your Consultant will keep a copy
in your file and the signed original will be sent to CDC+.


Making Purchases Consistent with Your Purchasing Plan
You should buy the services and other purchases detailed on your
Purchasing Plan. This confirms you are meeting your needs and
effectively managing your own services. It also guarantees your budget
is being used according to CDC+ rules.


Keep Track of Monthly Spending
The Bookkeeper will send you a monthly report listing all your expenses
and the balance of funds in your account. The report will be mailed to
you with the payroll checks for your workers. You can also view the
reports online.

You must keep track of your spending throughout the month so you do
not overspend. This monthly tracking can be very simple. You can use
whatever system you use now for keeping track of your monthly living
expenses.




CDC+ Consumer Notebook 4/26/04      24
Track the Hours Your Employees Work
You should make a written note each time they come to help you of how
many hours your employees worked. [Timesheets/ IVR]

Remember, your payroll may be greater in months that have 31 days.

Reports You Will Receive
The Bookkeeper will send you a report once a month, telling you exactly
what you have spent in payroll, taxes, cash and other purchases.

Because the report records the payments you have made, it will be sent
to you too late to prevent overspending. That is why it is important for
you to keep track of what you spend. Under CDC+ rules, if your
account has no money left, the Bookkeeper will not process
payment, even if you have approved it.

Use last month’s report to help you plan next month’s, and especially to
correct any problems.

Keeping Track of Cash Purchases
If you use cash, keep receipts. You also need a record of what you have
used the cash to buy. A simple system that records how you have used
the cash is fine. Write down in a notebook when you made the
purchase, what was purchased, and how much it cost. Record the cash
amount received each month and deduct the purchases to keep track of
the balance.

For example:
                                 Balance 11/1/03             $ 31.90
    11 November 2003             Bandage            $ 2.39
    14 November 2003             Poise Pads         $12.50     -14.89
                                 Balance 11/15/03              $17.01
                                 Received 12/1/03            + $30.00
                                 Balance 12/1/03              $ 47.01

Receipts should show the date of purchase, item(s) purchased, amount
of purchase, and name of person or company from whom the purchase
was made. Your Consultant will review your list of cash purchases and



CDC+ Consumer Notebook 4/26/04           25
your receipts. You cannot use cash to purchase items from categories
not listed in the cash (500s) section of your purchasing plan. You
cannot be reimbursed for cash purchases; you must use cash from the
monthly cash check to purchase with cash.


Updating Your Purchasing Plan
You should purchase what you wrote down on your Purchasing Plan.
However, you may increase or decrease the amounts of purchases
slightly as long as the purchases are identified in your approved
Purchasing Plan. For example, you may find a special offer on some
supplies you need and pay less than you budgeted or it may be more
cost effective to buy a larger quantity to save on future purchases.


You DO NOT Need to Update your Purchasing Plan if:
   A family member comes from out of town and provides you some
     assistance while he or she is visiting for a week or two. You may
     then spend less than you planned on a service that month and
     save the funds for a future purchase or for emergencies. You
     would not have to contact your Consultant or write a new plan
     unless the family member will stay for an extended time period.

     Your account balance remains below 1 ½ times your monthly
      budget amount at the end of each month.


You DO need to Update your Purchasing Plan if:
   You want to make a big change, such as increasing your worker's
     rate of pay, you will need to write a new plan and have it approved
     by your Consultant. You will need to write a new plan because to
     spend more on one service means you will have to spend less
     somewhere else. Call your Consultant if you need more
     Purchasing Plan forms.

     You want to add a new need or a new service; you will also have
      to write a new Purchasing Plan. To spend funds on a new service
      means you will have to spend less somewhere else. To include a



CDC+ Consumer Notebook 4/26/04     26
         new need means you will have to adjust your spending to buy
         services or supplies to meet the new need.

     Your monthly budget amount changes.

     You have just used your savings to make a special purchase and
      you now want to continue saving for another item which will
      support your independence. You will have to contact your
      Consultant to make sure your intended purchase is allowed. You
      will then need to write a new Purchasing Plan that lists the item
      you intend to buy, its estimated cost, the amount you intend to
      save each month and how long you need to save for the item.

Please call your Consultant at any time you are unsure if a new
Purchasing Plan is needed. Your Consultant can discuss what you want
to change and let you know if a new plan is required or not.

Annual Reassessment
Once a year, your Consultant will visit you for an annual re-assessment
(just like in your former program). At the annual re-assessment visit,
your Consultant will ask you to write a new Purchasing Plan if your
needs or what you are buying changes.


Summary
   Your Purchasing Plan must be approved by your Consultant
    before the monthly CDC+ budget will start
   You and your Consultant will decide when your CDC+ budget will
    start
   You should keep track of your spending throughout the month
   You must keep your spending within the monthly budget
   You may use your savings for emergencies or to make larger
    purchases
   You must make a list or log of all cash purchases and keep
    receipts
   Your purchases must meet a need listed on your Purchasing Plan
   If you need purchases not on your Purchasing Plan, call your
    Consultant to discuss the need for an updated Purchasing Plan.



CDC+ Consumer Notebook 4/26/04       27
You should call your Consultant if you have questions about writing your
Purchasing Plan.




CDC+ Consumer Notebook 4/26/04     28
F. Getting Started as a CDC+ Consumer
Deciding what is Most Important to You
The CDC+ allows you to decide what services and purchases will best
meet your needs. Spend some time thinking about what is most
important to you. Review your current care or support plan-in most
cases, this plan is the basis for the purchasing plan. This information
will help you write your Purchasing Plan.

Note: If you have not already completed the form "What is Most
Important to You?" it will be helpful to do so now. The "What Is Most
Important to You?" form was mailed to you with the training information
you received on enrollment.


How to Get Your Needs Met
When you have made a list of the things you see as most important, use
it to help you answer the following questions. These questions are
designed to assist you in making the best selection of services available
to you, some of which may not cost you any money:

    1. Can you get any of the things on your list for free?
    Do not answer this question too quickly. Are your friends and
    relatives aware of your specific needs? Sometimes what may be
    obvious to you is not so obvious to others.

    If you have not discussed your needs with your friends and family in
    a while, take some time to talk with them.

    People close to you may want to help, but they may not know how.
    Maybe your community or church or neighbors can assist. They may
    not wish to ask you if they can help for fear of offending you or
    hurting your feelings. Don’t be afraid to ask. Be as specific as you
    can. A specific request is much easier to say "yes" to than an open-
    ended general request for help, which can be overwhelming.




CDC+ Consumer Notebook 4/26/04      29
     If your friends and family cannot help, they may know someone else
     who can. Give them permission to "spread the word" about the help
     you are looking for.

     2. Can any of the things on your list be provided for free by a
     local club, civic body, or faith-based organization?
     Most often the answer to this question is "I don't know." What you
     need is a place to start.

     Sometimes the best place to start is to call a help line, sometimes
     known as an information and referral (I&R) service. There are many
     of these through the state. Try calling 211.

     If you do not know the phone number of your local information and
     referral line and 211 is not helpful, ask your Consultant. Many times
     the first call does not get you exactly what you want, but it gets you
     started asking for help. Have a pencil and paper ready to take notes.
     There is a place at the end of the Notebook for useful numbers.
     Copy these numbers by your phone, so you have them close when
     you need them again.

     The information specialist at the information and referral line will
     probably give you several more phone numbers to call. Be careful
     not to screen out any of them because you think they cannot help.
     Let the people at those phone numbers tell you they cannot help.
     Often, even if they cannot help, they will give you another number to
     call.

     If the number they give you is not local, ask if there is a toll-free
     number. Toll free numbers often begin 1-800 or 1-8_ _.

     If there is not a toll-free number, tell the person on the phone you
     are calling long-distance. Many times they will offer to call you back
     to discuss what you are looking for. Finding what you need often
     takes time and patience. But if you stick with it, you will most often
     get at least some of your needs met!




CDC+ Consumer Notebook 4/26/04         30
     3. What things on the list are you willing and able to pay for?
     Finding things you will pay for is often easier than finding things for
     free, but it still takes time and patience. After all, you want to "shop"
     for the best price but still make sure you make a quality purchase.
     Most importantly, you want to make sure what you buy meets your
     needs, whether it is services, equipment, or supplies.

    Just like when you are looking for "free" help, ask others to help you
    find the best deals. The more people that know you are looking for
    something, the better chance you have of finding it! Be sure to let
    others know what you need and be specific.

    Network
    There is a good chance that someone else (another Consumer) in
    CDC+ is looking for some of the same help you are. If you are
    interested in networking and sharing what you have found out with
    other Consumers, let your Consultant know. Your Consultant can
    give your phone number to other Consumers. Look on the CDC+
    website, or ask your Consultant to do this for you; it may have helpful
    information for you.


Purchasing Plan Instructions
Read "Using Your Consumer-Directed Care Budget" before reading the
Instructions and have the Sample Purchasing Plan form available to
look at as you read. All uses of your budget must fit the categories on
the Purchasing Plan form. Service code descriptions are attached to the
instructions. Read the descriptions before attempting to complete your
Purchasing Plan.

The Service Codes in the instructions are not authorizations and are not
to be construed as authorization to purchase any of the items listed.
Authority to purchase comes from your individual program approving
your purchasing plan. That is, you should put your program-authorized
purchases in the proper categories, as described.

The overflow section is included for you to use when you run out of
room for writing within a purchasing category. Overflow Items will not be



CDC+ Consumer Notebook 4/26/04         31
shown as such on your budget report. The overflow item expenditures
will be included in the proper category on the report.

Elder Affairs, Adult Services, Brain and Spinal Cord Injury Program
Consumers use different Purchasing Plan Instructions and Sample
Purchasing Plan than the Developmental Disabilities Program. Make
sure you choose the right instructions and forms from the FORMS
section of this notebook before you begin to work on your purchasing
plan.




CDC+ Consumer Notebook 4/26/04    32
G. Working with the Program Bookkeeper


What You can Expect from the Bookkeeper

The Bookkeeper provides you a full bookkeeping, payroll and
accounting service. The Bookkeeper will also:

           Hold your CDC+ funds for you, like a bank

           Use the forms in your employee forms package (after you fill
            them out) to do your payroll

           Process your workers' time sheets,

           Pay payroll taxes,

           Write the paychecks for your workers from your account

           Pay any invoices you approve for work done by an
            independent contractor or an agency.




CDC+ Consumer Notebook 4/26/04        33
SECTION 3: GETTING WHAT YOU NEED AND BEING THE BOSS

This Section focuses on how to turn your Purchasing Plan into the
services you need to receive. This means helping you get what you
need, and be an effective employer.

It has five parts. These are:
    H. Finding and Choosing Someone to Work for You
    I. Screening, Interviewing, and Background Checks
    J. Deciding How Much to Pay Your Workers, Offering Benefits, and
       Using Employer/Employee Agreements
    K. Workers’ Compensation Insurance
    L. Payroll Taxes and Labor Laws

This section relates to key skill 2: knowing how to hire workers and
contract with vendors to get the services you need.


H. Finding and Choosing Someone to Work for You
You can purchase services from an individual or an agency – it is up to
you. There are advantages and disadvantages for both choices.

An individual might be a family member, neighbor, or worker known to
you or a stranger. An agency may be a not-for-profit, or for-profit,
business, based in your area.

You should choose whichever is right for you. You may wish to
purchase services from both individuals and agencies. Do whatever fits
your needs the best. You do not have to choose Medicaid providers for
this Program, even though you are using Medicaid funds.


Getting Services from an Individual
Hiring an individual to provide your services may be a good idea if:

          You are more comfortable with a worker you know well

          You want the same worker to provide your services every time




CDC+ Consumer Notebook 4/26/04       34
          You need services provided outside of regular business hours
           (early mornings, nights, weekends)

          You want to decide what day and time your worker comes

          You want your worker to provide a service the agency does not
           provide

          You want to decide how much to pay your employee.


Writing a Job Description
Before you start looking for someone to provide services for you, it is a
good idea to write a job description for that service or job. A job
description is important, especially if you plan to hire a friend or family
member.

A job description has several uses:

    1. A job description will give potential workers a good idea of what
       the job requires.

    2. It can be used as a guideline for asking questions during the
       interview.

    3. It can be used as a checklist of duties and responsibilities after a
       worker has been hired and is being trained.

    4. It can be helpful when deciding if you are happy with the way a
       worker is doing the job.

The job description should be written with your personal needs in mind
and should include:
    •    Basic job duties
    •    Required qualifications
    •    The way you want the job done
    •    The number of hours and days needed.




CDC+ Consumer Notebook 4/26/04        35
The information on the job description does not have to be permanent. It
is fine to change the job description later if you change your mind about
what you need. However, if you change the job description after you
hire someone, you should discuss the changes with the worker to make
sure they understand. If you change the job duties too much, the worker
may not be qualified, agree to continue or may not want to work unless
pay is increased.

Job descriptions can be written in a lot of different ways. The most
important thing is that the information be shared with the worker before
he/she agrees to accept the job.


Finding Workers
Finding workers can be as simple as telling people you already know
that you are looking for someone to hire. Maybe you already have
someone in mind.

Hiring Friends and Family
If you think you might like to hire someone you know well (family
member or close friend), consider the following:

                                 Benefits

                 It may be easier to find someone
                 Friends and family may understand your likes and dislikes
                 The relationship may be more dependable
                 A more flexible work schedule may be possible

                                 Risks

              Firing may be harder to do
              Giving criticism may be more difficult
              Adjusting to the employer/employee relationship could cause
               problems
              Friends and family could decide it is OK to work on their own
               schedule




CDC+ Consumer Notebook 4/26/04              36
Most importantly, consider what will happen to the personal relationship
if the work relationship does not work out.

For years, family members and friends have been providing support to
loved-ones who need help. It works well in some cases, and not so well
in other cases. Only you can decide if this is a good choice for you.


Hiring in the Open Market
If you do not want to hire someone you know (family member or friend)
or cannot find someone by word of mouth, you may want to run an ad in
your local newspaper. If you do not want to pay to advertise, you can
run an ad in a free advertiser paper. You can also post a "help wanted"
notice on a bulletin board of your local vocational school, university,
local library, church, synagogue or mosque. If you do this, you may wish
to find a safe way to have people contact you.

You may have other ideas about where to post a notice. In smaller
towns, people often post notices at the post office, grocery store, gas
station, or other businesses.

How to Advertise
When you are writing a job advertisement, stress the positive aspects of
the job but always be truthful about what you want the worker to do.
Keep the description of the job clear and short. Before you start writing
your ad, it might be helpful to read other ads to give you some ideas.
Things you will want to include in the job advertisement are:

     The name of the job (the title of the position could be important for
      tax purposes. See part [ ] - Taxes, Labor Laws and Insurance)

     The number of hours per week and time of day needed

     A brief description of the job duties

     How an interested person can get in touch with you (for safety
      reasons, never list your full name or address)




CDC+ Consumer Notebook 4/26/04       37
     How much you will pay per hour for the job (optional)

     Other things that are important to you such as smoking preference
      or experience necessary.

The more things you list as requirements for the job, the fewer the
number of people that are likely to respond. However, the people who
do respond will more likely be a "good fit" for the job. Be sure to list the
things that are most important to you as requirements. List the things
that are less important to you as preferences or wait to mention them
later.

If you get lots of responses, you may want to consider doing a short
interview on the telephone (telephone screening) to narrow down the
number of people you interview in person.




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I. Screening, Interviewing, and Background Checks

Screening
You hope there will be more candidates for the work/ job(s) you are
offering than you need. This will give you the opportunity to choose the
best person(s) to meet your needs. Screen the candidates carefully
before you make any employment offer, starting with a telephone
screening, and then proceeding to a face to face interview.

Telephone Screening
If you decide to do a telephone screening, start the conversation with a
brief description of the job. You may want to write a few things down
ahead of time so you do not forget to mention something important
during the conversation.

Be sure to mention the pay rate (if you did not do so in the ad) and give
the person a general idea of where you live (without telling them your
address).

You may also want to make a list of questions you will ask the people
you interview during the phone call. As a rule, your list should include no
more than ten questions. Some things you may want to ask about are:
   Why they are interested in this job
   If they have ever done a job like this before
   How they will get to work
   If they are able to lift (if the job requires heavy lifting)
   If they have other responsibilities that might interfere with their
      work schedule
   What are some of the things they liked best about similar jobs
      they've had.

You might ask if they have any references, or people they have worked
for you can talk to about them.

If you are able, makes notes as the person answers the questions you
ask. Remember, this is a time for you to learn things about the potential




CDC+ Consumer Notebook 4/26/04      39
worker so you can narrow down the number of people you interview in
person.

Do not share personal information about yourself during the telephone
screening. If the applicant asks questions, only answer job related
questions.

Write down or record your initial impressions of the candidate as soon
as you hang up from the call. By the time you have talked to several
people, it is easy to confuse them in your mind.

You may even think of some other questions you did not ask on the call
but would like to ask later. Make a note of these and be sure to ask
them at the next interview.

Face-to-Face Interview
The next step is to review your notes and call the people you want to
interview face to face. You may want to ask them to bring to the
interview:
        Their resumes,
        Two employment references and two personal references,
        Their identification cards (with picture) and
        Their Social Security cards.

If driving is a requirement of the job, ask them to bring their driver's
license and proof of a clear driving record (available from the Office of
Motor Vehicles.) Make sure you have their full name and phone number
in case you need to change the date or time of the interview.

Be Safe at Interview
The two safest ways to interview someone you do not know well are:

     Have one of your friends or family members present for the
      interview if you choose to have it in your home

     Have the interview at a public place (library, senior center, Center
      for Independent Living, restaurant).




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If you decide to meet at a restaurant, be sure to be clear about whether
you are meeting for a beverage or a meal and who is paying so there
are no misunderstandings.

Interviewing – Be Well Prepared
Be prepared! Before the applicant arrives, have a blank application
form, the job description, and a list of questions ready. If you plan to
check references, have a plan for getting the contact information from
the applicant.

When the applicant arrives, introduce yourself and do what you can to
make him/her feel comfortable. Ask the applicant to fill out the
application. You can provide the applicant with the job description to
read while you review the completed application.


Background Checks and References
You should tell everyone you interview that you are required by law and
by CDC+ rules to do a criminal background check and check their
references.

As the Consumer, you are also responsible for your own safety.

Background Checks

All individuals who will be rendering care to a consumer enrolled in this
program must either:
        Be a Medicaid enrolled provider who underwent background
         screening at the time of their enrollment into the Medicaid program
         (and who remains in good standing in the Medicaid program); or
        Pass a background screening; or
        Be a person who has undergone screening, who is qualified for
         employment and who has not been unemployed for more than 180
         days following such screening. Such a person is not required to be
         re-screened, but must attest under penalty of perjury to not having
         been convicted of a disqualifying offense since completing
         screening.




CDC+ Consumer Notebook 4/26/04        41
Developmental Disabilities Program Consumer employees will receive
their screening instruction packets from their District Developmental
Disabilities Program office. Employees will be notified by letter of the
results of the background screening and, if found to be disqualified, their
right to appeal the disqualification. The district staff will ensure a copy
of the Level I and Level II background screening is given to the CDC+
consultant who will provide the copy to the Consumer. The employee
will pay all costs associated with the background screening.

Elders, Adult Services and Brain and Spinal Cord Injury Consumer
employees will receive their provider’s Level I background screening
through the Fiscal/Employer Agent (FEA) contracted with the
Department of Elder Affairs for the CDC + program. Information from
the employees, submitted through the consumer, will be processed by
the FEA. The FEA will screen the background checks for disqualifying
offenses as referenced in Chapter 435.03, F.S. The employee and
Consumer will be notified if there are any disqualifying offenses. If
found to be disqualified, employees will be advised of their right to
appeal the disqualification. Employees are responsible for all costs
associated with the screening.

Reference Checks
It is highly recommended that you call at least two references for each
potential worker. Make sure at least one is a work reference. The
second could be a work or personal reference.

Explain to the person (reference) that you are a potential employer of
the person you want to hire (use their name). You do not have to tell the
reference your name. Ask questions about the potential worker that will
help you decide about hiring. You may want to ask these questions:

                    Was the worker dependable?
                    Did he/she use good judgment?
                    Why did he/she leave?
                    Would you want to rehire the person?
                    Would you recommend the person for this kind of job?




CDC+ Consumer Notebook 4/26/04           42
Think about the questions you want to ask before you call. It is a good
idea to write the questions down so you do not forget to ask something
important.




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J. Deciding How Much to Pay Your Workers, Offering Benefits, and
Using Employer/Employee Agreements

Deciding how much to pay
Choose your workers carefully and aim for value for money. CDC+ rules
require purchases to be “cost-effective”, meaning that the price you pay
for them needs to be justified according to the service value they bring
to you.

CDC+ will only work for you if you make wise choices about your
purchases. You are able to buy the help you need and you should
expect quality services for the money, regardless of who provides the
services.

Setting the Level
There are probably “going rates” in your community for the kinds of
service you need. Try to find out what these rates are to help you
discuss pay rates with applicants and your workers.

One of the benefits of the CDC+ is that you (the Consumer) get to
decide how much you want to pay your workers for their services. By
law, most of your workers will have to be paid at least minimum wage
($5.15 per hour as of January, 2004).

It is not a good idea to let your workers tell you how much they want to
be paid. You decide what you think is a fair wage. If you are not sure,
ask your Consultant. Your Consultant will usually be familiar with what
other people are being paid for similar work.

If you decide to pay a worker a rate above the local market level, your
Consultant will probably ask you about it when he/she gets your
Purchasing Plan. Avoid paying someone a higher rate just because you
know him or her or you think he/she "needs the money."




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Pay Raises
Since you decide how much to pay your worker(s), you can also choose
to give them a pay raise. Think through the idea of giving your worker a
raise carefully. Make sure you have enough funds to give the raise and
continue to meet your other needs before you mention it to your worker.
You may want to talk to someone else about the idea too. Reasons you
might want to consider paying your workers more are:

    Example 1: a worker is doing his/her job so well that you need less
    of their time than you planned. The worker's efficiency allows you to
    pay a higher hourly rate for less time, still have the same work done
    and perhaps even save money.

         In example 1, you would not need to use any additional CDC+
         funds for the raise.

    Example 2: if you have increased a worker's job responsibilities to
    include more demanding or more skilled duties.

         In example 2, you will have to give up something else you were
         going to purchase with your budget to have enough extra funds for
         the raise. In this case, you will update your Purchasing Plan with
         your Consultant.

    Example 3: local market conditions change, such as a new employer
    coming to your area who is able to compete with you for the labor
    you need, but at a higher rate.

         In example 3, you will have to update your Purchasing Plan with
         your Consultant.

Keep in mind that your CDC+ budget will not increase during this
Program unless your needs change significantly and the state has funds
available. You will not be given a "cost of living" increase on your
budget. For help on setting a wage for your worker(s) that is affordable,
see the Consumer Aid Sheet and the Consumer Tax Tables at the back
of this Notebook in the section called FORMS.




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Offering Benefits
Good employers all know that happy workers tend to work better than
unhappy ones. But being happy is not just about fair pay and conditions.
Workers need to be encouraged to take pride in their work, which is
easier for them if they believe that you value them – as people as much
as your employees.

So what can you do to get the best out of your workers, given that there
are not enough funds in your CDC+ budget to offer them benefits that
cost a lot? Here are some ideas:
    Pay your workers a fair wage for the work they do for you
    Let your workers have a say about their work schedule
    Encourage your workers to take planned vacations
    Allow your workers to take sick days
    Compliment your workers when they are doing a good job
    Where you can, make the job interesting and fulfilling.


Written Employer/ Employee Agreements
You must complete the written Employer/Employee Agreement with
each of your workers. Especially when you are hiring a family member
or close friend, working through and signing the agreement will help you
avoid misunderstandings later on.

The form takes only a short time to fill out and includes all the important
points of agreement between you and your worker:
    The start date,
    The work schedule,
    The job duties, and
    The hourly pay rate.

When you and your worker sign the agreement, it reinforces your new
employer-employee relationship. A copy of an Employer/Employee
Agreement can be found at the back of the Notebook in the section
called FORMS.




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Getting Services from an Agency
Hiring someone from an agency may be a good idea if you:
    Like the way one (or more) of your services is being provided now,
      exactly the way it is
    Are having difficulty finding or keeping back-up workers for your
      emergency back-up plan
    Have a need for temporary help.

If you decide to hire someone from an agency, check to see if there is
more than one agency that provides the service you need. If so, call
each one and compare prices and ask questions about how they can
meet your needs.

Once services have started, be sure to give the agency feedback on the
quality of services. Since you are the one who makes the choice about
using an agency, you have the freedom to find someone else to do the
work if you are not satisfied.


Being a Successful Employer
Your role as an employer in CDC+ gives you the power to choose who
provides your services. No matter whom you choose to provide your
services, there will be successes and challenges. One of the biggest
challenges of an employer is to find a balance between getting what you
want from your worker while still allowing your worker to be who he/she
is. The following tips will help make your experience as an employer a
successful and rewarding one:

     Take advantage of the diversified workforce available to you

     Avoid stereotyping people based on age, race, or gender

     Allow people to behave and communicate differently from you

     Be aware of how you behave around people who are different
      from you



CDC+ Consumer Notebook 4/26/04     47
     Communicate openly and directly with others

     Show respect, courtesy, and appreciation to others

     Tackle issues early and tactfully; do not let problems build up.




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K. Workers’ Compensation Insurance


Workers' Compensation Laws
Workers' Compensation laws are meant to protect workers and
employers from the cost of injury on the job. Florida law requires
workers' compensation insurance if you have four or more workers at
one time. Both full time and part time workers are counted.

If you do not hire more than three workers at any one time, you will
not have to buy workers' compensation insurance. It does not
matter how many workers you hire throughout the year, just how many
workers you have at any one time.

Domestic workers are exempt from workers' compensation laws.
The law says domestic workers include maids, cooks and maintenance
workers. That means if you hire a homemaker (someone who mainly
cooks, cleans, or is a companion), he/she is exempt from workers'
compensation laws and WILL NOT count toward the three-worker limit.

A domestic worker may not spend more than 20% of his/her total work
time providing personal assistance and still be exempt. Personal
assistance includes duties such as helping with bathing, eating,
dressing and toileting. For example, a homemaker you have hired to
work 10 hours per week cannot provide more than 2 hours of personal
care services as part of his/her weekly duties. If your homemaker does
spend more than 20% of his/her time doing personal care, the worker
will not be exempt and will count toward the three-worker limit.

You must tell your employees whether you have workers' compensation
insurance or not. The Florida Workers' Compensation law requires you
to post a notice on the job site. The notice must be posted in an obvious
place.




CDC+ Consumer Notebook 4/26/04     49
Employees or Independent Contractors?
Workers' compensation laws only apply to people you hire as
employees. Your worker is generally considered to be an employee if
he or she works according to your will and control. Workers'
compensation laws do not apply to independent contractors. Examples
of independent contractors include a person or business you hire to
build a wheelchair ramp and registered nurses and licensed practical
nurses that work independently from an agency.

If you decide to purchase workers' compensation insurance, use an
insurance company that is authorized to submit applications to the
Florida Workers' Compensation Joint Underwriting Association. Call an
insurance agent in your area for more information. If you are having
trouble getting workers' compensation insurance, call the Workers'
Compensation Insurance Purchasing Alliance at (850) 413-2652 at the
Florida Department of Insurance.


Summary
     If you hire more than three non-exempt employees at any one
       time, you must purchase workers' compensation insurance.

            Domestic workers are exempt from workers' compensation
             laws. Domestic workers include maids (homemakers), cooks
             and maintenance workers.

            You, the employer, are totally responsible for the payment of
             your workers' compensation premium.

            You may not withhold, deduct, or collect payment for workers'
             compensation premiums from any employee.




CDC+ Consumer Notebook 4/26/04         50
L. Payroll Taxes and Labor Laws


Introduction
As an employer you are required to report whom you hire and when they
quit or leave. Taxes and social security payments must be withheld from
your employees' paychecks. Your bookkeeper will do these tasks for
you.

What follows is a brief explanation of some of the most important things
that you must keep track of or complete. This Section is organized into
three areas:

•    Things the Bookkeeper Will Do For You
•    Things the Bookkeeper Will Do For You But You Must Watch
     Closely
•    Things You Must Do Yourself

If you do not understand any of these areas, please call the Bookkeeper
so they can explain it to you.


Things the Bookkeeper Will Do For You

Federal and Florida Employment Requirements:
File SS-4 Application for Federal Tax I.D. number - A part of the
package you will receive from Acumen is called the “Acumen
Authorization Form”. By signing this form, you are authorizing Acumen
to file the IRS SS-4 Application for you. Acumen will use the information
you fill out on this form to apply for a Federal Identification Number on
your behalf. The Federal Government uses this number to track
information about your employees.

Report newly hired employees to the state – the Bookkeeper will report
all of your newly hired employees to the State of Florida so their taxes
may be properly tracked.




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File and give copy of W-2 to each employee at the end of each calendar
year - The Bookkeeper will file and send you copies of the W-2 to give
to your employees.

Immigration Law: Complete INS Form I-9 for each new employee - The
I-9 form will be included in the start up packet for you and the employee
to complete and send back to the Bookkeeper. The people you hire
must be U.S. Citizens or must have been granted special rights to work
in the United States. The employee must give you this information and
fill out a 1-9 that the government will use to verify their employment
status. Every new employee must fill out an INS Form I-9.


Things the Bookkeeper Will Do For You But You Need To Watch

Employer Taxes:
As an employer you are required to withhold and pay taxes to the state
and federal governments as well as the Social Security Administration.
For Social Security you are required to match the amount your
employees pay. You must also pay unemployment taxes to both the
state and federal government on behalf of your employees. The
bookkeeping service will do all of this for you.

Social Security Taxes

Federal Insurance Contributions Act
The Federal Insurance Contributions Act (FICA) provides for a federal
system of old age, survivors, disability (Social Security), and hospital
insurance benefits (Medicare) for workers and their families.

You may need to pay FICA for your employees:

If you:
     Pay wages of $1,100 or more per year to any one household
      employee;
     Do not count wages you pay to your spouse, your child under
      age 21, or your parent;




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Then you need to:
   Withhold and pay Social Security and Medicare taxes.
   The taxes are 15.3% of wages.
   Your employee's share is 7.65%.
   Your share is 7.65 %.

You (the employer) are responsible for paying FICA. You can withhold
your employees’ share from their wages and pay your share from your
CDC+ budget. The Bookkeeper will collect and set aside the withholding
and your share for every employee you hire. If the total wages for the
year are less than $1,100 for an employee, both the employees'
withholding and your share will be refunded.

Federal unemployment tax (FUTA) - In general you will be taxed at the
rate of .008 of the wages earned by each employee up to a maximum of
$7,000. You do not have to pay FUTA on certain family members or
employees who earn less than $1,000 in any calendar year. You will
also get a credit for taxes you pay toward state unemployment taxes. If
you do not understand why a certain tax is being paid, ask Acumen for
an explanation.

State Unemployment Tax Act (SUTA) - You will pay a Florida state
unemployment tax. The tax rate is .0270 and it is done very much like
the Federal tax. At least quarterly you will pay taxes on the amount of
money your employees earn.

All Unemployment Compensation (UC) tax payments are deposited to
the Unemployment Compensation Trust Fund for the sole purpose of
paying benefits to eligible claimants. The employer pays for this
unemployment compensation program. Workers do not pay any part of
the Florida Unemployment Compensation Tax and employers must not
make payroll deductions for this purpose.

Employers who, in the current or prior year, have paid $1,000 or more in
cash wages in any one-calendar quarter are liable for unemployment
compensation tax. The unemployment compensation tax requirement
applies to all workers you hire, regardless of the source of funds for their
pay.



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For example, if, during a calendar quarter, you pay one worker $800
from your CDC+ budget and pay another worker $350 from your
personal funds, you are liable for unemployment compensation taxes
because the total wages for the calendar quarter ($1,150) are $1,000 or
more.

Total Employer Taxes are:

    FICA   7.65%
    FUTA 0.80%
    SUTA 2.70%
    Total 11.15%

Exempt From Employer Taxes
Services performed for a son, daughter, or spouse, including step
relationships, or by children, or stepchildren, under the age of 21 for
their father or mother are exempt from employer taxes.


Things You Must Do Yourself
The Fair Labor Standards Act (NOTE - The following information is
excerpted from the Fair Labor Standards Act Handbook published by
the U. S. Department of Labor.)

The Fair Labor Standards Act (FLSA) establishes minimum wage,
overtime pay, record keeping, and child labor standards affecting full-
time and part-time workers in the private sector and in Federal, State,
and local governments. You are required to follow the provisions of the
Fair Labor Standards Act.

Covered nonexempt workers are entitled to a minimum wage of not less
than $5.15 an hour and overtime pay at a rate of not less than one and
one-half times their regular rate of pay after 40 hours of work in a
workweek.

While FLSA does set basic minimum wage and overtime pay standards
and regulates the employment of minors, there are a number of




CDC+ Consumer Notebook 4/26/04      54
employment practices that the Fair Labor Standards Act does not
regulate. For example, FLSA does not require:

(1) Vacation, holiday, severance, or sick pay;

(2) Meal or rest periods, holidays off, or vacations;

(3) Premium pay for weekend or holiday work;

(4) Pay raises or fringe benefits; or

(5) A discharge notice, reason for discharge, or immediate payment of
final wages to terminated employees.

Domestic service workers such as your personal care attendants are
covered if their cash wages from one employer are at least $1,000 in a
calendar year or they work a total of more than eight hours a week for
one or more employers that are covered by the Fair Labor Standards
Act.


Child Labor Provisions
The Fair Labor Standards Act child labor provisions are designed to
protect the educational opportunities of minors and prohibit their
employment in jobs and under conditions detrimental to their health or
well-being. The provisions include restrictions on hours of work for
minors under 16 and lists of hazardous occupations for both farm and
non-farm jobs declared by the Secretary of Labor to be too dangerous
for minors to perform. Further information on prohibited occupations is
available from local Wage-Hour offices. In non-farm work, the
permissible jobs and hours of work, by age, are as follows:

     Youths 18 years or older may perform any job, whether hazardous
      or not, for unlimited hours;

     Youths 16 and 17 years old may perform any non-hazardous job,
      for unlimited hours, and;




CDC+ Consumer Notebook 4/26/04          55
     Youths 14 and 15 years old may work outside school hours in
      non-hazardous jobs under the following conditions: no more than
      three hours on a school day, 18 hours in a school week, eight
      hours on a non-school day, or 40 hours in a non-school week.
      Also, work may not begin before 7 a.m., nor end after 7 p.m.,
      except from June 1 through Labor Day, when evening hours are
      extended to 9 p.m. Under a special provision, youths 14 and 15
      years old enrolled in an approved Work Experience and Career
      Exploration Program (WECEP) may be employed for up to 23
      hours in school weeks and three hours on school days (including
      during school hours).

     Fourteen is the minimum age.

Record Keeping
The Fair Labor Standards Act requires employers to keep records on
wages, hours, and other items, as specified in Department of Labor
record keeping regulations. Employers in ordinary business practice and
in compliance with other laws and regulations generally maintain most
of this kind of information. The records do not have to be kept in any
particular form and time clocks need not be used.

With respect to an employee subject to the minimum wage provisions or
both the minimum wage and overtime pay provisions, the following
records must be kept:

         Personal information, including employee's name, home
          address, occupation, sex, and birth date if under 19 years of
          age;

         Hour and day when workweek begins;

         Total hours worked each workday and each workweek;

         Total daily or weekly straight-time earnings;

         Regular hourly pay rate for any week when overtime is worked;




CDC+ Consumer Notebook 4/26/04        56
         Total overtime pay for the workweek;

         Deductions from or additions to wages;

         Total wages paid each pay period; and,

         Date of payment and pay period covered.


Terms Used in FLSA
Workweek - A workweek is a period of 168 hours during seven
consecutive 24-hour periods. It may begin on any day of the week and
at any hour of the day established by the employer. Generally, for
purposes of minimum wage and overtime payment each workweek
stands alone; there can be no averaging of two or more workweeks.
Employee coverage, compliance with wage payment requirements, and
the application of most exemptions are determined on a workweek
basis.

Hours Worked - Covered employees must be paid for all hours worked
in a workweek. In general, "hours worked" includes all time an employee
must be on duty, or on the employer's premises or at any other
prescribed place of work. Also included is any additional time the
employee is allowed to work.

Computing Overtime Pay
Overtime must be paid at a rate of at least one and one-half times the
employee's regular rate of pay for each hour worked in a workweek in
excess of the maximum 40-hour workweek. Generally, the regular rate
includes all payments made by the employer to or on behalf of the
employee.

Hourly rate - (Regular pay rate for an employee paid by the hour.) If
more than 40 hours are worked, at least one and one-half times the
regular rate for each hour over 40 is due.

Example: An employee paid $8.00 an hour works 44 hours in a
workweek. The employee is entitled to at least one and one-half times



CDC+ Consumer Notebook 4/26/04      57
$8.00, or $12.00, for each hour over 40. Pay for the week would be
$320 for the first 40 hours, plus $48.00 for the four hours of overtime-a
total of $368.00.


Enforcement
Investigators stationed across the US carry out Wage-Hour's
enforcement of FLSA. As Wage-Hour's authorized representatives, they
conduct investigations and gather data on wages, hours, and other
employment conditions or practices, in order to determine compliance
with the law. Where violations are found, they also may recommend
changes in employment practices to bring an employer into compliance.

It is a violation to fire or in any other manner discriminate against an
employee for filing a complaint or for participating in a legal proceeding
under FLSA:

     Willful violations may be prosecuted criminally and the violator
      fined up to $10,000. A second conviction may result in
      imprisonment;

     Violators of the child labor provisions are subject to a civil money
      penalty of up to $10,000 for each employee who was the subject
      of a violation; or,

     Employers who willfully or repeatedly violate the minimum wage or
      overtime pay requirements are subject to a civil money penalty of
      up to $1,000 for each such violation.


Conclusion
If you don't understand something, ask your Consultant or call Acumen
for clarification. No question is too small or unimportant. Know where
your money is going and why things are happening. This program is
meant to make you more independent, not to burden you with forms and
regulations.




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SECTION 4: GET THE QUALITY YOU DESERVE

This Section focuses on how to get the best quality services from your
Purchasing Plan dollars. It has two parts. These are:
   M. Ensuring Quality Services
   N. Working with Your Consultant.

This section relates to key skill 3: “You will want to get the best quality
that you can afford for your services, so you will need to oversee people
who work for you.”

While the initial role of your Consultant is to get you trained and started,
the longer-term relationship you develop with your Consultant will be a
major factor in your ability to get the best quality result for yourself from
CDC+.

M. Ensuring Quality Services

You, as the Consumer, get to decide if you are satisfied with your
services. If you are not satisfied, you can make changes. You also have
the power to influence the quality of your services by the things you do.
For example, hiring workers that are qualified to do the kind of work you
need done will help ensure your health and safety.

Invest Your Time in Training
If you train your workers on how you want things done, there is a good
chance you will be more satisfied with your services than if you do not
train them. By training your workers you have helped them succeed at
doing things the way you want them done.

Other ways you can help ensure you receive quality services are:
   Telling your workers about the quality of their work,
   Planning for emergencies in advance, and
   Dealing with problems early so they do not grow into bigger
     problems.




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Choosing a Qualified Person for the Job
As a Consumer, you have the freedom to choose whom you want to
provide your services. The people you choose to provide your services
do not have to be Medicaid providers. However, it is very important that
the people you choose to provide your services are qualified. If you
choose a worker who is not qualified to provide the service, you may
risk harming your health and safety as well as wasting money.

Skilled Nursing Care
You should only hire licensed, trained professionals to provide skilled
nursing services. For example, you should not hire a neighbor to
provide services requiring a nurse's knowledge and training - unless
your neighbor is a nurse.

There are two types of nurses, registered nurses and licensed practical
nurses. Under Florida laws, registered nurses may perform nursing
tasks such as: nursing observation and diagnosis, planning, intervention
and evaluation of care, and giving medication. Registered nurses may
also supervise and teach other people to perform such tasks.

This means when a registered nurse trains a person to perform certain
tasks, that person can be delegated to do the tasks.

Periodically, a registered nurse must observe a CNA or HHA doing his
or her job.

The other type of nurse is a licensed practical nurse. A licensed
practical nurse may administer nursing treatments and medications
under the direction of a registered nurse or doctor. If you are not sure if
the services you need require a nurse, call your doctor for advice. Using
unqualified workers to provide skilled health care services could cause
you to be disenrolled from the Program.

Certified Nursing Assistants and Home Health Aides
Certified nursing assistants (CNAs) and home health aides (HHAs)
often work for businesses such as home health agencies and nursing
homes. Sometimes, certified nursing assistants and home health aides
work for themselves and not for agencies.



CDC+ Consumer Notebook 4/26/04      60
1. If the certified nursing assistant or home health aide is employed by
a home health agency there are laws, which govern what kinds of tasks,
a CNA or HHA can do.

The CNA
A Certified Nursing Assistant is a person who has been trained and
issued a certificate after fulfilling the requirements of Florida Statute
400.211. For a home health agency to be able to provide certified
nursing assistant services in your home, you must be under the care of
a doctor. Some services require a care plan signed by your doctor.

The CNA MAY
The CNA MAY assist you with:
   Bathing
   Dressing
   Toileting
   Grooming
   Eating
   Physical transfer
   Normal daily routines you could do for yourself if you were
     physically capable.

The CNA MAY NOT:
   Provide medical or health care services that require special
     training and may be performed only by licensed health care
     providers.

An HHA
A Home Health Aide is someone who provides personal care services
in your home under the supervision of a registered nurse. For a home
health agency to be able to provide home health aide services in your
home, you must be under the care of a doctor. Some services require a
care plan signed by your doctor.

The home health aide will be limited to assisting you with:
   Personal care (personal hygiene), ambulation, eating, dressing,
     shaving, and physical transfer



CDC+ Consumer Notebook 4/26/04      61
        Changing a colostomy bag or reinforcing a dressing
        Using adaptive devices such as wheelchairs or walkers
        Motion exercises
        Ice caps or collars
        Urine tests for sugar, ketones or albumin
        Measuring and preparing special diets
        Measuring intake and output of fluids
        Assisting with preparations to take self-administered medication.

A home health aide MAY NOT:
    Change sterile dressings
    Irrigate body cavities (give an enema)
    Irrigate a colostomy wound
    Perform a gastric irrigation or enteral feeding
    Catheterize someone
    Administer medication
    Apply heat by any method
    Care for a tracheotomy tube.

Florida law requires that a registered nurse supervise the services
provided by a CNA or a HHA from a home health agency. When you
purchase CNA or HHA services from an agency, you must also
purchase the services of the supervising nurse. Call your local home
health agencies to find out how often the nurse must supervise the
home health agency's CNA or HHA (usually once a month). Ask how
much the nursing supervision will cost.

Be sure to include the costs of the nursing supervision services
when you plan how you will spend your Consumer-Directed Care
budget.


Personal Care Services
2. If someone who has been trained as a certified nursing assistant or
home health aide is employed independently (not by a home health
agency) the law does not specifically address what the CNA or HHA can
do.



CDC+ Consumer Notebook 4/26/04        62
There is nothing specific in Florida laws to prohibit a CNA or HHA from
using their training to provide personal care services.

Personal care services include assistance with:
   Bathing
   Dressing
   Eating
   Personal hygiene
   Activities of daily living
   Meal preparation
   Housekeeping.

The law does specify a CNA or HHA may not provide nursing services.
It is up to you, as the employer, to hire workers who are capable of
performing their job duties safely.

Companions, Sitters, and Homemakers
A companion or sitter is someone who sits with you, accompanies you
on trips and outings, prepares and serves your meals, or helps you with
walking, standing, or sitting but may not provide personal care.

Companions or sitters may:
   Provide companionship
   Provide escort services such as accompanying someone to a
    doctor's appointment
   Provide light housekeeping such as preparing meals or doing
    laundry
   Assist with walking, standing or sitting.

A homemaker is someone who has taken on the duties of the family
homemaker.

When employed by an agency, homemakers must have 16 hours of
training in topics related to human development and relationships,
nutrition, shopping, use of equipment and supplies, planning and
organizing household tasks, and the principles of cleanliness and
safety.



CDC+ Consumer Notebook 4/26/04     63
Homemakers MAY:
   Prepare meals
   Do laundry
   Shop
   Care for children
   Keep the home clean and safe.

Homemakers MAY NOT:
   Provide personal care (assistance with bathing, dressing, personal
    hygiene, etc.)

When employed by an individual to work in a private home,
homemakers are usually called housekeepers. Housekeepers are
exempt from workers compensation laws. This means a housekeeper
does not count toward the three-employee limit imposed by workers
compensation laws. A housekeeper may not spend more than 20% of
their total work hours providing personal care.

Private Contractors
Although there is no law telling you whom you can hire to do things like
build a wheelchair ramp or install grab bars, using a licensed contractor
helps insure the worker is knowledgeable in his/her trade. It also helps
insure the contractor uses safe and legal practices.

Talk with a couple of people who have had work done by the contractor
you have in mind to use before you give them a contract. A good
contractor will be happy to give you the names of people for whom
he/she has worked in the past.


Training Your Workers
It is your responsibility to properly train your workers. Training your
workers about the way you want things done will help insure your
satisfaction with your services. The amount of training required will
depend on how difficult the job is and the worker's experience.




CDC+ Consumer Notebook 4/26/04       64
Spend a good part of your worker's first day on the job talking about
your preferences; be clear and direct as to what you expect. For
example, tell them where things go in the kitchen and bathroom and
how you like your closets and drawers done.

This will be time well spent. Training can be as simple and personal as
telling your worker how you prefer to have your food cooked or laundry
done.

Make sure your worker has a copy of his/her job description. During the
training, focus on the things that mean most to you. If you want or need
something done in a specific way, it may help if you explain to the
worker why it is important that it be done that way.

For more challenging tasks, such as lifting or moving you, it may take
some coaching by you for your worker to learn to do it safely and
comfortably. That means you may have to tell your worker how to do
something more than once. You may want a family member or friend
who has been helping you to demonstrate a procedure for the new
worker. Talk to your worker as he/she is doing the task and don't be
afraid to tell them when they are doing something incorrectly.

Your Consultant has short descriptions (with pictures) for most personal
care tasks. Ask your Consultant for this information if you think it would
be helpful in training your new workers.

Your local Center for Independent Living may offer training for personal
care workers. This training is usually free. Call them to see if training is
available in your community.

You may have to provide some "refresher" training later on. Your worker
may forget something you told them or develop a habit you do not like.
Gently remind your worker of the way you want the job done, but be
specific. Giving your worker regular feedback on the job they are doing
will help re-enforce what you have told them during training. Providing
feedback will help keep you from having to train your workers over and
over.




CDC+ Consumer Notebook 4/26/04       65
Providing Feedback to Your Workers
Keep the following in mind when communicating with your worker:
   Do not assume your worker has understood the job description or
     your instructions.
   Be patient. Do not expect your worker to get everything right the
     first time (or even the second time).
   Assume your worker wants to do a good job. Your role is to give
     him/her the information they need to do the job right.
   Do not assume everyone is like you. Be sensitive to differences in
     communication styles.
   Keep in mind that it is easier to talk about things you are not
     satisfied with if you do it promptly. The longer you wait, the bigger
     the problem becomes.




CDC+ Consumer Notebook 4/26/04      66
N. Working with Your Consultant

The Consumer/Consultant Agreement
If you and your Consultant have not yet signed the
Consumer/Consultant Agreement, do so now – before you activate your
first Purchasing Plan.

Your signature on the Agreement will tell your Consultant that you
understand and accept your responsibilities.

Read the section of this Notebook again on your respective roles and
responsibilities carefully so there is no misunderstanding between you
and your Consultant about what he/she can and cannot do for you in
CDC+.

Remember: your Consultant has a different role than a Case Manager
or Support Coordinator. Even if your Consultant is the same person
who provided your case management or support coordination services,
he/she now has other responsibilities as your Consultant.

For example,


How to Contact Your Consultant
Your Consultant will give you a contact sheet with all the important
phone numbers and addresses you will need. If you use the Internet,
you can also communicate by email.

If he/she has not given contact information to you, ask your Consultant
for it now. The Consultant information on the contact sheet should
include:

                Your Consultant's name
                Your Consultant's business phone number
                Your Consultant's business address
                The name of the agency employing your Consultant (if any)
                The name of your Consultant's supervisor (if any)



CDC+ Consumer Notebook 4/26/04          67
              Agency’s address (if different from Consultant address)
              Agency’s phone number (if different from Consultant phone
               number).

Your Consultant may also give you a second telephone number, such
as a pager or a cellular phone. If so, make sure your Consultant
explains how to use these other numbers. You may even want to
practice using the number together if you have never called a cellular
phone or a pager.

When to Contact your Consultant
You can contact your Consultant anytime you have a question or need
to discuss something related to the CDC+. If your Consultant is not
available when you call, he/she should call you back within a short time.

You may want to write down your question(s) as you think of them. If
you write them down, you will not forget to mention anything when you
do speak to your Consultant. You will also have paper available to take
notes when you talk to your Consultant.

Monthly Contacts
Your Consultant will contact you at least monthly. You Consultant will
ask you how you are doing and if you are having any problems. If you
have questions or need help, call your Consultant. Do not wait for your
Consultant to call you.

Bookkeeping Reports
Your Consultant will get a copy of your monthly Budget Report from the
Bookkeeper at the same time you do. The expenses listed in the report
should closely match your Purchasing Plan. Your Consultant many call
you if he/she has questions about expenses listed in your report.

Second Month Visit
Your Consultant will visit you in your home during the second month of
your participation in CDC+. The visit is for your Consultant to see if you
are doing okay. Your consultant may also check your cash purchase
receipts.




CDC+ Consumer Notebook 4/26/04        68
It is your responsibility to call your Consultant if you need
information or help. You are welcome to call your Consultant during
business hours if you need help. A big part of your Consultant's job is to
give you information, support, and to answer your questions.

Other places to get information are: your Consumer Notebook, the
CDC+ Newsletter, and other Consumers in the Program. Remember
that other Consumers are a great resource for information but they
cannot approve or disapprove your purchases.




CDC+ Consumer Notebook 4/26/04      69
SECTION 5: MAKING CHANGES AND TROUBLESHOOTING
This Section focuses on how to make changes in the way you put your
Purchasing Plan dollars to work, especially if your efforts to achieve
quality do not satisfy you. It has two parts. These are:
   O. Problem Solving and Making Changes
   P. Fraud, Abuse, Neglect, and Exploitation

This section relates to key skill 4. “You may need to make changes in
your Plan, or make special requests.”

If you find things getting on top of you, talk with your Consultant. Of if
your Consultant is the problem, follow the procedure for requesting a
change of Consultant.
Tip: many successful managers first ask themselves “am I the
problem?” before they look to others as the cause of their difficulties.

O. Problem Solving and Making Changes
What if you have tried training your worker and giving him/her regular
feedback and things are still not working out?

Firing a Worker
If the problem is serious, the solution to the problem may be to fire the
worker immediately. For example, if your worker is hurting you or
stealing from you, call your local law enforcement office to report it and
fire your worker. In this case you may want to fire your worker over the
phone. If you have to fire them in person, have a friend or family
member there with you. Make arrangements to pay the worker any
wages you owe them and tell the worker you have called the local law
enforcement office.

If the problem is not serious and you are interested in solving the
problem, try talking to someone else about it. Often a new perspective
can help you understand a problem better. Your Consultant, or another
Consumer, may be able to make some suggestions about how to solve
the problem. If you choose to talk to a friend or family member, find




CDC+ Consumer Notebook 4/26/04       70
someone who is a good listener, someone who may offer suggestions
but will not be tempted to tell you what to do.

Making Changes
If after talking to someone else you still are not able to resolve the
situation to your satisfaction, you will have to make a change. Change
may not be easy, but is sometimes necessary. As an employer, you are
responsible for telling your worker he/she is fired. Be direct when
talking to your worker so there are no misunderstandings.

Depending on the situation, you may want to give the worker a few days
notice. That will give your worker some time to start looking for another
job and you time to start looking for another worker. If you decide to fire
a worker, you may want to use your emergency back up plan while you
look for a replacement worker. If your emergency back-up plan costs
more than regular services, make sure you make adjustments in your
budget that month so you do not over-spend. You may have to use
some of your savings to pay for services while you are changing
workers.




CDC+ Consumer Notebook 4/26/04      71
P. Fraud, Abuse, Neglect, and Exploitation
Why You Need to Know What These Words Mean
The words fraud, abuse, neglect, and exploitation can be frightening.
You, as an informed Consumer, need to know what these words mean.
Please be aware that professionals, friends, and even family members
can commit fraud, abuse, and exploitation. An informed Consumer will
recognize the signs of fraud, abuse, neglect, exploitation and avoid
these problems whenever possible.

Since there is not a typical description of someone who is likely to
commit fraud, abuse, neglect, or exploitation, you need to be careful
about who you hire. Watch out for people who question you about how
much money you have to pay for their services. Watch out for workers
who ask if anyone else is around during the day or how much money
you have in a savings or checking account. All of this information could
be used by someone planning to defraud, abuse, neglect or exploit you.


Understanding What Fraud. Abuse. Neglect, and Exploitation Mean
Following are definitions of each of the words above:

    Fraud:                   Fraud is the intentional twisting of the truth to trick
                             someone into giving up something of value or to
                             surrender a legal right. For example, your worker
                             requests that you give them something valuable or
                             asks you to put their name on your checking
                             account. If you do, you risk never seeing the item of
                             value again or losing the money in your checking
                             account.

  Abuse:                     Abuse is a deliberate act that causes physical or
                             mental injury. Your worker cannot forcefully grab or
                             restrain you. Your worker may not verbally abuse you.
                             It also means that your worker cannot encourage
                             someone else to abuse you.




CDC+ Consumer Notebook 4/26/04                72
                           For example, your worker may not call you names or
                           talk to you as if you were a child. Example: Saying to
                           you, "I can't believe you asked me such a stupid
                           question."

Neglect:                   Neglect is a repeated act of carelessness. The worker
                           must not fail to provide the services you have
                           contracted with them to provide.

                           For example, if you hired a worker to get you out of
                           bed in the morning and he/she continually arrives
                           several hours late, this is neglect.

Exploitation:              Exploitation is when you trust someone and he/she lies
                           or scares you in order to take or use your property or
                           money for him or herself. An example of exploitation
                           would be a worker taking something of value from you
                           without permission. For example, taking your
                           television, VCR or automobile without asking your
                           permission is exploitation. Or, if your worker asks you
                           to put his/her name on your bank account, this is
                           exploitation.


Who To Tell If You Suspect Fraud. Abuse. Neglect, or Exploitation
If you believe or suspect that you are a victim of abuse, neglect or
exploitation you should report it immediately. Call your Consultant or the
Florida Abuse Hotline (toll free) at 1-800-962-2873 or (850) 487-4332.

Medicaid fraud is a crime against all taxpayers and is a state and
federal offense. Medicaid money that is taken from you by dishonest
people or spent inappropriately leaves less money for Floridians who
need Medicaid services to remain healthy, independent, and living at
home. Without these services, everyone who needs help would be
forced to go to a nursing home or other facility. Not only is facility care
less desirable to most people, but also is extremely costly to the state
and federal government. All suspected Medicaid fraud should be
reported immediately by calling the Agency for Healthcare
Administration at 1-888-419-3456.


CDC+ Consumer Notebook 4/26/04               73
SECTION 6: EMERGENCY BACK UP PLANS
This Section focuses on how to make you as safe and secure as
possible, yet remain independent. It concerns creating an emergency
back up plans if things go wrong – for example, a key worker does not
show up for work one day. It also concerns dealing with emergencies –
which are always a little easier to cope with, and ideally avoid – if you
have a plan in place before they happen.


Planning for Emergencies
Planning for emergencies is one of the most important things you will do
to get yourself ready to direct your own services. You never know when
you may have an unexpected need for emergency services.

The basic purpose of the emergency back up plan is to provide critically
needed services when a directly hired employee or agency worker is
absent. You may also use your emergency back up plan if you have to
replace workers. If your worker quits unexpectedly, you may have even
less notice than if you fire your worker. It is best to plan ahead so you
will always have services when you need them.

You will need to describe your emergency back up plan in your
Purchasing Plan. The purchasing plan instructions include a section on
the emergency back up plan. Please read the instructions and think
about your critical needs, how long and how often emergency services
might be necessary, estimating the costs and how you will pay for
emergency back up services.

Do not forget about your emergency back up plan after your Consultant
has approved your purchasing plan. It is a good idea to review your plan
every three months to make sure it will still work. For example, you may
have a friend or family member listed as a back-up worker. If that friend
or family member moves, changes jobs, has new family responsibilities,
or is in poor health, he or she may not be able to provide your back up
services. Talk with your back-up worker(s) regularly to make sure they
are still available. You may want to give your back-up worker a few
hours of work now and then to keep a relationship with him/her.



CDC+ Consumer Notebook 4/26/04      74
It is strongly recommended that you plan to save a little of your CDC+
funds each month for emergencies. How you will use the emergency
savings must be specified in your emergency back up plan. These
savings should be separate from any planned savings for specific future
purchases.


Keeping Safe: Understanding Universal Precautions
A universal precaution is a way to control infection. Infection can be
found in human blood and certain human body fluids. The most
common infections or blood borne pathogens are Human
Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) Blood borne
pathogens are organisms that are in blood and can cause disease in
humans. Universal precautions are to be followed in all situations where
there is a possibility of contact with blood or other infectious material.
Other infectious material might be saliva, urine, feces, and vaginal or
other bodily fluids. If you are not sure whether a bodily fluid is infectious
or not, then treat it as though it is infectious.

Occupational exposure is contact a worker may have with blood or other
infectious materials while on the job. You must train your worker to use
protective equipment to help prevent occupational exposure to
infectious materials. Such equipment includes gloves, face shields or
masks, and eye protection. This equipment is inexpensive and can be
purchased at a medical supply store. Good protective equipment does
not permit blood or other infectious materials to pass through or reach
your work clothes, street clothes, undergarments, skin, eyes, or mouth.
Your worker should practice proper methods to control or reduce the
likelihood of exposure to infectious material. All procedures involving
blood or other potentially infectious materials must be done in a manner
that will minimize spattering, splashing, or spraying. Have your worker:

     Wash hands before and after they have contact with you and
      immediately if they come in direct contact with blood or body
      fluids. Avoid hand to mouth/eye contact;




CDC+ Consumer Notebook 4/26/04       75
     Not eat, drink, smoke, apply cosmetics or lip balm, or handle
      contact lenses in areas of infectious materials;

     Wash hands when gloves are removed and as soon as possible
      after skin contact with blood or other potentially infectious
      materials.

Being careful and following safe procedures will reduce your workers'
risk, and your risk of being exposed to infectious bodily fluids.




CDC+ Consumer Notebook 4/26/04      76
SECTION 7: OTHER INFORMATION
Where to Find Additional Help and Information
The Consumer-Directed Care Newsletter
The CDC+ Newsletter, CDC+News, is published quarterly and mailed to
you, and also posted on the CDC+ website.

The Newsletter encourages Consultants and Consumers to share things
they have learned and resources they have found. It also is a way to
provide additional training and information. Be sure to let your
Consultant know if you have information to share with other Consumers
in the Newsletter or contact the newsletter editor directly.

Peer Support
Some of the most useful help you will get will come from other
Consumers in the Program and in the community. There are peer
support groups at most Centers for Independent Living in the state. Ask
your Consultant for the name, address and telephone number of the
Center for Independent Living closest to you.

There are probably other groups or organizations in your community
that provide peer support activities, as well. You may even want to start
a peer support group of your own by exchanging your name and phone
number with other people in CDC+. You can use telephone calls,
written letters, small group meetings, or electronic means (email, for
example) to talk to one another. If you do not want to be part of a group,
you might want to exchange information with one person.

Beyond the Consumer Notebook
The Consumer-directed care Plus program will be a learning experience
for everyone involved. Consumer-directed care is a different way to get
services to people who need them. Please share what you know!




CDC+ Consumer Notebook 4/26/04      77
                                  Glossary

Consultant - A case manager or support coordinator specifically trained to
assist Consumer- Directed Care Plus Program (CDC+) participants with
program administration and care management.

District CDC Coordinator - Department of Children and Families District
Office employee who administers CDC+.

District Offices- Department of Children and Families regional centers that
administer programs at the local level.

Consumer-Directed Care – A philosophy based upon the belief that informed
individuals or their representatives can determine their own service needs,
determine how and by whom these service needs will be met, and monitor the
quality of services received. Program participants and their representatives use
a Fiscal/Employer Agent to assist them with employer-related (i.e., payroll) and
bill paying tasks. Consultants assist consumers/representatives in assessing
their needs and determining how to access services, in developing and
implementing their Purchasing Plans and in obtaining information about how
to manage their services, providers, and workers.

Contract Manager - Department of Elder Affairs employee who serves as
liaison with the FEA contractor and is responsible for monitoring performance
and compliance with contract terms and conditions.

DOEA - The Florida Department of Elder Affairs

Employer of Record – The Medicaid waiver recipient participating in CDC+.

Fiscal/Employer Agent (FEA) – A vendor operating under Section 3504 of the
IRS Code and Revenue Procedure 70-6 who acts as the agent of consumers or
their representatives for the purpose of receiving and disbursing program
funds; withholding, filing and depositing federal and state employment taxes;
collecting, verifying and processing workers’ time sheets; preparing and
disbursing workers’ payroll checks; and processing and paying non-labor
related invoices included in the program participants’ Purchasing Plans. The



CDC+ Consumer Notebook 4/26/04         78
FEA also assists in verifying citizenship/legal alien status, providing technical
assistance to program participants/representatives and consultants and
generating standardized reports for state program agencies, program
participants and their representatives as required.

Lead Agency – An elder care management agency that contracts with the Area
Agency on Aging to provide case management services. CDC consultants are
employed by lead agencies.

Medicaid Provider – A provider with an executed Medicaid provider agreement
with the State that meets all Medicaid requirements and is operating in good
standing.

Program – The Consumer-Directed Care Plus (CDC+) program.

Program Office or State Program Office – Florida Department of Elder Affairs,
Florida Department of Children and Families and Florida Department of Health
CDC+ headquarters offices in Tallahassee.

Program Participant – An individual enrolled in consumer-directed care. Also
referred to as consumer.

Purchasing Plan – A monthly services and supports expenditure plan developed
by consumer-directed care program participants.

Representative – An individual selected by the program participant to manage
the program. Representatives may also be duly appointed or designated in the
manner required by law or rule to act on behalf of another individual (e.g., legal
guardian, conservator, or power of attorney). Representatives act on behalf of
the program participant in all CDC+ matters.




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                                 Forms


Purchasing Plan


SAMPLE Purchasing Plan


Purchasing Plan Instructions


Developmental Disabilities Purchasing Plan


Developmental Disabilities SAMPLE Purchasing Plan


Developmental Disabilities Purchasing Plan Instructions


Consumer Aid Sheet


Consumer Tax Table


Employer/Employee Agreement


Bookkeeper Complaint Form


Consultant Complaint Form


Consumer Appeal Form




CDC+ Consumer Notebook 4/26/04    80
                                               CDC+ Purchasing Plan Instructions
                                 Elder Affairs, Adult Services, Brain and Spinal Cord Injury

The following is a step-by step process for completing the Purchasing Plan.

Step One: Please check the         to indicate your program: Elder Affairs, Adult Services, or Brain and Spinal Cord Injury.

Step Two: A. Consumer

Please PRINT the requested information. Check the box that indicates whether the consumer or the representative is filling out the
Purchasing Plan.

Step Three: B. Purchasing Categories

100 - Directly Hired Employees

    Name - Please Print the employee’s name. Write the employee’s Social Security Number under his or her name.

    Service Description - Using the list of service definitions you received with your Purchasing Plan packet, select a service and print
    the name of the service under Description.

    Service Code - Print the service code number of the service you selected. If the service is “critical,” check the   box. A “critical”
    service is one that must be performed or the consumer’s health, safety or well-being is at immediate risk. If you indicate a service
    as “critical” it must be included in your Emergency Backup Plan, and you must have emergency funds, if necessary, to pay
    for the critical service.

    Hourly Pay - Fill in the employee’s hourly pay.

    Total Hours Month - Indicate the total number of hours the employee will work in one month. To convert weekly hours to monthly,
    multiply the weekly hours by 4.33.

NOTE: Employees must be paid the minimum wage. Your employees may not work more than 40 hours in one work week at regular
pay. Any hours over 40 hours in a work week is overtime and, by law, must be paid at the rate of 1 ½ times the hourly pay.

CDC+ Consumer Notebook 4/26/04                                       1
Exceptions: (1) Companion services are exempt from the minimum wage law. (2) The overtime rule does not apply to companion
services or to live in help.



Calculate the Monthly Pay for each employee by multiplying the regular Hourly Pay by the Total Hours.

To calculate taxes, multiply the Monthly Pay by .1115. Then add the monthly pay and taxes together to get the total
cost of the employee’s wages per month.

                      Example: Monthly Pay $180.00 x .1115 = $20.07

   Hourly Pay           Total Hours     Monthly Pay Employer Taxes         Total Cost
       $9.00              x 20        =   $180.00   +   $20.07 =            $200.07



NOTE: Some wages are not subject to employer taxes: Employer taxes are not paid for work performed for a son, daughter or
spouse, including step relationships. Employer taxes are not paid for work performed for a parent by a child or stepchild under the age
of 21. You do not pay employer taxes for services performed by individuals under age18 unless in-home service is their occupation.


Step Four:

200 - Home Care Agency Services

    Print the name of the agency providing a home care service. Using the service definitions, select a service and PRINT the name of
    that service below Service Description. Under Code, print the service code number of the service you selected. If the service is
    “critical” check the  box. Remember, if you indicate a service as “critical” it must be included in your Emergency Backup Plan,
    and you must have emergency funds, if necessary, to pay for the service.




CDC+ Consumer Notebook 4/26/04                                     2
    Enter the number of units per month, the cost of each unit and the total monthly cost. Multiply the Hours/Units per Month by the Cost to get the

    Total Cost per Month.


 Example:

    Hours/Units per Month                            Cost        Total Cost per Month
              2                       x              $20                = $40

Once the total cost per month is calculated for each agency service add up the total cost per month column
together for the Total Cost for Home Care Agency Services.

Step Five:

300 - Community Services/Vendors

    Print the name of the Community Organization/Vendor that will be providing services. Using the service definitions, select a service
    and write the name of that service below Service Description. Under Code, print the service code number of the service you
    selected. Remember, if you check a service as “critical” it must be included in your Emergency Backup Plan, and you must
    have emergency funds, if necessary, to pay for the service.

    Enter the number of units per month, the cost of each unit, and the total monthly cost. Multiply the Hours/Units Per Month and

    Cost to get the Total Cost per Month.




CDC+ Consumer Notebook 4/26/04                                            3
   Example:

                        Hours/Units
             per Month                           Cost                        Total
   Cost per Month
                      3          x       $20               =        $60


Once the total cost per month is calculated for each agency service, add up the Total Cost Per Month column to get
the Total Cost for Community Services/Vendors.

Step Six:

400 - Personal Care Supplies/Vendors

    Print the name of the Community Organization/Vendor that will be providing the supplies. Select a service definition and print the
    name of that service below Service Description. Print the service code number of the service you selected.

   Example:
                                                             ITEM
   Vendor                                 Description                     Code
   XZY Inc.                          Consumable Medical Supplies           463


    In addition, you must enter the Units per month, the Cost, and the Total Cost per Month. Multiply the Units per month by the unit

    Cost to get the Total Cost Per Month.




CDC+ Consumer Notebook 4/26/04                                      4
   Example:


       Units per Month                        Cost           Total Cost Per Month
              2                      x        $15          =          $30

Step Seven:

500 - Cash Purchases

         Under the Service or Supply column, specifically list what the item is. Using the service definitions, select a service and print
         the name of that service below Description. Under Code, print the service code number of the service you selected.

      Example:                                                        Service
          Service or Supply                        Description               Code

            Ensure                         Nutritional supplements             566


         Enter the number of Units per month, the cost of each unit, and the Total Cost per Month. Multiply the Units per month and Unit
         Cost to get the Total Cost Per Month.

      Example:

         Unit per Month                       Cost               Total Cost Per Month
                1                x           15.00               =           $15.00




Once the Total Cost Per Month is calculated for each agency service, add up the Total Cost Per Month column to get the Total Cost for

Cash Purchases.


CDC+ Consumer Notebook 4/26/04                                         5
  NOTE: Your program office must approve any monthly budget that has a cash amount over $250. You must
  keep receipts for your purchases. Your receipts must show the date of purchase, item(s) purchased, amount of
  purchase, and the name of the person or company from whom the purchase was made. Invoices must show a
  detailed description of the items purchased. Your consultant will review your record of cash purchases and
  your receipts every month.

Step Eight:

Savings

    Enter the monthly amount to transfer from your account balance to savings in the
    box below C. Monthly Savings.

   Example:
   Amount to transfer from account balance to savings each month:                $50.00


  In the Savings Plan box, print the specific name of the Item/Service for which you
  will be saving. The Emergency back up cost, if any, must be the first saving priority
  in the plan. Using the service definitions, select a service and print the name of that
  service below Service Description. Under Code, print the service code number of the
  service you selected. Under Estimated Cost, enter the estimated cost of the purchase
  and under Estimated Date of Purchase enter the date you anticipate purchasing the
  item/service. Except for directly hired employees, any item or service
  purchased with savings requires an invoice/receipt in order to be paid by
  Acumen. Enter the monthly dollar amount you want to allocate for each savings
  purchase under Amount in the last column.

    There is no transaction fee for transferring funds between your account balance and your savings balance.
CDC+ Consumer Notebook 4/26/04                                     6
   Saving Plan Example:

                      Item/Service      Estimated        Estimated          Saving
   Description                   Code               Purchase/Completion    Per Month
                                        Cost
   1. Emergency Back up           699                   2/15/2004         $50.00
                                        $100.00
   2. Equipment Repairs           683   $150.00         5/15/2004         $50.00


    Once the Estimated Amount and the Estimated Purchase/Completion divide the number of
    month by the Estimated Amount to get the Savings per Month. To calculate the Savings Plan,
    add up the Savings per Month column to get the Total Savings Per Month.

Step Nine:

700 - FEA Fees

    For processing your monthly budget each month, Acumen will charge a flat fee of $17.99. There is also a $6.99 transaction fee for
    each payment by check or by electronic funds transfer (EFT). Review sections 100-500 of your purchasing plan and count one
    transaction fee for each employee, vendor or agency who provides a monthly service/item. For employees and for vendors who bill
    twice per month, count two transactions.




CDC+ Consumer Notebook 4/26/04                                      7
      Example:

      Section 100                       4 (Employee is paid twice
      per month)
      Section 200                       1
      Section 300                       1
      Section 400                       1
      Section 500                       1

      Total                         8
Flat fee = $17.99            Transaction fee: 8 X $6.99 = $55.92
Total fees: $17.99 + $41.94 = $73.91

Note: Eight transactions are excessive for the example budget amount; the reason is that
each section of the plan was used to show a sample purchase. Thus, the sampleFEA Fee
is higher than it would be for most consumers.
Step Ten:

E. Service Needs

    In this section, indicate your needs. These needs should match the services you have selected. If you have a need that is not
    listed, please list it on the blank lines provided and check the box.

Step Eleven:

F. Budget

In this section, indicate your monthly budget amount on the Amount Received line. Add up each section of your budget listed in
Section B to get the amount of your total costs. Your total costs should be the exact amount of your monthly budget amount.

 Example:                         Section 100 Total =    $422.37

CDC+ Consumer Notebook 4/26/04                                      8
                                    Section 200 Total    =     40.00
                                    Section 300 Total    =     60.00
                                    Section 400 Total    =     30.00
                                    Section 500 Total    =     15.00
                                    Section C. Total      =     73.54
                                     Section 700 Total    =     73.91
                                 Total monthly costs     =    $693.51

 Example:
                                  Amount Received             $693.51
                                  Less Total Costs            $693.51
                                  Balance                     $ 0.00

NOTE: You and your consultant must sign and date the purchasing plan before it can be submitted for approval.


Step Twelve:

Emergency Backup Plan

List the services from sections 100, 200 and 300 that are critical to the consumer’s health, safety and well being. Using the service
definitions, select a service and print the name of that service beneath Service Description. Under Code, print the service code
number of the service you selected. Consumer choice of provider and backup are vitally important for these critically needed services
that relate to the health and safety of the consumer. The backup provider may be an agency or an individual.
Determine the Emergency Cost: Under Provider, list the employee/agency/volunteer that will provide the service. If the provider is an
employee, you must include employer taxes as part of the total cost. To find the employer tax amount, multiply the employee
Emergency Cost by .1115.

The emergency back up plan requires an estimate of how long an emergency will last, how often it will occur and which
service/provider are likely to result in an emergency situation. It is a good idea to plan for the worst; you can always adjust the
emergency back up plan after you have experience with your employees and other providers.

 Example:

CDC+ Consumer Notebook 4/26/04                                          9
                 Employee                  Emergency cost           Taxes               Total
                 Karol Bye                    $20.00         x     .1115             = $2.23

       Name                Provider    Estimated    Plan    Emergency            Added     Emergency
     of Service                          Hours      Cost      Cost               Amount      Cost
                                         /Units    Hour       Hour
Description   Code                                 /Unit      /Unit
                                       Needed

1. PCA               132   Karol Bye      10       $9.00         $11.00           $2.00         $22.23




  CDC+ Consumer Notebook 4/26/04                                            10
                                                                                                                        Multiply Hours
                                                          Number of Hours Worked                                       Per Week by 4.33
Hourly Rate
of Pay                       5                10          15               20            25             30             35                  40
       $5.15               $28.62              $57.24       $85.86     $114.48     $143.11       $171.73             $200.35          $228.97
       $5.50               $30.57              $61.13       $91.70     $122.27     $152.83       $183.40             $213.96          $244.53
       $6.00               $33.35              $66.69      $100.04     $133.38     $166.73       $200.07             $233.42          $266.76
       $6.50               $36.12              $72.25      $108.37     $144.50     $180.62       $216.74             $252.87          $288.89
       $7.00               $38.90              $77.81      $116.71     $155.61     $194.51       $233.42             $272.32          $311.22
       $7.50               $41.68              $83.36      $125.04     $166.73     $208.41       $250.09             $291.77          $333.45
       $8.00               $44.46              $88.92      $133.38     $177.84     $222.30       $266.76             $311.22          $355.68
       $8.50               $47.24              $94.48      $141.72     $188.96     $236.19       $283.43             $330.67          $377.91
       $9.00               $50.02             $100.04      $150.05     $200.07     $250.09       $300.11             $350.12          $400.14
       $9.50               $52.80             $105.59      $158.39     $211.19     $263.98       $316.78             $369.57          $422.37
      $10.00               $55.58             $111.15      $166.73     $222.30     $277.88       $333.45             $389.03          $444.60
      $10.50               $58.35             $116.71      $175.06     $233.42     $291.77       $350.12             $408.48          $466.83
      $11.00               $61.13             $122.27      $183.40     $244.53     $305.66       $366.80             $427.93          $489.06
      $11.50               $63.91             $127.82      $191.73     $255.65     $319.56       $383.47             $447.38          $511.29
      $12.00               $66.69             $133.38      $200.07     $266.76     $333.45       $400.14             $466.83          $533.52
      $12.50               $69.47             $138.94      #208.41     $277.88     $347.34       $416.81             $486.28          $555.75
      $13.00               $72.25             $144.50      $216.74     $288.99     $361.24       $433.49             $505.73          $577.98
      $13.50               $75.03             $150.05      $225.08     $300.11     $375.13       $450.16             $525.18          $600.21
      $14.00               $77.81             $155.61      $233.42     $311.22     $389.03       $466.83             $544.64          $622.44
      $14.50               $80.58             $161.17      $241.75     $322.34     $402.92       $483.50             $564.09          $644.67
      $15.00               $83.36             $166.73      $250.09     $333.45     $416.81       $500.18             $583.54          $666.90
                                                             Consumer Tax Table
      $15.50               $86.14             $172.28      $258.42     $344.57     $430.71       $516.85             $602.99          $689.13
                                                    Consumer & Employee Share FICA Tax
      $16.00               $88.92             $177.84      $266.76     $355.68     $444.60       $533.52             $622.44          $711.36
      $16.50               $91.70             $183.40      $275.10     $366.80     $458.49       $550.19             $641.89          $733.59
Worker’s Wage
      $17.00               $94.48
                          7.65%               $188.96 2.7% $283.43 Cost$377.91
                                            .8%                 Total              $472.39 7.65% $566.87
                                                                                                       .8%           $661.34
                                                                                                                         2.7%         $755.82
                                                                                                                                    Total Cost
per Hour
      $17.50             FICA Tax
                           $97.26                          $291.77         Worker’s$486.28
                                              $194.51SUTA Tax per Hour $389.03           FICA Tax   FUTA
                                                                                                 $583.54 Tax           SUTA
                                                                                                                     $680.79Tax     per Hour
                                                                                                                                      $778.05
                                         FUTA Tax                            Wage
              $5.15              $0.39        $0.04     $0.14      $5.72               $12.25   $0.94        $0.10          $0.33         $13.62
              $5.25              $0.40        $0.04     $0.14      $5.84        per Hour
                                                                                       $12.50   $0.96        $0.10          $0.34         $13.89
              $5.50              $0.42        $0.04     $0.15      $6.11               $12.75   $0.98        $0.10          $0.34         $14.17
CDC+ Consumer Notebook 4/26/04                                          11
             $5.75               $0.44   $0.05   $0.16    $6.39    $13.00   $0.99   $0.10   $0.35   $14.45
             $6.00               $0.46   $0.05   $0.16    $6.67    $13.25   $1.01   $0.11   $0.36   $14.73
             $6.25               $0.48   $0.05   $0.17    $6.95    $13.50   $1.03   $0.11   $0.36   $15.01
             $6.50               $0.50   $0.05   $0.18    $7.22    #13.75   $1.05   $0.11   $0.37   $15.28
             $6.75               $0.52   $0.05   $0.18    $7.50    $14.00   $1.07   $0.11   $0.38   $15.56
             $7.00               $0.54   $0.06   $0.19    $7.78    $14.25   $1.09   $0.11   $0.38   $15.84
             $7.25               $0.55   $0.06   $0.20    $8.06    $14.50   $1.11   $0.12   $0.39   $16.12
             $7.50               $0.57   $0.06   $0.20    $8.34    $14.75   $1.13   $0.12   $0.40   $16.39
             $7.75               $0.59   $0.06   $0.21    $8.61    $15.00   $1.15   $0.12   $0.41   $16.67
             $8.00               $0.61   $0.06   $0.22    $8.89    $15.25   $1.17   $0.12   $0.41   $16.95
             $8.25               $0.63   $0.07   $0.22    $9.17    $15.50   $1.19   $0.12   $0.42   $17.23
             $8.50               $0.65   $0.07   $0.23    $9.45    $15.75   $1.20   $0.13   $0.43   $17.51
             $8.75               $0.67   $0.07   $0.24    $9.73    $16.00   $1.22   $0.13   $0.43   $17.78
             $9.00               $0.69   $0.07   $0.24   $10.00    $16.25   $1.24   $0.13   $0.44   $18.06
             $9.25               $0.71   $0.07   $0.25   $10.28    $16.50   $1.26   $0.13   $0.45   $18.34
             $9.50               $0.73   $0.08   $0.26   $10.56    $16.75   $1.28   $0.13   $0.45   $18.62
             $9.75               $0.75   $0.08   $0.26   $10.84    $17.00   $1.30   $0.14   $0.46   $18.90
            $10.00               $0.77   $0.08   $0.27   $11.12    $17.25   $1.32   $0.14   $0.47   $19.17
            $10.25               $0.78   $0.08   $0.28   $11.39    $17.50   $1.34   $0.14   $0.47   $19.45
            $10.50               $0.80   $0.08   $0.28   $11.67    $17.75   $1.36   $0.14   $0.48   $19.73
            $10.75               $0.82   $0.09   $0.29   $11.95    $18.00   $1.38   $0.14   $0.49   $20.01
            $11.00               $0.84   $0.09   $0.30   $12.23    $18.25   $1.40   $0.15   $0.49   $20.28
            $11.25               $0.86   $0.09   $0.30   $12.50    $18.50   $1.42   $0.15   $0.50   $20.56
            $11.50               $0.88   $0.09   $0.31   $12.78    $18.75   $1.43   $0.15   $0.51   $20.84
            $11.75               $0.90   $0.09   $0.32   $13.06    $19.00   $1.45   $0.15   $0.51   $21.12
            $12.00               $0.92   $0.10   $0.32   $13.34    $19.25   $1.47   $0.15   $0.52   $21.40




CDC+ Consumer Notebook 4/26/04                                12
                            Consumer-Directed Care Plus
                           Consumer/Consultant Agreement

The purpose of this agreement is to clarify the responsibilities of
consumers and consultants, and make sure everyone understands those
responsibilities.

Your Responsibilities as a Consumer:

1.       Complete mandatory training.

2.       Develop a purchasing plan to show how the budget will be spent
         each month.

3.       Keep all purchases within your monthly budget.

4.       Make purchases that are the same as listed on the purchasing plan.

5.       Select a representative for assistance with managing finances or
         decision making if needed.

6.       Develop an emergency back-up plan for coverage when your regular
         employee is absent because of illness, transportation problems, or
         needing time off.

7.       Find and hire employees and submit the employment forms’ package
         for each employee to the Fiscal Employer Agent (FEA).

8.       Send the employment forms package to the program FEA.

9.       Train employees about their job duties and what you expect
         from them.

10.      Make sure employee time sheets reach the FEA on time.

11.      Pay employees as soon as you get the paychecks from the FEA.

12.      Approve invoices from vendors, agencies or independent contractors
         and mail them to the Fiscal Employer Agent.


CDC+ Consumer Notebook 4/26/04           1
13.      Review monthly budget reports from the FEA.

14.      Report and changes in income and assets to your consultant and to
         the Office of Economic Self Sufficiency.

15.      Tell your consultant about your satisfaction with the services he or
         she is giving you.

16.      Contact your consultant when you have questions.

17.      Contact your consultant if you have concerns so small problems
         won't become big problems.

Your Consultant's Responsibilities to You:

1.       Attend training for consultants and understand the Consumer-
         Directed Care Plus program philosophy.

2.       Provide training to you and adjust the training to meet your needs.

3.       Encourage and support you in making independent choices about
         services, purchases and employees.

4.       Review your purchasing plan and back-up plan. Call you if additional
         information is needed.

5.       Talk with you about your satisfaction of the quality of services you are
         purchasing.

6.       Review your monthly budget reports from the FEA..

7.       Be available to you to answer questions or provide technical
         assistance in resolving problems.

8.       Work with you to develop a corrective action plan if you have
         problems managing your services or the monthly budget.

10.      Inform you about community resources.



CDC+ Consumer Notebook 4/26/04           2
11.      Coordinate your annual Medicaid redetermination with the Office of
         Economic Self Sufficiency.

What the Consultant will not do:

       1.       Interview, hire, train or supervise your employeess.

       2.       Tell your employeess if you are unhappy with their work.

       3.       Fire your employees.

       4.       Fill out the employment forms package.

       5.       Find emergency back up employees or providers for you.

      6.       Write your purchasing plan.

      7.       Be able to get you extra money if you spend more than your
               monthly budget.

I understand and accept the responsibilities listed in this agreement.


_________________________                    _________________
(Consumer Signature)                              (Date)


_________________________                  __________________
(Consultant Signature)                          (Date)




CDC+ Consumer Notebook 4/26/04             3
    Employer/Employee Agreement Consumer-Directed Care
                           Plus




This agreement between ____________________________ and
                              Print (Employer)

                                 ______________________________
                                          Print (Employee)

is executed to make the terms of employment clear.


Employee Start Date: ___/____/___


WORK SCHEDULE
The employee's work schedule will be as follows:




CDC+ Consumer Notebook 4/26/04              4
EMPLOYER RESPONSIBILITIES:

Compensation
The employer agrees to pay the employee $_____________ per hour.

The employer will pay the employer’s portion of all federal and state
government unemployment taxes, social security and Medicare taxes. The
CDC+ fiscal/employer agent will send you a summary of income and
income tax payroll withholdings (the W2 Form) by January 31st for the
previous calendar year.

Job Duties

    1.____________________________________________________

    2.____________________________________________________

    3.____________________________________________________

    4.____________________________________________________

    5.____________________________________________________

    6.____________________________________________________

    7.____________________________________________________

    8.____________________________________________________

    9.____________________________________________________

    10.___________________________________________________




CDC+ Consumer Notebook 4/26/04      5
EMPLOYEE RESPONSIBILITIES:

Reporting to Work/Time Off

Please initial:

I _____ agree to report to work on time.

I _____ agree to carry out assigned duties and responsibilities as
        explained by my employer.

I _____ agree to tell my employer two weeks in advance when I need time
        off. Vacations dates will be set by mutual agreement between the
        employer and me.

I _____ agree to call my employer with as much advance notice as
        possible if I am ill or if I am unable to report to work on time due to
        emergencies (car trouble, severe weather, etc.).

I _____ understand I am expected to be dependable.

I _____ agree to give my employer two weeks written notice if I decide to
        terminate my employment agreement.

I have read and understand the job duties expected of me.


___________________________                      _______________
Signature of Employee       Date


___________________________   _______________
Signature of Employer       Date




CDC+ Consumer Notebook 4/26/04         6
                   CONSUMER-DIRECTED CARE PLUS PROGRAM
                       BOOKKEEPER COMPLAINT FORM

Consumer/Representative Name:
(PLEASE PRINT)


Address:


City:                                      Zip:             Telephone: (   )

Best time to call: _____AM _____PM

Please explain in the space below the problem you are having with the program Bookkeeper.
Use back of page if additional space is needed.




Have you told the Bookkeeper about the problem? Yes No If yes, what was done?




                                       Please mail this form to:
                                     Department of Elder Affairs
                                 Consumer-Directed Care Plus Program
                                         4040 Esplanade Way
CDC+ Consumer Notebook 4/26/04       Tallahassee, FL 32399-7000
                                              7
                                   Consumer Appeal Form

Name of Consumer:

Name of Representative:
Address:

City/Zip:                                            Telephone: (       )

Reason for appeal
      I do not agree I need assistance of a representative.
      I do not agree with the corrective action plan written by my Consultant.
      I do not agree with my Consultants’ recommendation to return to the
        Home and Community Based Services Program and disenroll from the
        Consumer-Directed Care Program.

What problem or situation caused your Consultant to make the recommendation listed
above?




What do you think should be done?




Printed Name:
  CDC+ Consumer Notebook 4/26/04               8
Signature:
 Appeal Form Revised 01/08/04                                       Date:
                          CONSUMER-DIRECTED CARE PLUS PROGRAM
                              CONSULTANT COMPLAINT FORM

Consumer/Representative Name:
(PLEASE PRINT)


Address:

City:                                 Zip:             Telephone: (     )

Best time to call: _____AM _____PM
Please explain in the space below the problem you are having with your Consultant. Use
back of page if additional space is needed.




Have you told your Consultant about the problem? Yes No If yes, what was done?




CDC+ Consumer Notebook 4/26/04          9
Mail the Consultant Complaint Form to your state program office at the
following address:

    Elders:
          Department of Elder Affairs
          CDC+ Staff
          Suite 235
          4040 Esplanade Way
          Tallahassee, FL 32399-7000

    Developmental Services:

          Department of Children and Families
          Developmental Disabilities Program CDC+ Staff
          Building 3
          1317 Winewood Boulevard
          Tallahassee, FL 32399

    For Adult Services:

          Department of Children and Families
          Adult Services Program CDC+ Staff
          Building 3, Room
          1317 Winewood Boulevard
          Tallahassee, FL 32399


    For Brain and Spinal Cord Injury:
          Department of Health
          BSCIP CDC+ Staff
          4052 Bald Cypress Way
          Bin C-25
          Tallahassee, Fl 32399-1744




CDC+ Consumer Notebook 4/26/04          10

				
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