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Duties of ADD

  1. Maintain a written job description for the Participant Directed Services Coordinator/Service Advisor/Quality Assurance.
  2. Maintain Policies and Procedures for PDS Staff including Financial Management Agency.
  3. Designate a Supervisor to oversee Service Advisors and PDS process.

Duties of Service Advisor

  1. Act on behalf of the participant without violating the integrity of the program.
  2. Assist the participant in gaining and exercising control over her/his life.
  3. Encourage the opportunity to participate in the community.
  4. Recognize goals, desires, and interests.
  5. Provide any needed assistance to a Participant with any aspect of PDS or blended services.
  6. Be available to a participant twenty-four (24) hours per day, seven (7) days per week.
  7. Comply with all applicable federal and state laws and requirements.
  8. Continually monitor a participant’s health, safety and welfare.
  9. Complete or revise a plan of care using the person-centered planning principles established in the Person Centered Planning: Guiding Principles.
  10. Utilize the Medicaid Waiver Management Application for PDS Coordination while maintaining the paper chart.

Procedure for Participant Directed Services

  1. Conduct an initial visit at or within seven (7) days of referral or receiving the case transfer within MWMA and follow-up with monthly face-to-face visits with the participant/representative thereafter.
  2. Explain in detail PDS services and processes both verbally and in written form.
  3. Develop the Person Centered Plan with participant/representative and all other service providers, waiver and non-waiver.
  4. Thoroughly explain and discuss the Rights, Responsibilities and Risks document with the participant/representative and obtain signature of understanding with date.
  5. Complete all necessary representative documentation, if applicable.
  6. Complete Map 2000 to include start date for case management, representative designation (if applicable) and signature/dates of appropriate persons.
  7. Complete any and all other required forms/documentation set forth by DMS and DAIL.  This includes the agency’s monthly case note and any ongoing case notes.  These notes are to be filed in the participant’s record within 10 days of completion and located within the participant's record in MWMA.
  8. Train the participant/representative on employer responsibilities and employee requirements so that necessary employee documentation and requirements are met.
  9. Provide fraud/abuse/neglect/exploitation training to both the participant/representative and employee.
  10. Employee(s) will complete required forms that include but are not limited to:
    1. K-4
    2. W-4
    3. I-9
    4. W-9 and copy of OIG certificate for Personal Service Agency (if applicable)
    5. Employee/Provider Contract
    6. KARES Consent and KARES Application with Eligible Form
    7. Employee Training Verification
    8. Direct Deposit form
    9. Household Employee Tax Information form (if applicable)
    10. Employment Application
    11. Timesheet Training form
    12. TB Screening
    13. CPR/First Aid Certification
    14. Driver’s License (if providing transportation)
    15. Vehicle Insurance (if providing transportation)
    16. Approval documentation for Immediate Family Members, Legal Guardians and Legally Responsible Individuals
    17. DAIL Attendant Care Training  Certification
    18. All agency documentation/forms
    19. Any and all other DAIL and DMS required documents

      11. Complete 2678 and SS-4 in the name of the employer.

      12. KARES checks will be completed within the required timeframe and eligible form filed along with TB screening, CPR/First Aid, etc. with expiration dates monitored so that renewal requirements are met.

      13. When the Person Centered Plan is approved and the PA is received, only after the employee is cleared for employment and all required documentation is complete, uploaded and filed, the participant/representative is notified and the employee is trained to complete employee timesheets and begin direct services.  For new participants, the Map 552 should also be available.  All other service providers are to be informed of this as well.

      14. Each participant is provided PDS and FMS Coordination as instructed in applicable regulation.  It is understood that each case will distinctly vary and require personalization and an independent approach.

Procedure for Exception Process (HCB1 Participants Only – To end 9/14/17)/Modifying the Person-Centered Plan within MWMA

  1. If the budget received from DMS does not meet the participant’s needs, the Service Advisor can proceed with the exception process.
  2. The Service Advisor will meet with the participant/representative and develop a 15 minute increment schedule that describes a week in the participant’s life.  This schedule will note how much assistance is required for all activities documented. 
  3. The DAIL 100 will be completed thoroughly and accurately and submitted to DAIL for review and approval along with the schedule and other documentation necessary to evaluate the need for the requested exception.
  4. An exception budget will be developed by DMS when the exception has been approved by DAIL.
  5. When the exception budget is received, the new budget along with the revised Plan of Care are to be provided to Carewise for a new prior authorization to be approved.
  6. When prior authorization is received, the new Plan of Care can be implemented to satisfy the increased needs of the participant.
  7. Person-Centered Plans may be modified within MWMA by selecting Plans of Care and modifying the current Person-Centered Plan.
  8. The MAP 116 allows for modifications to be requested based on change of service providers, level of need, change in service, etc.
  9. Once reviewed by Carewise Health, the Person-Centered Plan is then approved with supporting Prior Authorization noting the approval of the modified plan. 

Participant’s Paper Chart

  1.  The participant’s chart will include the following documentation as listed on the Table of Contents:                           



MAP 10

MAP 2000

Rights, Responsibilities and Risks

Representative Responsibilities and Expectations

Employer Responsibilities and Expectations

Required Representative Documentation (KARES)

MAP 115 (If Applicable)

MAP 116

Miscellaneous (LCAAA Privacy Policies, In-House Policy, Surveys)



MAP 350


Miscellaneous (MAP 24, ABI – MAP 24C, Exception Documentation)



Miscellaneous (PA, Confirmation Notice, LOI, ABI – Mayo Report, Rancho Scale, Allocation Letter)


Case Notes

Miscellaneous (Referral)


Corrective Action Plans

Miscellaneous (Liability Agreement, Goods and Services Agreement, Goods and Services, Fax Transmittals, Additional Documentation)


Participant Training Verification

Employee Information

CDO/PDS Employee/Provider Contract

KARES Documentation


AOC Request form

AOC Criminal Background Check

Nurse Aide Abuse Registry Check

Central Registry Check (If Applicable)

KY Caregiver Misconduct Registry

TB Screening/CPR and First Aid

Driver’s License (If Applicable)

Approval Documentation for Immediate Family Members, Legal Guardians and Legally Responsible Individuals

CDO/PDS Application for Employment

DAIL Attendant Care Training

Verification of Training of Abuse, Neglect, Fraud and Exploitation

Miscellaneous (Questionnaire, Employee In-House Policy, Timesheet Training Signature Page, Additional Documentation

Termination from Participant Directed Services          

  1. Voluntary Termination:  If a participant/representative chooses to return to traditional services or simply terminate from the PDS program, the Map 2000 is to be completed.  The voluntary termination portion of the Map 2000 should be initialed and dated by the participant/representative and also signed at the bottom.  The Service Advisor is to also sign and date.  The Map 2000 is then uploaded in MWMA and program closure is requested and documented within the paper chart.  If the participant chooses to transfer to a traditional service provider, the MAP 2000 is then uploaded to View Documents in MWMA and a transfer is requested within the management system.  If the participant’s case has not been or cannot be managed within MWMA, the Map 2000 and Map 24 is faxed to Carewise Health and the Map 24 is faxed to the local DCBS office for notification of service change.  The paper chart is updated.
  2. Involuntary Termination:  If a participant expires or for any reason does not receive an approved service for greater than 60 days (newly approved participants), the participant is to be involuntarily discharged.  The Map 2000 is to be completed accordingly noting the involuntary discharge and is to be signed by the Service Advisor with date.  If the participant is non-compliant, violates regulation and/or a Corrective Action Plan has been implemented and the participant/representative has chosen not to adhere to the agreed plan, the PDS Coordinator can request involuntary termination by providing appropriate documentation to DAIL Staff and the DAIL Commissioner for the case to be reviewed and decided upon.  All necessary documentation is again uploaded in MWMA and documented within the paper chart.

LCADD Contact Info

Lake Cumberland Area Development District
P.O. Box 1570
(mailing address)
2384 Lakeway Dr.
(street address)
Russell Springs, KY 42642
Phone: 270-866-4200
Toll Free: 800-264-7093
TDD: 800-648-6056
Fax: 270-866-2044

LCADD Calendar

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