Self-Direction Glossary

Self-directing your own or a loved one's care can be complex, and the terminology is no exception. That’s why we have compiled a glossary of common self-direction terms used by providers, case managers, support planners, families, and more. Many of these definitions are from the Community-Based Services Manual (CBSM) glossary created by Minnesota Department

to Human Services (DHS).  Visit their page for a more exhaustive list of terms or learn more about the CBSM below.

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245D: The Department of Human Services (DHS) licenses certain Home and Community-Based Services (HCBS) provided to people with disabilities and those over age 65. Most of the services are funded under one of Minnesota’s Medicaid waiver programs. The HCBS standards under Minnesota Statutes, chapter 245D lays out the structure and requirements of 245D licensure. 245D Services Include:

  • Basic Support Services: These are services that provide the level of assistance, supervision and care that is necessary to ensure the health and safety of the person.

  • Intensive Support Service: These services are intended to promote training, habilitation or rehabilitation of the person.



Activity of Daily Living (ADL): Tasks essential to perform routine self-care functions (e.g., dressing, grooming, bathing, eating, transfers, mobility, positioning, toileting).



Case Manager (CM): Professional who assists a person with access to and navigation of social, health, education, vocational and other community and natural supports and services, based on the person's values, strengths, goals and needs. The professional is responsible to provide the person with information necessary for them to make informed choices. A Care Coordinator may also fill this role.

Centers for Medicare/Medicaid Services (CMS): Federal agency within the U.S. Department of Health and Human Services that administers the Medicare and Medicaid programs. CMS ensures states administer national health care programs properly, establishes policies for paying health care providers, conducts research on the effectiveness of various methods of health care management, assesses the quality of health care facilities/services and takes enforcement actions as appropriate.

Client Directed Services (CDS): A division of MRCI, that is a leading provider of Financial Management Services (FMS) for the State of Minnesota. Since 1998, MRCI-CDS has worked with families throughout the state to provide self-directed services to individuals and families who choose to self-direct their own services.

Community Based Services Manual (CBSM): The CBSM is a resource for lead agencies who administer home and community-based services that support older adults and people with disabilities. The Aging and Adult Services Division (AASD) and Disability Services Division (DSD) publish guidance on and explanation of policy in the manual.

Community First Services and Supports (CFSS): The Minnesota Department of Human Services is preparing to transition from personal care assistance (PCA) to community first services and supports (CFSS). Both PCA and CFSS provide supports to people to help them remain independent in the community. The Consumer Support Grant (CSG) will also transition to CFSS. You can learn more about CFSS in our blog post: What is CFSS?

Community Support Plan (CSP): A written summary completed for everyone who has an assessment, regardless of whether the person is eligible for Minnesota Health Care Programs (MHCP) or chooses to receive publicly funded home and community-based or state plan services. The document provides a summary of what the assessor discovered through the assessment process and identifies next steps based on the person's needs.

Consumer Directed Community Supports (CDCS): Service option available to people on the home and community-based services (HCBS) waivers and Alternative Care (AC) program. CDCS gives a person flexibility in service planning and responsibility for self-directing their services, including hiring, including qualified parents, spouses, neighbors, or friends, and managing support workers. CDCS may include traditional services and goods and self-designed services.

Consumer Support Grant (CSG): The Consumer Support Grant program is a state-funded alternative to Medicaid home care services of a home health aide. The CSG Program provides clients with greater flexibility and freedom of choice in service selection, staff wages, service delivery specifications and employment of service providers. Parents, spouses, family members, trusted neighbors or friends can be paid for service.



Electronic Visit Verification (EVV): The 21st Century Cures Act, signed in December 2016, will require Direct Care Workers and Personal Care Attendants (PCA) to verify and submit time worked electronically. Read more about EVV on our blog.

Employer Identification Number (EIN): Nine-digit number the Internal Revenue Service (IRS) assigns to an entity to identify business taxpayers. MRCI-CDS will help you apply for this number, which allows our clients to be the employer of their own staff.

Employer of Record (EOR): An Employer of Record (EOR) is a third-party organization that hires and pays an employee on behalf of another company and takes responsibility for all formal employment tasks.



Financial Management Service (FMS): Services that provide help with financial tasks, billing and employer-related responsibilities for people who self-direct their services through consumer directed community supports (CDCS), the Consumer Support Grant (CSG) and Community First Services and Supports (CFSS). These services are provided by financial management services (FMS) providers like MRCI-CDS.

Fiscal Support Entity (FSE): Provider type that was replaced by Financial Management Service (FMS) Providers



Health Insurance Portability and Accountability Act (HIPAA): Federal law that provides individuals with rights over their health information and sets rules and limits on who can look at and receive personal health information. It also protects health information in electronic form and requires entities covered by HIPAA to ensure electronic protected health information is secure and the confidentiality provisions of the Patient Safety Rule are enforced.

Home and Community Based Services (HCBS): Services not normally covered by Medical Assistance that are covered under a 1915(c) federally funded waiver program or through state funds. HCBS waivers allow states flexibility to cover virtually all long-term care services that people with disabilities need to live independently in home and community settings. States may operate several 1915 (c) HCBS waiver programs at once, each offering a distinct package of services and supports to different groups of people.

Host Home:  Host Home providers operate adult foster care homes under the 245D license held by other organizations such as MRCI CDS. Host Home allows participants to remain in their community outside of a group residential setting.



Individualized Home Supports (IHS): Formerly known as Personal Supports, Individualized Home Supports is a traditional service option that provides licensed staffing support in the person’s home or community to: achieve his/her full potential, increase his/her independence, and meet community inclusion goals that are important to and important for the person and based on an assessed need.


Instrumental Activity of Daily Living (IADL): Meal planning and preparation, managing finances, shopping for food, communication by telephone and other media, transportation and participating in the community.

Internal Revenue Service (IRS): The IRS is a bureau of the Department of the Treasury. The IRS role is to help the large majority of compliant taxpayers with the tax law, while ensuring that the minority who are unwilling to comply pay their fair share.



Lead Agency: A county, tribal nation, or managed care organization.

Long-term care/long-term support services (LTSS): Services that a person will likely need for the rest of his/her life.



Managed Care Organization (MCO): An organization certified by the Minnesota Department of Health to provide all defined health care benefits to people enrolled in a Minnesota Health Care Program (MHCP) in return for a capitated payment. MCOs are also referred to as health plans or prepaid health plans.

Medical Assistance (MA): Minnesota's name for the Federal Medicaid program that provides medical care for people with low income.

Minnesota Department of Human Services (DHS): The Minnesota Department of Human Services (DHS) helps provide essential services to Minnesota's most vulnerable residents. Working with many others, including counties, tribes and nonprofits, DHS helps ensure that Minnesota seniors, people with disabilities, children and others meet their basic needs and have the opportunity to reach their full potential.

  • Aging and Adult Services Division (AASD): Aging and Adult Service Division is part of the Continuing Care for Older Adults Administration in the Minnesota Department of Human Services (DHS). AASD develops policy and administers State and Federal programs for older adults that provide home and community-based services, protective services, caregiver support and alternative housing arrangements.

  • Disability Services Division (DSD): The Disability Services Division is part of the Community Supports Administration in the Minnesota Department of Human Services. DSD manages publicly funded programs that support people with a variety of disabilities, including: acquired or traumatic brain injuries, chronic medical conditions, developmental disabilities, and physical disabilities. DSD also includes the HIV/AIDS Unit. The HIV/AIDS unit has insurance, drug reimbursement, dental, nutrition and case management programs to help Minnesotans with HIV/AIDS.

Minnesota Health Care Programs (MHCP): DHS-administered programs that include: Medical Assistance (MA), MinnesotaCare, Minnesota Family Planning Program, Home and Community-Based waiver programs, and Medicare Savings Programs.



Night Supervision: Night supervision services include an awake staff in the person’s own home when the person needs assistance and supervision in at least one of the following areas: carrying out the person’s positive support programming and transition plans, reinforcing skill development supports, assisting with activities of daily living (ADLs), and/or assisting with instrumental activities of daily living (IADLs).



Paid Parent of Minor (PPM): Personal assistance services are the only services for which a spouse or parent of a minor may be paid. For the purposes of this definition, “parent” includes the following: adoptive parent, biological parent, stepparent legal guardian of a minor, legally responsible person of a minor. Minor: A person who is younger than 18 years old.

Patient Safety Rule: Subpart C: Federal law that describes confidentiality protections, which protect identifiable information being used to analyze patient safety events and improve patient safety.

Payroll Model: An FMS provider such as MRCI-CDS offers only one employment model: the payroll model. In the payroll model, a person who uses CDCS or CSG is the employer of his/her support workers. Previously, the FSE offered three employment models: agency with choice, payroll and fiscal conduit.

PCA Choice: Through the PCA Choice program, participants can receive help with routine activities that people tend to do every day such as eating, bathing, dressing, mobility, as well as other health-related tasks, behaviors, and more. Individuals are empowered to recruit, hire and train their own PCAs who provide their care.

Person Centered Planning (PCP): Process focusing on a person and what they want for their future. There are many different approaches to person-centered planning.

Personal Care Assistance (PCA): Services to help a person with day-to-day activities in their home and community to help maximize his/her independence.

Personal Care Assistant (PCA): Provides personal care assistance services.

Private Pay: Families and individuals can pay for staffing and hire a Financial Management Service (FMS) such as MRCI-CDS to handle payroll taxes and other IRS obligations of having paid staff. An FMS will ensure that you are accurately complying with all IRS guidelines for reporting wages and paying taxes.



Qualified Professional (QP): Professional who provides oversight and supervision of personal care assistance (PCA) services and staff in the delivery of PCA services.



Respite:  Respite is a short-term care service provided due to the absence or need for relief of the family member(s) or primary caregiver normally providing the care. The Respite service option is available to people on a waiver that provides licensed staffing support.



Self-Direction/Consumer Direction: Philosophy through which people make informed choices about the services they receive. Consumer direction provides people flexibility and responsibility to direct their own services and supports.

SignNow: MRCI-CDS has partnered with SignNow to bring you documents that you can complete online. For a list of available documents, visit our SignNow page.

Service Employees International Union (SEIU): “An organization of 2-million members united by the belief in the dignity and worth of workers and the services they provide and dedicated to improving the lives of workers and their families and creating a more just and humane society.” - SEIU About page

Service Agreement (SA): Document used to identify services, providers and payment information for a person who receives home care, Alternative Care (AC) or waiver services. A service agreement allows providers to bill for approved services and DHS to audit usage and payment data.

Spenddown: Amount of money a person enrolled in a Minnesota Health Care Program (MHCP) is responsible to pay before he/she is eligible for Medical Assistance (MA). A person may have a monthly spenddown payment to maintain their MA Eligibility.

Social Security Administration (SSA): Federal agency that administers Social Security, a program consisting of disability, retirement, and survivors' benefits.

Support Planner (SP): An optional service to help the person with the long-term services and supports (LTSS) support planning process in Payroll Model programs such as Consumer Directed Community Supports (CDCS) or Community Support Grant (CSG).



Unique Minnesota Provider ID (UMPI): Your NPI (National Provider Identifier) or UMPI is required on all claims submitted to MHCP and allows you to be paid for MHCP-covered services provided to MHCP members. A 10-digit Unique Minnesota Provider Identifier that MHCP is assigned to you at the time of your enrollment.



Veteran-Directed Care (VDC): Serves Veterans of all ages who are eligible for nursing facility level of care.  The VDC program gives the Veteran the opportunity to remain in their home and community with assistance from family and friends.



Waiver Programs: Waiver and Alternative Care (AC) programs provide home and community-based services (HCBS) to meet the needs of people with disabilities and older adults. A person must be a Minnesota resident and meet eligibility requirements specific to each waiver/AC program.

Waiver Reimagine: The name of ongoing work DHS is doing to simplify waiver services, reshape the waiver program structure and transition to an individual budgeting model for people who access disability waivers. With these changes, services and supports will align with a person’s needs—not their diagnoses. Follow the link to learn more about Waiver Reimagine.

Waiver Types:

  • Alternative Care (AC): For older Minnesotans who require the level of care provided in a nursing facility and who are not yet eligible for Medical Assistance (MA).

  • Brain Injury (BI) Waiver: For people with a traumatic, acquired, or degenerative brain injury who require the level of care provided in a nursing facility that provides specialized services for people with BI, or who require the level of care provided in a neurobehavioral hospital.

  • Community Access for Disability Inclusion (CADI) Waiver: For people with disabilities who require the level of care provided in a nursing facility.

  • Community Alternative Care (CAC) Waiver: For people who are chronically ill or medically fragile and require the level of care provided in a hospital.

  • Developmental Disabilities (DD) Waiver: For people with developmental disabilities or related conditions who require the level of care provided in an intermediate care facility for persons with developmental disabilities (ICF/DD).

  • Elderly Waiver (EW): For older Minnesotans who require the level of care provided in a nursing facility.