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Consumer Directed Care Plus

Module: CDC+ Application Packet. Consumer Directed Care Plus. 1. REVISED 9/2012. Introduction. This module addresses the CDC+ Application Packet: CDC+ Program Application Form IRS Form SS-4 EIN Third Party Designee Authorization CDC+ Consumer/Consultant Agreement CDC+ Consent Form

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Consumer Directed Care Plus

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  1. Module: CDC+ Application Packet Consumer Directed Care Plus 1 REVISED 9/2012

  2. Introduction • This module addresses the CDC+ Application Packet: • CDC+ Program Application Form • IRS Form SS-4 • EIN Third Party Designee Authorization • CDC+ Consumer/Consultant Agreement • CDC+ Consent Form • CDC+ Representative Agreement/Registration Form (optional) • Check each form to ensure it has been completed in its entirety and that appropriate signatures have been obtained. 2

  3. CDC+ Program Application • The CDC+ Application Packet can be downloaded from the CDC+ website at: www.cdcplus.org. • The CDC+ program application requires the following Medicaid waiver client information: • Medicaid ID number; • Social Security number; • Date of birth; and • Contact information. 3

  4. CDC+ Program Application, continued • The application must include the annual care plan amount, after case management fees are deducted. • The application is signed by the consumer/representative and the consultant. • Signatures from the appropriate agency: Agency for Health Care Administration, Area Agency on Aging, Department of Children and Families, or Department of Health must be obtained to authorize the Medicaid waiver client’s participation. 4

  5. CDC+ Program Application Divide the annual care plan amount, after case management fees, by 12 months to determine the consumer’s monthly budget amount. All signatures are required. 5

  6. Employer Identification Number (EIN) Third Party Designee Authorization The EIN Third Party Designee Authorization is a statement from the consumer/representative authorizing the DOEA, as Fiscal/Employer Agent (F/EA), to apply for an EIN with the IRS. 6

  7. EIN Third Party Designee Authorization 7

  8. IRS Form SS-4 • The SS-4 Application for Employer Identification Number (EIN) authorizes the Department of Elder Affairs (DOEA), as Fiscal/Employer Agent (F/EA), to obtain an EIN for the consumer. • For IRS purposes, a CDC+ consumer is a household employer, and an EIN is needed to file the correct employer taxes. 8

  9. IRS Form SS-4 This section is for the CDC+ applicant’s Information. Complete lines 1-7b; EXCEPT lines 2 -3 • IRS requires one of the following: • Consumer’s signature. • “X” along with witness’ signature. • The consumer’s Power of Attorney (POA) is authorized to sign for the consumer (a copy must be provided with the application packet). 9

  10. CDC+ Consumer/Consultant Agreement • The CDC+ Consumer/Consultant Agreement outlines the consumer/representative’s responsibilities. • The form also outlines the consultant’s responsibilities. 10

  11. CDC+ Consumer/Consultant Agreement 11

  12. CDC+ Consent Form • The CDC+ Consent Form states: • The consumer consents that he/she will use the monthly budget in accordance with his/her long-term care needs. • Other consumer benefits may or may not be affected because of their participation in CDC+. • The consumer may decide, at any time, to disenroll from CDC+ and may return to his/her original home and community-based service program. 12

  13. CDC+ Consent Form

  14. CDC+ Consumer Representative Agreement/Registration Form • If the consumer wishes to appoint a representative, this form must be included in the Application Packet. • This form outlines the representatives' responsibilities, such as agreeing to work on the consumers’ behalf, ensuring that consumers are getting the services they need and that their health and well being are not at risk. • The appointed representative must pass a Level II Background Screening. Please review the module entitled: Background Screening for CDC+ Employees and Representatives. 14

  15. Representative Agreement / Registration Form

  16. How to submit theCDC+ Program Application • The CDC+ Program Application can be submitted to the • CDC+ Program Office in one of the following methods: • Fax to: 850-414-2310 -OR- • Mail to: Florida Department of Elder Affairs • Consumer Directed Care Plus (CDC+) • 4040 Esplanade Way , Suite 350 • Tallahassee, FL 32399-7000 16

  17. Technical Assistance • All questions regarding this training module should be directed to: • Customer Service: 1-866-232-3733 • Email address: cdcplus@elderaffairs.org 17

  18. Thank you. 18

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