Choose the person who cares for you at home

Agency home care has one flaw built into it. The agency picks the aide. The agency sets the hours. If the aide is a poor fit, you get a different stranger.

Consumer Directed Services removes the flaw. The state decides how many hours you need. You decide who works them.

Communicare Elite, LLC, organized in Missouri on July 31, 2013, is the vendor that makes that arrangement run. The office is at 4477 Woodson Rd, Suite 106, St. Louis, MO 63134, minutes from Lambert International Airport. Medical oversight is provided by Dr. Gurpreet Singh Padda, MD, MBA, MHP.

Not sure this is your page? Tap the directory assistant (the light in the corner of the page) and it will point you to the right place.

What is Consumer Directed Services in Missouri?

CDS is a MO HealthNet program. MO HealthNet is Missouri Medicaid. The program pays for non-medical personal care at home for adults with a physical disability who can direct their own care.

The consumer is the employer. You hire the attendant. You train them. You set the hours. You sign the timesheets. You can let them go.

That split is not a company policy. It is state law. RSMo 208.900 says a vendor holds a written agreement with the state to provide monitoring and oversight of the attendant, orientation and training of the consumer, and fiscal conduit services. The vendor carries the money and the paperwork. You carry the decisions.

Communicare Elite's side of the ledger:

• Verifies the paperwork you and your attendant need, including background screening
• Teaches you how to be an employer: hire, schedule, supervise and, if necessary, replace
• Processes the timesheets you both sign
• Runs payroll, withholds and remits taxes, issues your attendant's W-2
• Bills MO HealthNet, so no money passes between you and your attendant
• Keeps the records the state requires and cooperates with audits

What it never does is decide who cares for you. That belongs to you.

Does CDS cost you anything?

No. CDS is funded through MO HealthNet. If you are approved for the program and eligible for MO HealthNet, you do not pay Communicare Elite and you do not pay your attendant out of pocket.

Who qualifies for Consumer Directed Services?

Five requirements. You need all five.

1. 18 or older. There is no upper age limit. A 92-year-old and a 24-year-old qualify on the same terms.
2. Eligible for MO HealthNet. That turns on income, what you own and your disability. Not enrolled? That application comes first.
3. A physical disability. State law describes the loss, or loss of use, of nerves, muscles or bones, enough that you need help with everyday tasks. Spinal cord injury, multiple sclerosis, muscular dystrophy, cerebral palsy, stroke, bad arthritis, amputation, ALS and Parkinson's often qualify. The name of the condition matters less than what you can and cannot do.
4. Able to direct your own care. The most misread requirement. You do not need your own hands to do anything. You need to make the decisions, say what you want, check the hours and sign.
5. Assessed at a nursing facility level of care. That is the point of the program. People who could go to a nursing home stay in their own house instead.

The Missouri Department of Health and Senior Services, through its Division of Senior and Disability Services, makes the call. Not the vendor. A vendor that implies it can approve you is misrepresenting the program.

RSMo 208.900 excludes people with a guardian or conservator making their decisions. A 2009 federal court ruling limited that exclusion. If there is a guardianship, ask the state rather than assume.

What does not disqualify you?

People rule themselves out on rules that do not exist.

• Living with family. Adult children, parents, anyone.
• Owning your home. Not, by itself, an asset-test failure for MO HealthNet.
• Having a job. Working does not disqualify you. Essential transportation to work can be an authorized task.
• Receiving other services. Many combinations are permitted. Ask.

Can a family member be paid to care for you in Missouri?

Yes.

RSMo 208.900 defines a personal care attendant as "a person, other than the consumer's spouse." One exclusion. The spouse. That is the entire family restriction.

Who can be paid: an adult son or daughter, a mother or father, a brother or sister, a grandchild, niece, nephew or cousin, an in-law, a friend, a neighbor. If someone told you Missouri bans paying family, they confused CDS with a different program or a different state.

The sequence:

1. The person receiving care qualifies. You do not have to.
2. They request a state assessment and receive an authorized care plan. The Department of Health and Senior Services referral line is 866-835-3505.
3. They hire you and name Communicare Elite as their vendor.
4. You complete employment paperwork, tax forms, background screening and orientation.
5. You are paid as an employee on a regular payroll cycle, taxes withheld, W-2 at year end. Not a contractor. Never cash.

What the paycheck does and does not cover

Hours you were giving away now come with a pay stub, withholding and a work record.

The limits are hard. Only tasks on the plan count. The plan caps the hours, not the care you actually give, and most family caregivers give more than the plan authorizes. Nothing is billed while your relative is in the hospital. The pay is earned income and can affect your own eligibility for income-tested programs.

Both of you sign the timesheet. Both of you own its accuracy. Signing for unworked hours is Medicaid fraud, and it is the most common way well-meaning families get into serious trouble.

What can a CDS attendant help with?

The state authorizes tasks one by one after an in-home assessment. Your care plan decides what your attendant is paid to do.

Personal care: bathing, showering and sponge baths, shampooing and hair care, dressing and undressing, combing and grooming, shaving, oral hygiene and denture care, nail care, toileting and incontinence care.

Mobility: transfers between bed, chair and wheelchair, repositioning to prevent pressure injuries, walking assistance, help with prescribed assistive devices.

Household: meal preparation and help eating, laundry and bed linens, light housekeeping in the areas you use, grocery shopping and essential errands.

Rides: doctor visits, groceries and errands, school or work. The trip has to be for one of those. It is not a taxi service.

What is outside CDS?

• Nursing tasks: shots, sterile wound care, IV therapy, feeding tubes
• Physical, occupational or speech therapy
• Judging or diagnosing a medical problem
• Care for anyone but you
• Heavy repairs, yard work, big cleaning jobs
• Anything not on your care plan

The household line causes real friction. Your attendant cooks the meal you eat, not dinner for four. Does your laundry, not the family's. Cleans the rooms you use, not the whole house. Family attendants find that hard to say out loud. Say it for them.

Medicine is the gray area. An attendant can usually remind you and open the bottle. Giving you the medicine is a nursing task.

How are care plan hours decided?

Task by task. The state estimates the minutes each task takes and adds them up. "I need help bathing" gets you less than describing what happens when you try to get into the tub.

So talk about your worst days, not your best ones. Pride makes people play down how hard things are, and the plan ends up smaller than the need. If you get worse or come home from the hospital, ask the state to look again. You must report big changes within ten days anyway.

How do you start CDS?

1. Request an assessment. Call 866-835-3505 and ask for a Home and Community Based Services assessment. You, a relative, a friend, a discharge planner or a physician can make the referral. Communicare Elite will walk you through the call first.
2. The state visits. An assessor walks through your day: getting out of bed, bathing, meals, what you can and cannot reach.
3. The plan is authorized. Approved tasks, time for each.
4. You pick your vendor. Your choice alone. Not the assessor's, not a hospital's, not a relative's.
5. You name your attendant. They do the forms, the background check and the training.
6. Work starts. Your schedule, inside your authorized hours.

Timeline? It depends on when the state can visit and how fast your attendant clears screening. Communicare Elite will not promise a number of days, because the slowest step is not its to control. It starts your attendant's paperwork alongside the state process, so nothing waits its turn.

No one to hire? Communicare Elite recruits attendants across the St. Louis area and brings you candidates. You interview. You decide. Nobody is installed in your home over your objection.

If an attendant harms you, takes from you or frightens you, that is a safety matter, not an employment one. Call Communicare Elite and the Missouri Adult Abuse and Neglect Hotline at 1-800-392-0210.

How do timesheets, EVV and pay work?

RSMo 208.909 puts the timesheet on you: prepare and submit a timesheet signed by you and your attendant every two weeks, and verify the wages paid.

Missouri also requires electronic visit verification for Medicaid personal care under the federal 21st Century Cures Act. Your attendant logs the start and end of each visit electronically. EVV records that a visit happened and when. It is not surveillance of your home.

Communicare Elite checks each timesheet against the care plan and the EVV record, runs payroll and bills MO HealthNet.

Late timesheets are the number one cause of late pay. A missed deadline generally rolls the pay to the next cycle. Put the date on a calendar.

Never sign a blank timesheet. Your signature certifies the hours. A blank one hands someone else the power to claim hours in your name. If a payroll error is Communicare Elite's, it corrects it without making the attendant wait a full cycle.

Can you switch CDS vendors?

Yes, and you owe no one an explanation. People switch over late or wrong payroll, phones nobody answers, timesheet problems that never close, bad tax withholding, or being signed up by a hospital or relative without really choosing.

You keep your eligibility, your care plan, your authorized hours and your attendant. You do not reapply. Communicare Elite completes new enrollment, onboards your attendant, notifies the state, and sets the effective date in writing.

That date is the whole game. The most common switching failure is an attendant working hours neither vendor pays because the handover was vague. Your attendant keeps working until the written date, and not in a gap.

CDS or home health: which do you need?

Communicare Elite runs both. It is one of the few organizations in the St. Louis area operating both a Medicare-certified home health agency and an enrolled MO HealthNet CDS vendor.

The two fix different problems.

	Consumer Directed Services	Home health
What it is	Non-medical personal care	Skilled nursing and therapy
Who chooses the person	You, anyone but your spouse	The agency assigns licensed staff
Relative can be paid	Yes	No
Physician order	No	Yes
Who decides eligibility	Missouri DHSS, after an in-home assessment	Your physician, plus your payer
How long	Ongoing, while eligible	Episodic, ends when the skilled need resolves
Paid by	MO HealthNet	MO HealthNet, private insurance, private pay

What home health covers

Communicare Elite is a Missouri-licensed, Medicare-certified home health agency.

• Skilled nursing: wound care, injections, infusion and IV therapy, catheter and ostomy care, medication management, monitoring of heart failure, COPD and diabetes
• Physical, occupational and speech therapy: rehabilitation at home after a stroke, a fall, surgery or a hospital stay
• Home health aide: hands-on care under a nurse's supervision, a different arrangement from the CDS attendant you employ
• Medical social work: benefits, community resources, coping, and planning for what comes after the episode

It needs a physician's order, a signed plan of care and a skilled need that legally requires a nurse or licensed therapist. Some visits come from Communicare Elite's own staff and some from partner providers. One agency stays accountable for the plan, so you call one number instead of four.

Payment runs through MO HealthNet, private insurance or private pay. Communicare Elite is Medicare-certified but does not currently accept Medicare as payment for home health. Certification is a statement about the agency's standard. Billing is a separate matter. Rates are not posted, because pricing depends on the service, the frequency and your coverage; call for real figures. Coverage, prior authorization, visit limits and anything you would owe are verified before care starts, not after.

Why one organization for both

A stroke. Two weeks in the hospital. Home with therapy and a nurse watching new medicines. That is home health, and in a couple of months it does its job and stops.

What does not stop is needing help bathing and dressing every morning. No clinical benefit pays for that. For a MO HealthNet participant, CDS does, and the daughter can be the paid attendant.

The gap between the two is where families get hurt, and they usually find it in a crisis. Here, the medical social workers raise it before discharge, and CDS can start while home health is still running.

Want to work as a personal care attendant?

You need no nursing license, CNA certificate, degree or prior caregiving job. You need:

• Legal authorization to work in the United States
• Not to be the consumer's spouse
• Clearance on background screening, usually the Family Care Safety Registry, criminal history and abuse and neglect registries
• The physical ability to do the authorized tasks, including transfers and bathing help
• Communicare Elite's onboarding and orientation

Communicare Elite is the employer of record: regular payroll, taxes withheld, W-2. You never invoice the person you care for. Nobody starts before clearances are in place.

A record involving violence, abuse, neglect or exploiting vulnerable people rules you out. Many other records do not. Disclose up front. A record you disclose is a conversation. A record found after you said there was nothing ends the application.

Demand is heaviest in North County, where the office is. Wentzville, O'Fallon and Festus are hardest to fill, simply because fewer attendants live there.

How Communicare Elite handles compliance

In CDS, the people most likely to break a rule are not the vendor's staff. They are participants and attendants who do not know where the lines are. A daughter signs for a week she was mostly there. An attendant fills in Friday from memory on Sunday. Neither calls it fraud. Both just filed a false Medicaid claim.

So the rules are published where people read them, and Communicare Elite verifies before it pays, trains both sides, investigates discrepancies instead of absorbing them, cooperates with state reviews and does not retaliate against good-faith reports.

Already made a mistake? Call today. An error you disclose and correct is a different situation from one an audit finds eighteen months later, in how it is characterized, what it costs and what happens to you.

Where does Communicare Elite serve?

St. Louis City, all of St. Louis County, and Missouri communities within about 40 miles: all of St. Charles County, northern and central Jefferson County, and eastern Franklin and Lincoln counties. Florissant, Ferguson, Hazelwood, Bridgeton, Maryland Heights, University City, Kirkwood, Chesterfield, Arnold, Festus, St. Charles, St. Peters, O'Fallon, Wentzville.

Missouri only. CDS is a Missouri Medicaid program. An Illinois resident is not eligible for MO HealthNet, however close to the river. Illinois runs its own programs.

The 40 miles is not a line drawn around an office. CDS depends on someone arriving at a home, often daily, often early. The distance that matters most is between you and your attendant. Fifteen minutes away beats an hour away over a year.

How do you reach Communicare Elite?

4477 Woodson Rd, Suite 106, St. Louis, MO 63134 Call (314) 809-6655 · Text (314) 886-5902 · Fax (314) 481-3037 Communicare Elite, LLC · NPI 1194159053

Call for a free consultation. A five-minute talk usually settles whether you qualify. If you clearly do not, you will hear that and be pointed somewhere better, not signed into paperwork that leads nowhere.

The rest of the healthcare category is at pain and metabolic medicine in St. Louis.

Frequently asked questions

My parent has dementia. Can they still use CDS?

The program requires the consumer to direct their own care and excludes people with a legal limit on decision-making such as a guardianship. Dementia complicates that test, so ask DHSS directly at 866-835-3505.

Do I need a certificate to be paid as a family caregiver?

No. CDS is non-medical personal care. You need background screening and orientation, not a nursing credential.

Can I fire my attendant without losing my services?

Yes. You are the employer. Discharging an attendant does not cost you your services or your hours, and Communicare Elite handles the payroll end and onboards the replacement.

What if home health is not covered but I still need help?

For a MO HealthNet participant, CDS covers long-term personal care. It does not cover skilled clinical care, but when the real need is daily help rather than nursing, it is often the better answer.

What if the state reduces or denies my services?

You have the right to appeal. If a notice arrives and you are not sure what it means, call Communicare Elite.