1. Consumer Directed Service Agency (CDSA)
Compliance Monitoring Guide
DADS Form 1722 and Instructions

2. Demographic Information
DADS Form 1722
Demographic Information
Consumer and Employer
2. CDSA Provider Agency
Monitor, Review Date, Review
Period, Review Type
Contract Monitoring Guide - Page 1

3. STANDARD 1 Orientation and Service Agreement
Face-to-Face by CDSA Representative
Consumer’s Residence
Employer and Designated Responsible party (if applicable) must attend
Documented (DADS Form 1736, Documentation of Employer Orientation)
Service Agreement
CDSA and Employer (DADS Form 1735)
Documents Incorporated in Agreement
Contract Monitoring Guide - Page 1

4. STANDARD 1 Orientation and Service Agreement
The following documents are incorporated in the Service Agreement by Reference
Form 1726, Relationship Definitions in Consumer Directed Services
Form 1733, Employer and Employee Exemption from Nursing License for Certain Services
Form 1736, Documentation of Employer Orientation
Form 1738, Rules Acknowledgement
Contract Monitoring Guide - Page 1

5. STANDARD 2 Budget Development
Employer/DRP and CDSA Participation
Budget must be developed using the DADS CDS Budget Workbook
Budget must be “VALID”
Each Service Plan
Must be current. Revisions with changes to the Consumer’s Service Plan affecting CDS services
Must have a CDS Budget for each service category delivered through CDS
Approved by CDSA / Acknowledged by the Employer/DRP
Contract Monitoring Guide - Page 1

6. Definitions / Clarification
CONSUMER - Individual receiving program services and participating in Consumer Directed Services (CDS)
MINOR - Individual UNDER the age of 18
ADULT - Individual OVER the age of 18
DESIGNATED RESPONSIBLE PARTY – Willing adult that agrees to assist the Employer with responsibilities for CDS
PARENT – Natural, Legal, Adopted, Step-Parent, Foster Parent, Court Appointed Guardian
SPOUSE –Married with Formalities (Legal) or Married without Formalities (Common Law) Texas Family Code

7. STANDARD 3 Employer and Employer-Agent Registration
CONSUMER – Age 18 or more; Does NOT have a court appointed guardian
PARENT – of a minor-aged Consumer (Consumer is under 18 years of age)
CONSUMER – Consumer, under 18 years of age, but has been
Emancipated by the court OR
Is legally married
GUARDIAN – Court Appointed Guardian, regardless of the Consumer’s age
POWER OF ATTORNEY = Designated Responsible Party
Designated Responsible Party (DRP) is NOT the Employer.
Contract Monitoring Guide - Page 2

8. STANDARD 3 Employer and Employer-Agent Registration
FEDERAL GOVERNMENT
INTERNAL REVENUE SERVICE (IRS)
Employer: Employer Identification Number (EIN)
CDSA: Employer Appointment of Agent (Employer-Agent)
STATE GOVERNMENT
TEXAS WORKFORCE COMMISSION (TWC)
Employer: Employer TWC Account Number
CDSA: Authorization to Represent Employing Unit (“Employer’)
Contract Monitoring Guide - Page 2

9. STANDARD 4 CDSA Responsibilities, Federal and State Agencies
WITHHOLDINGS
EMPLOYEE CONTRIBUTIONS:
Income Tax
Social Security Tax
Medicare Tax
Voluntary Benefits
Garnishments
Wage Attachments
Optional Benefits
EMPLOYER CONTRIBUTIONS:
Match:
Social Security Tax
Medicare Tax
Total Amount:
Unemployment Tax
Total Amount or Share:
Benefits
DEPOSITS
Contract Monitoring Guide - Page 2

10. STANDARD 4 CDSA Responsibilities, Federal and State Agencies
Workers’ Compensation and Employee Work-Related Injuries
Texas Workers’ Compensation Commission (TWCC)
Liability Insurance – Homeowner/Renter
Deductions
Garnishments – Court Ordered (Child Support)
Wage Attachments – Government Agency Directive (Guaranteed Student Loan Payment)
Optional Deductions – Insurance Premiums, 401K,
Contract Monitoring Guide - Page 2

11. STANDARD 4 CDSA Responsibilities, Federal and State Agencies
Annual Tax-Related Forms -
IRS Form W-2, Wage and Tax Statement;
IRS Form W-3, Transmittal of WAGE and Tax Statements;
IRS Form 1099-MISC, Miscellaneous Income
TAX REPORTING ANNUALLY: Calendar Year, January 1 – December 31
CDSA DUE DATES:
To Employee: W-2 by January 31
To IRS and Employer: W-3, with copy of Form(s) W-2 by the last day of February
To Contractor: 1099MISC by January 31
To IRS and Employer: 1099MISC by the last day of February
Contract Monitoring Guide - Page 2

12. STANDARD 4 CDSA Responsibilities, Federal and State Agencies
Records – Federal and State Agencies
Provide Copy or Original of Employer-Related Forms and Reports to Employer
Retain Copy or Original of Employer-Related Forms and Employer-Agent Forms and Reports
Contract Monitoring Guide - Page 2

13. STANDARD 5 CDSA Responsibilities, Payroll and Accounts Payable
Payroll Payments – Based on complete, accurate, Employer-approved Timesheets
Payroll Distribution – Two times each calendar monthly in accordance with posted payday schedule.
a.) Based on complete, accurate, Employer-approved invoice or receipt
b.) Distribute payment within 30 DADS’ workdays of receipt by the CDSA of the acceptable invoice or receipt
Invoice Payments –
Receipt Payments –
Contract Monitoring Guide - Page 3

14. Contract Monitoring Guide - Page 3
STANDARD 6 CDSA Responsibilities, Payroll Status Monitoring and Reporting
Account Balances – Each Service Area; Ongoing Balances; Based on All Transactions; Complete and Accurate Records
Provide Summaries at Least Quarterly:
To Employer
To Consumer’s Case Manager
Contract Monitoring Guide - Page 3

15. STANDARD 7 CDSA Responsibilities, Ongoing Training
Training, Support, Assistance by CDSA
Based on –
Employer/DRP Documentation, Performance, and Compliance;
Budget Compliance
Employee and Contractor Documentation
Contract Monitoring Guide - Page 4

16. STANDARD 8 CDSA Responsibilities, Criminal Conviction History Check
Report obtained:
From the Texas Department of Public Safety (DPS),
Before applicant was hired, or contractor retained, and
Before service delivery by the individual
Employer Notification by CDSA before individual was hired/retained by the Employer (if check was conducted by the CDSA)
Contract Monitoring Guide - Page 4

17. STANDARD 8 - CDSA Responsibilities, Criminal Conviction History Check
Copy of Report on File at CDSA:
Report from the Texas Department of Public Safety
CDSA must not make payment to an individual barred from employment based on Criminal Conviction History Check
(Note as a Financial Error if Applicable)
Offers of Employment / Retain Contractor - Individuals barred from employment by Chapter 250, Health and Safety Code, must not deliver services or receive payment for services.
Contract Monitoring Guide - Page 4

18. STANDARD 9 CDSA Responsibilities, Complaints
Contracting Requirements: § 49.17(d)(3) Complaint Procedures
CDSA
(a) maintains a log of all complaints and
(b) makes records and resolution of
complaints accessible to DADS Staff
Contract Monitoring Guide - Page 5

19. STANDARD 9 CDSA Responsibilities, Complaints
Contracting Requirements: § 49.17(d)(3) Complaint Procedures
Each complaint received from any source must be:
(a) Documented, and
(b) Resolved
Based on documentation, did CDSA:
(a) Investigate and resolve each complaint in 5 DADS’ workdays?
(b) Provide written complaint procedures initially and at least annually thereafter?
Contract Monitoring Guide - Page 5

20. Contract Monitoring Guide - Page 1
CASE REVIEW SUMMARY
Transfer results of Case Review to Form 3853, Provider Agency Evaluation Summary.
Contract Monitoring Guide - Page 1

21. DADS Form 3853, Provider Agency Evaluation Summary
Texas Department of Aging and Disability Services
Contract/Program Compliance
Provider Agency Evaluation Summary
Form 3853
September 2001

22. DADS Form 1722, Compliance Monitoring Guide
Demographic Information
CONSUMER = INDIVIDUAL RECEIVING SERVICES
EMPLOYER = Consumer, Parent of Minor, or Court Appointed Guardian

23. DADS Form 1722, Compliance Monitoring Guide
Demographic Information
CDSA = CONUSMER DIRECTED SERVICE AGENCY (CDSA)
MONITOR = DADS CONTRACT MANAGER/MONITOR
REVIEW = REVIEW PERIOD AND TYPE

24. DADS Form 1722, Compliance Monitoring Guide
Monitoring Guide - Page 1

25. DADS Form 1722, Compliance Monitoring Guide
Monitoring Guide – Page 2

26. DADS Form 1722, Compliance Monitoring Guide
Monitoring Guide – Page 4

27. DADS Form 1722, Compliance Monitoring Guide
Case Review Summary:
Transfer results of case review to Form 3853, Provider Agency Evaluation Summary.
Monitoring Guide – Page 1

28. DADS Form 3853, Provider Agency Evaluation Summary
 ABOVE COMPLIANCE–Your agency is performing at or above 90%, which is the minimum compliance level. Please review the “Findings” section (below), if appropriate, for areas of concern.
 BELOW COMPLIANCE–Your agency is performing BELOW 90%, which is the minimum compliance level. The major reasons for noncompliance of standards are noted in the “Findings” section (below).

29. CDSA Compliance Monitoring
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