What is the difference between the home care agency and CDS for delivery of services?

The home care agency:

  • The home care agency hires attendants
  • The home care agency sets wages for attendants
  • The home care agency does payroll and taxes
  • The home care agency works with you on a schedule


  • You hire your own employee(s)
  • You set wages and benefits based on your service budget
  • You select a Financial Management Services Agency (FMSA) to do payroll and taxes
  • You set the schedule

How does CDS work?

  • The consumer chooses a FMS Agency (FMSA). The agency trains the consumer
    on how to be an employer.
  • The consumer recruits an employee and sends the employee paperwork to the FMSA.
  • The agency acts as a human resources department and a payroll department. The agency makes sure all employee documentation is correct and processes payroll.
  • The agency also pays federal and state taxes and files the employer tax returns.
  • The FMSA must train the consumer on a variety of subjects pertinent to hiring and managing their own employee(s) and assist the consumer with setting up an initial budget for services delivered through CDS. This ensures the consumer is able to make informed decisions regarding recruitment, salaries, benefits, and administrative costs for services delivered through CDS.
  • The FMSA is paid a monthly fee by the State of Texas or the managed care organization.

There’s quite a bit of paperwork to get started. We help you with it. After that, it’s timesheets twice a month and an annual evaluation. For more details see “Roles and Responsibilities” under the “What is CDS” tab.

Why would I want to choose CDS?

It gives you greater control over your employee(s) and your schedule.
When you hire your own employee(s) you can often find family, neighbors, or friends to work for you. Within your allotted service budget, you can set the wages and benefits for your employee(s) and, in most cases you can offer a higher per hour wage. Also, you can hire back-up employee(s) for those times when your regular employee is not available to work.

How will I find people to hire?

You will be given training by the FMSA that you select. You can also ask friends, neighbors, and family members if they are interested in working for you. You can also advertise.

How would my employee(s) be paid?

Your Employee will clock in and out using an Electronic Visit Verification (EVV) method. Some services such as Transportation or Nursing will require a timesheet sent to our office. We process your payroll and deposit any taxes for you.

Who trains my employee(s)?

You train your own employee(s) in the specific tasks you require of them. Also, we give you training materials on how an employee completes employment and payroll forms and we give you an employer manual that has some good advice on being an employer. We are available by phone as a resource.

How do I do all the paperwork that is required of an employer?

You receive training from us on the paperwork you need to do and the paperwork we do for you. You are also given information on what paperwork you must keep for your records.

What do I do if an employee doesn't work out?

As the employer, you can dismiss anyone you hire who is not working out. We will give you training on how to manage your employee(s).

What happens if I choose CDS and later change my mind?

You have the right not to participate in Consumer Directed Services at any time. You will be required to be off of the option for at least 90 days before participating in CDS again.

Who do I call if I need help?

If you need help with employer related questions, call us. If you need help with the services that are authorized, call your case manager or service coordinator.

Who's responsible for ensuring that consumers receive their authorized services?

The consumer takes responsibility for the provision of all the program services chosen to self-direct. The consumer will recruit, hire, and supervise their own employee(s) and any back-up employee(s).

The consumer may, if they choose, contract with an agency to provide backup and/or in-home respite services. The FMSA is not responsible for providing any employee(s) for the consumer.

Does the FMS Agency need to be close to me?

No – FMS agencies can perform all of the required services from any location. We cover the entire state of Texas from Brownsville to Amarillo, El Paso to Beaumont and all places in between.

How is HHSC billed for the services?

Timesheets, receipts, and invoices that are related to services delivered are submitted by the consumer to us. We pay allowable expenses on behalf of the employer. Then we bill HHSC for the services provided or allowable costs incurred. We are paid a monthly fee for providing this support.

Do many people use Consumer Direction?

Yes – over 22,000 individuals are using CDS as of May 2022 and the number grows every month.

What does Consumer Directed Services mean to me?

  • Consumer Directed Services (also called CDS) means you become the employer. You choose who helps you instead of an agency or provider.
  • This is also called self-direction.
  • The number of hours and type of services you currently may be receiving does not change when you use the CDS option. The only thing that changes is that you will become the employer and your Financial Management Services Agency (FMSA) will help you.

Who do I contact if I want to know more about CDS?

Start with your case manager or service coordinator who will give you information on consumer direction and how it works.

If you use the internet, visit the CDS website set up by HHSC. The link is: https://hhs.texas.gov/services/disability/consumer-directed-services. From this link you can read all that HHSC has published about CDS and view a video.

You can also look at the list of agencies that provide CDS services and call some of them. Just ask them to tell you more about the CDS program and how it works..

Check with friends who are receiving community based services. They may be receiving their services through the CDS option and can tell you how it has worked for them.

What would be required of me?

Becoming the employer carries some responsibilities. You need to decide whether you want these responsibilities. Some of them are:

  1. Recruiting, interviewing, and training the service provider.
  2. Working with your employee to complete all the new hire documents.
  3. Being responsible for arranging back up services if your service provider cannot come to work.
  4. Keeping track of the hours that are worked.
  5. Keeping copies of all your CDS paperwork.
  6. Counseling your employee(s) if they do not follow your directions.
  7. Firing unsatisfactory employee(s) and finding new ones.
  8. Following the CDS rules period.
  9. Following your program rules.

What does a FMSA do?

Your FMSA provides you with information and support to help you be a successful employer. Your FMSA will:

  1. Provide you with initial training.
  2. Assist you in preparation of a budget that will allow you to determine what employer-related expenses you will need and
    to determine how much your service providers will be paid. If you want expenses such as a bonus for your employee(s), they will help you with this.
  3. Verify that the person you want to hire is eligible to provide services.
  4. Make sure your employee paperwork is correct. You cannot hire someone until your FMSA gives you the go ahead.
  5. Register as your employer-agent with the IRS in order to pay federal employer taxes and file reports on your behalf.
  6. Process your payroll.
  7. Deposit your employer-related taxes and file quarterly or annual reports.
  8. Send you and your case manager or service coordinator quarterly reports.

What kind of person chooses the CDS option?

  • A young mother who has never worked outside the home
  • A grandmother with responsibility for her grandchild
  • A 50-year-old man who has become disabled through illness or accident
  • An 80-year-old woman who needs a little help to stay in her home
  • A 45-year-old woman with a disability who is raising a child
  • A foster parent who cares for children with special needs
  • All kinds of people use the CDS option.

Do a lot of people use CDS?

Yes – over 15,000 as of January 2012

What would someone using CDS tell me about the program?

One consumer wrote:

“Participating in the CDS option is a lot like running your own little business. When you hire someone, you will
need to have each employee complete a hiring packet containing all relevant forms necessary to employ that person.

After this, most of the paperwork you will be dealing with will revolve around completing and submitting timesheets to your FMSA so that your employee(s) can get paid. While all this talk about paperwork may sound complicated, it really isn’t when you consider that you won’t be alone in this. Your FMSA will be your guide.

Knowledge is everything, and the best way to decide whether something might be good for you is to first learn as much as you can about it. You should begin by notifying your case manager/service coordinator that you are interested in the CDS option and in the process of becoming an employer. Your case manager/service coordinator will then talk to you about your options and will probably schedule a visit so that you can sign some documents expressing your interest in the CDS option and so that you can be provided with a list of agencies that provide CDS services.”

A second consumer wrote:

I would say that the CDS option allows more flexibility and benefits, not only for the consumer but for the provider as well. The CDS option offers a higher pay scale for the attendants, which creates a lower turnover rate.

It is also an easy system to navigate through with the CDS company managing the budget and payroll issues. It may seem overwhelming to a new client, but after the initial paperwork is completed, it only requires minimal work each month. It is such a worthwhile decision to make and definitely worth the effort.

A third consumer wrote:

What I would say and have found to be true by our own experience utilizing the CDS Option:
People with disabilities have different needs. What one would need does not necessarily mean what all may need. CDS is not a one size fits all program. The CDS Option allows people with disabilities and or their family or friends caring for them the opportunity and freedom to be creative about how one’s needs can be met so that they may all have the same quality of life that everyone deserves while living in their own homes and or their communities.

What do I ask a FMS Agency?

You want to get a sense of how reliable the agency is and whether they know what they are doing. Some possible questions:

  • How long have you been in business?
  • What exactly do you do for me?
  • How often do you pay? Do you offer direct deposit?
  • If I move outside a managed care area can you continue to support me on CDS?
  • How many people in CDS does your company currently serve?
  • How many people within your company are familiar with CDS and when did those individuals last attend a FMSA training presented by HHSC?
  • Have you had any complaints about handling payroll taxes and employer related taxes?
  • Have you been monitored by the State? Did you pass?
  • How long does it take you to process a new employee?
  • How would you say your agency is different from other FMS agencies?
  • Do you have a website?
  • Can you give me 2-3 names of people I can contact as references?

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