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November 19, 2009 The guidance applies to self-directed personal assistance services, also known as "Cash and Counseling," and to home- and community-based waiver programs when states offer the self-direction opportunity and permit participants to purchase individual-directed goods and services. Permissible purchases of goods or services that individuals may make in order to increase their independence must be related to a goal or need identified in the state-approved person-centered service plan and must be used for the purpose of increasing independence or substituting for human assistance that would otherwise be paid for by Medicaid. The . . .

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