Common use of Participant Self-Directed Services Clause in Contracts

Participant Self-Directed Services. In addition to the traditional agency model, CHC-MCOs must offer Participants who are eligible for HCBS the opportunity to self-direct Personal Assistance Services as the first option over the traditional agency model, through one of two models. • Participants may elect the Participant-Directed Employer Authority model, in which the Participant employs his or her own personal assistance and/or respite provider, who can be a family member, a friend, a neighbor, or any other qualified personal assistance worker as determined by the Department. Participants in this model may elect to also receive some of their services through an agency or; or • Participants may elect the Budget Authority model called Services My Way, in which the PCSP is converted to a budget and the Participant develops a spending plan to purchase needed goods and services. Participants in this model may elect to receive personal assistance and/or respite services through an agency or to employ their own personal assistance providers, or both. An FMS vendor processes timesheets, makes payments, and manages all required tax withholdings, including Federal Insurance Contributions Act (FICA) taxes, for personal assistance workers employed by Participants under either self-directed model. The CHC-MCO may use only the FMS entity procured by the Department and must establish agreements and cooperate with the Commonwealth-procured FMS entity in order that necessary FMS services are provided to Participants. The CHC-MCO is responsible for paying the FMS provider: • Reimbursement for payments the FMS provider makes on behalf of the Participant-employer for workers’ training, required pre-service orientation, wages, and vendor goods and services • A per-member per-month fee to perform the tasks outlined in the FMS service description • A one-time start-up fee for new Participants, paid once in a lifetime per Participant. The CHC-MCO must advance sufficient funds to the FMS provider so that payroll is satisfied on a timely basis. The amount, time period and other terms for those advanced funds shall be set forth in policies established by the CHC-MCO and approved by the Department. The CHC-MCO must verify that before a direct care worker provides services, the direct care worker must have received a pre-service orientation provided through a not-for-profit organization under contract with the FMS provider. The CHC-MCO must require each direct care worker to obtain a Unique ID number from the DHS Unique ID registry and provide it to the FMS provider prior to providing services.

Participant Self-Directed Services. In addition to the traditional agency model, CHC-MCOs must offer Participants who are eligible for HCBS the opportunity to self-direct Personal Assistance Services as the first option over the traditional agency model, through one of two models. •  Participants may elect the Participant-Directed Employer Authority model, in which the Participant employs his or her own personal assistance and/or respite provider, who can be a family member, a friend, a neighbor, or any other qualified personal assistance worker as determined by the Department. Participants in this model may elect to also receive some of their services through an agency or; or •  Participants may elect the Budget Authority model called Services My Way, in which the PCSP is converted to a budget and the Participant develops a spending plan to purchase needed goods and services. Participants in this model may elect to receive personal assistance and/or respite services through an agency or to employ their own personal assistance providers, or both. An FMS vendor processes timesheets, makes payments, and manages all required tax withholdings, including Federal Insurance Contributions Act (FICA) taxes, for personal assistance workers employed by Participants under either self-directed model. The CHC-MCO may use only the FMS entity procured by the Department and must establish agreements and cooperate with the Commonwealth-procured FMS entity in order that necessary FMS services are provided to Participants. The CHC-MCO is responsible for paying the FMS provider: •  Reimbursement for payments the FMS provider makes on behalf of the Participant-employer for workers’ training, required pre-service orientation, wages, and vendor goods and services •  A per-member per-month fee to perform the tasks outlined in the FMS service description •  A one-time start-up fee for new Participants, paid once in a lifetime per Participant. The CHC-MCO must advance sufficient funds to the FMS provider so that payroll is satisfied on a timely basis. The amount, time period and other terms for those advanced funds shall be set forth in policies established by the CHC-MCO and approved by the Department. The CHC-MCO must verify that before a direct care worker provides services, the direct care worker must have received a pre-service orientation provided through a not-for-profit organization under contract with the FMS provider. The CHC-MCO must require and verify that each direct-care worker has an NPI with a taxonomy code “Attendant Care Provider” with the direct care worker to obtain a Unique ID number from worker’s home address listed as the DHS Unique ID registry and provide it to the FMS provider prior to providing services“Business Mailing Address.”

Participant Self-Directed Services. ‌ In addition to the traditional agency model, CHC-MCOs must offer Participants who are eligible for HCBS the opportunity to self-direct Personal Assistance Services as the first option over the traditional agency model, through one of two models. • Participants may elect the Participant-Directed Employer Authority model, in which the Participant employs his or her own personal assistance and/or respite provider, who can be a family member, a friend, a neighbor, or any other qualified personal assistance worker as determined by the Department. Participants in this model may elect to also receive some of their services through an agency or; or • Participants may elect the Budget Authority model called Services My Way, in which the PCSP is converted to a budget and the Participant develops a spending plan to purchase needed goods and services. Participants in this model may elect to receive personal assistance and/or respite services through an agency or to employ their own personal assistance providers, or both. An FMS vendor processes timesheets, makes payments, and manages all required tax withholdings, including Federal Insurance Contributions Act (FICA) taxes, for personal assistance workers employed by Participants under either self-directed model. The CHC-MCO may use only the FMS entity procured by the Department and must establish agreements and cooperate with the Commonwealth-procured FMS entity in order that necessary FMS services are provided to Participants. The CHC-MCO is responsible for paying the FMS provider: • Reimbursement for payments the FMS provider makes on behalf of the Participant-employer for workers’ training, required pre-service orientation, wages, and vendor goods and services • A per-member per-month fee to perform the tasks outlined in the FMS service description • A one-time start-up fee for new Participants, paid once in a lifetime per Participant. The CHC-MCO must advance sufficient funds to the FMS provider so that payroll is satisfied on a timely basis. The amount, time period and other terms for those advanced funds shall be set forth in policies established by the CHC-MCO and approved by the Department. The CHC-MCO must verify that before a direct care worker provides services, the direct care worker must have received a pre-service orientation provided through a not-for-profit organization under contract with the FMS provider. The CHC-MCO must require and verify that each direct-care worker has an NPI with a taxonomy code “Attendant Care Provider” with the direct care worker to obtain a Unique ID number from worker’s home address listed as the DHS Unique ID registry and provide it to the FMS provider prior to providing services“Business Mailing Address.”

Participant Self-Directed Services. In addition to the traditional agency model, CHC-MCOs must offer Participants who are eligible for HCBS the opportunity to self-direct Personal Assistance Services as the first option over the traditional agency model, through one of two models. • Participants may elect the Participant-Directed Employer Authority model, in which the Participant employs his or her own personal assistance and/or respite provider, who can be a family member, a friend, a neighbor, or any other qualified personal assistance worker as determined by the Department. Participants in this model may elect to also receive some of their services through an agency or; or • Participants may elect the Budget Authority model called Services My Way, in which the PCSP is converted to a budget and the Participant develops a spending plan to purchase needed goods and services. Participants in this model may elect to receive personal assistance and/or respite services through an agency or to employ their own personal assistance providers, or both. An FMS vendor processes timesheets, makes payments, and manages all required tax withholdings, including Federal Insurance Contributions Act (FICA) taxes, for personal assistance workers employed by Participants under either self-directed model. The CHC-MCO may use only the FMS entity procured by the Department and must establish agreements and cooperate with the Commonwealth-procured FMS entity in order that necessary FMS services are provided to Participants. The CHC-MCO is responsible for paying the FMS provider: • Reimbursement for payments the FMS provider makes on behalf of the Participant-employer for workers’ training, required pre-service orientation, wages, and vendor goods and services • A per-member per-month fee to perform the tasks outlined in the FMS service description • A one-time start-up fee for new Participants, paid once in a lifetime per Participant. The CHC-MCO must advance sufficient funds to the FMS provider so that payroll is satisfied on a timely basis. The amount, time period and other terms for those advanced funds shall be set forth in policies established by the CHC-MCO and approved by the Department. The CHC-MCO must verify that before a direct care worker provides services, the direct care worker must have received a pre-service orientation provided through a not-for-profit organization under contract with the FMS provider. The CHC-MCO must require and verify that each direct-care worker has an NPI with a taxonomy code “Attendant Care Provider” with the direct care worker to obtain a Unique ID number from worker’s home address listed as the DHS Unique ID registry and provide it to the FMS provider prior to providing services“Business Mailing Address.”