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Self-Direction Option for Community Choices Waiver … - louisiana dsw registry check

Self-Direction Option for Community Choices Waiver …-louisiana dsw registry check

Self-Direction Option for Community Choices Waiver
Employer Service Agreement
I. Employer Responsibilities - I agree/understand the following:
1. I will receive assistance from the support coordinator and the Louisiana
Department of Health (LDH) Office of Aging and Adult Services (OAAS), or its
designee, in order to ensure continued participation in the Self Direction option.
2. I choose to be the legal employer of the employees who will provide services
to me (or the participant I have been authorized to represent). The employer is
not the Fiscal Employer Agent (FEA) or the State of Louisiana. I must recruit,
hire, train, and supervise my employees and perform and fulfill the duties of an
employer, in accordance with applicable state and federal regulations and the
policies and procedures of Self-Direction.
3. The FEA will provide me with enrollment materials and guidance to complete
each form. It is my responsibility to ensure all forms that my employee and/or I
complete are correct and submitted timely.
4. The FEA will send me automated (general announcement) communications and
information electronically (i.e. email) including but not limited to account
statement reports. I understand that I can request to receive all information
through U.S. Mail service and not through email.
5. The FEA will fulfill my payroll duties and must clear all applicants/potential
employees for hire before I can hire them or allow them to perform any work
for me (or the participant).
6. I must comply and pay of all my employees in accordance with the Department
of Labor Regulations including the Fair Labor Standards Act and the Final Rule
effective December 1, 2016.
(Federal Link: https://www.dol.gov/whd/homecare/homecare_guide.pdf)
7. All applicants/potential employees must have a criminal conviction history
check conducted by the FEA and the applicant may not be hired if he/she has
a conviction that bars employment.
8. I am responsible for conducting ongoing checks of current employees on the
CNA/DSW Registry, LA State Adverse Actions List, and OIG Exclusions Database
as outlined in the OAAS Self-Direction Employer Handbook. The results of these
reports are to be kept confidential.
9. I will not allow employee(s) to begin work until I receive a "good to go" date and
the employee(s) is active in the system.
10. I am responsible for meeting my staffing needs and have the primary
responsibility for making arrangements for back-up services in the event that an
employee is unable to work on a scheduled day.
Issued October 25, 2017 OAAS-RF-17-013
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11. I have primary responsibility for having a functional, or working, emergency plan
in place in the event of a disaster.
12. I must determine my employees' duties consistent with the service specifications.
I am responsible for giving each employee a job description and/or employment
agreement, which contains the duties of the job.
13. I am responsible for making sure each employee complies with all training
requirements as established by LDH/OAAS or its designee. I also understand
that my employees must comply with all applicable training requirements in order
for the employee to be paid for working.
14. I am responsible for planning my employees' schedules and understand that
services must be provided in accordance with my approved Plan of Care (POC)
and within the limits of the program specifications.
15. The FEA will only make payments on my behalf in accordance with the authorized
amounts and hours approved in my POC consistent with program specifications.
16. The employees' and my signature on timesheets attest that all service hours and
dates submitted for payment are actual and accurate.
17. All paper payment requests must have my approval signature and date unless it
is submitted through the FEA's online time entry system.
18. Payment of my claims may be from Federal and State funds, and I may be
prosecuted under applicable Federal or State laws, for any false claims, false
statements or documents, or concealment of a material fact. Any misuse of funds
may result in being fined or penalized including but not limited to the repayment
of claims. Any collection costs or legal fees will be my responsibility to pay.
19. I must review my account statement which includes information on my remaining
available balance. I accept responsibility for payment of any overtime and hours
worked above what is approved and authorized in my POC.
20. I am responsible for timely completion and delivery of my employees' timesheets
according to the payroll schedule established by the FEA. I understand that late
arrival of the timesheet to the FEA may result in payment to my employees being
21. Service logs, including progress notes and timesheets, must be completed in
accordance with the LDH/OAAS' instructions for completing this documentation.
22. I am responsible for maintaining all required documentation and providing for the
retention of records in accordance with the policies and procedures of Self-
23. I am responsible for evaluating my employees' performance.
24. I must notify the FEA immediately if an employee is injured on the job.
25. I must notify the FEA and the support coordinator of the date and reason of any
employment termination.
26. I must report critical incidents in accordance with the policies and procedures
specified in the OAAS Self-Direction Employer Handbook.
Issued October 25, 2017 OAAS-RF-17-013
Page 2 of 4
27. I will follow all policies and procedures as specified in the OAAS Self-Direction
Employer Handbook and any notifications issued by LDH. I understand and agree
that if I do not follow the policies and procedures of Self Direction that I may be
involuntarily terminated from this option. Furthermore, I am also responsible for
repayment of any over payments or improper billing for which payment has been
28. I will immediately report any changes to the support coordinator that may affect
my eligibility, safety, and/or need for services.
29. I will notify the FEA immediately of any changes (e.g. loss of Medicaid,
hospitalization, placement in a facility, etc.) that affect my eligibility for Self-
Direction. I may be responsible for payment of any work performed during a loss
of eligibility.
II. Support Coordinator Responsibilities - I agree that the support
coordinator has:
1. Assisted me with learning about choices and options for services.
2. Informed me of all Self-Direction rules policies and procedures and of all program
rules, policies and procedures.
3. Assisted me with determining the supports I need to participate in Self-Direction
(e.g. minimum number of employees needed, access to fax machine or internet).
4. Assisted me with developing the POC, back-up staffing plan and emergency
5. Provided a copy of, and advised me on, the material contained in the OAAS Self-
Direction Employer Handbook which includes information on:
a. the process for hiring employees
b. how to orient and instruct my employees in duties
c. how to evaluate my employees' performance
d. how to instruct my employees in completing service logs that include
progress notes and critical incident reports
6. Assisted me with preparing and completing required forms for participation in
7. Assisted me with developing a job description, task list, and work schedule for
my employees consistent with the approved POC.
8. Assisted and will continue to assist me with budget planning and determining my
employees' wages within the program guidelines.
9. Informed me of the beginning annual balance of hours that I have available for
use in Self-Direction.
Issued October 25, 2017 OAAS-RF-17-013
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