Vendor Fiscal/Employer Agent (VF/EA) Financial Management Services (FMS) COMMON LAW EMPLOYER AGREEMENT

Transcription

1 Vendor Fiscal/Employer Agent (VF/EA) Financial Management Services (FMS) COMMON LAW EMPLOYER AGREEMENT I understand that participating in the VF/EA FMS model means that the Common Law Employer (CLE) has the ability to exercise decision-making authority over some or all of the services and supports as authorized Individual Support Plan (ISP). The CLE accepts the responsibility for managing the PDS services and supports and is, therefore, recognized as the legal employer of the qualified Support Service Workers (SSW) hired to provide the Participant Directed Services (PDS). Participant s information: Name of participant receiving PDS: (Print/type) Address: (Number) (Street) (Unit/Apt) (City) (State) (Zip Code) Cell phone: ( ) Home phone: ( ) Common law employer designation: (check one box) Participant Surrogate If the participant has designated a surrogate to be the common law employer, complete the information below: Surrogate s information: Name of surrogate: (Print/type) Address: (Number) (Street) (Unit/Apt) (City) (State) (Zip Code) Cell phone: ( ) Home phone:( ) address:

2 Common Law Employer Requirements: The participant or surrogate, when appointed by the participant, must meet the following criteria in order to be the CLE: Be at least 18 years of age or older. Must attest in writing that they have no convictions reported as per the Older Adult Protective Services Act (OAPSA) [35 P.S et.seq. and 6 Pa.Code Chapter 15], and when serving a child under age 18, conduct child abuse clearances as per the Child Protective Services Law (CPSL) [23 Pa. C.S. Chapter 63]. Be a resident of Pennsylvania for two (2) calendar years immediately preceding the date of request to become a Common Law Employer. o If the Common Law Employer has not been a Pennsylvania resident for the previous two (2) years or is not currently a resident, the Common Law Employer must attest in writing that they have no convictions reported in the Federal Criminal History Record from the Federal Bureau of Investigation (FBI), in addition to the Criminal History Record from the State Police. Participates in required training sponsored by ODP and the VF/EA FMS organization. Enters into and maintain compliance with all agreements related to the VF/EA FMS model. Agrees to perform all the tasks outlined in the Responsibilities Section. Agrees to work with the Supports Coordinator (SC) to develop and revise the participant s ISP as needed and required. Agrees to participate in SC monitorings at the required frequency and location outlined in the approved Waivers. Agrees to work with the Support Broker when the Supports Broker service has been authorized on the participant s ISP. Common Law Employer (CLE) Responsibilities: 1. Enroll with the VF/EA FMS organization and complete the required documents. This includes: Completing and signing this form, the Common Law Employer Agreement form, and submitting it to the VF/EA FMS organization. Completing and signing the Common Law Employer Designation form and submitting it to the VF/EA FMS organization. 2. Agree to manage the authorized participant-directed service in accordance with the Common Law Employer Agreement. 3. Recruit, interview and hire qualified SSWs. 4. Verify qualifications of SSWs and vendors prior to the person or entity rendering a waiver-funded participant-directed service. 5. Complete and submit required qualified SSW documents to the VF/EA FMS organization for processing. 6. Maintain an employment/qualification file on each qualified SSW and qualified vendor.

3 7. Verify ongoing qualifications for the SSWs, both regularly scheduled and emergency back-up SSWs, as needed per ODP Waiver requirements and timelines established in the approved Waiver. 8. Once the SSW is qualified, the CLE and the qualified SSW must sign the Support Service Worker (SSW) Agreement form and submit it to the VF/EA FMS organization. 11. Update any changes in qualified SSW information and submit the required information to the VF/EA. 12. Negotiate the wage, and optional benefit allowance, for qualified SSWs within the ODP established wage ranges and complete and sign the Support Service Worker (SSW) Rate Sheet, and submit the rate sheet to the SC for processing. 13. Negotiate and explain to a qualified vendor that the vendor will be reimbursed at the cost of the goods charged to the general public and in accordance with the authorized ISP. 14. Obtain bids or estimates and secure qualified vendors. 15. Explain to individuals providing mileage that mileage is a vendor payment for an SSW or a non-ssw and is paid at the mileage reimbursement rate established by ODP in accordance with the approved Waiver. 16. Sign the Request for Vendor Payment Form, when appropriate to do so. 17. Develop and implement emergency back-up plans which include qualified SSWs or natural supports to cover the hours when a regularly scheduled qualified SSW does not report to work. 18. Determine the work schedule of qualified SSWs up to a maximum of 40 hours per week based on the services authorized in the ISP. 19. Schedule SSWs work schedule to ensure required and authorized services are provided and overtime will not occur. 20. Determine the tasks/activities the qualified SSW or natural support person will perform including how and when to perform service-related tasks/activities, in accordance with the authorized ISP and ODP service definitions. 21. Orient and train qualified SSWs as per the qualification criteria and service definition requirements included in the approved Waivers and ISP. 22. Ensure that the ODP Progress Notes form is completed by you, qualified SSWs or vendors and that the form documents that all services delivered support the ISP outcomes. 23. Review, approve and sign the qualified SSW timesheets and vendor invoices to ensure accuracy prior to submitting to the VF/EA FMS organization. 24. Review, approve and sign the qualified SSW timesheets and vendor invoices and submit them to the to the VF/EA FMS organization for processing in accordance with its payment cycle or schedule and in accordance with PA Department of Labor & Industry standards. 25. Provide supervision to all qualified SSWs and emergency back-up SSWs, natural support persons 1 and vendors. 26. Terminate qualified SSWs for just cause and notify the VF/EA FMS organization of the dismissal of qualified SSWs. 1 Natural support persons are not paid.

4 27. Track utilization of authorized services and associated funds to ensure qualified SSWs and vendors provide participant-directed services in accordance with the authorized ISP. 28. Notify and discuss with the SC any changes in a participant s need that may require a team meeting and/or revision to the ISP. 29. Notify the SC and the VF/EA FMS organization when the CLE suspects or is aware of issues of Medicaid fraud or financial abuse related to the delivery of the participant s PDS. 30. In accordance with ODP policy on reportable incidents, report any reportable incidents to the SC. 31. Respond to surveys regarding the participant s or surrogate s satisfaction with the VF/EA FMS organization. 32. Participate in required orientation and trainings offered by the VF/EA FMS organization or ODP related to the VF/EA FMS model. 33. Enter into and maintain compliance with all standard agreements with the VF/EA FMS organization and ODP. 34. Prepare and report on ISP outcomes and progress achieved during ISP meetings. 35. Participate in remediation, training and termination processes as established and directed by ODP. By signing below, I attest that I have read this (Name of common law employer) Common Law Employer Agreement in its entirety. I understand that I must complete, sign and return this form to the VF/EA FMS organization under contract with the Office of Developmental Programs (ODP) as a condition of enrolling and participating in the VF/EA FMS model. I attest that I understand my responsibilities as a CLE and agree to abide by the CLE terms and conditions. I further understand and agree that violation of any of the terms and/or conditions of this agreement may result in corrective action including termination of this agreement. (Common law employer signature) (Print name) (Date)

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