Roles Involved in Virginia Medicaid Waivers

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When it comes to Consumer Directed (CD) waiver services, there are a lot of different roles involved in waivers to consider. Having different roles built-in to waivers allows the individuals to have an easier time accessing as well as maintaining the services available to them.

So what do all of the different roles mean? What goes into each one? Here is a list of the roles involved in these waivers and what you need to know about them.

Virginia Medicaid Waiver

Different Roles in Waivers

These are the varied roles involved in the Consumer-Directed waiver services.

Employer of Record (EOR)

The Employer of Record, or EOR, is the individual who acts as the employer for the consumer-directed model of service delivery. The person can be either the individual enrolled in the waiver, the caregiver, a family member, or another person.

For every one person receiving these Consumer-Directed services, they need to have an EOR. They will need to be at least 18 years old to be the EOR, and for an individual who is under 18, a parent or other responsible adult will take that role. In many cases of someone receiving these services over the age of 18, they choose to be their own EOR.

Typically an Employer of Record is only able to serve on the behalf of one person, and the only exception to this rule is for individuals receiving CD services that all live at the same address.

The Employer of Record duties include:

  • Signing tax paperwork
  • Signing timesheets
  • Managing attendants
  • Interviewing, training, hiring, recruiting, supervising, and directing all of the attendants. They also fire them if necessary.
  • Making schedules and creating tasks for attendants
  • Creating a system for signing and submitting timesheets to the Fiscal Employer Agent (F/EA)

Attendants (PCA)

Another vital role for Consumer-Directed waiver services is attendants. This role is filled by an individual who gives personal care and/or supports for the person utilizing the waiver.

The attendants provide services that are authorized by either its designated service authorization agent or DMAS. They will need to have the abilities, knowledge, and skills to perform the necessary duties and functions to support the individual receiving services.

Requirements for becoming an attendant include:

  • Being 18 years old (or older)
  • Having basic math, writing, and reading skills
  • Being authorized to work in the United States and have a valid Social Security number
  • Having the proper skills for the services needed in the individual’s service plan
  • Submitting to a criminal history background records check through the state police (if the individual is a minor, then they also go through the Virginia Department of Social Services (VDSS) and the Child Protective Services (CPS) Central Registry
  • Having the capability to perform the required health maintenance activities in the service plan, and being willing to receive the proper training for them

Attendants cannot be the spouse, parent, or step-parent of the individual receiving the waiver services. They also cannot be the individual’s case manager, support coordinator, or their services facilitator. Lastly, they cannot be the same person who is designated as the employer of record.

Service Facilitator (SF)

A Consumer-Directed Services Facilitator is a provider (enrolled through DMAS) who is responsible for supporting both the individual and the caregiver/family by ensuring the monitoring and development of the services plan of care. They also provide attendants with management training and complete ongoing review activities (as required by DMAS) for consumer-directed personal care and respite services.

This role includes:

  • Developing the service plan with the EOR and the individual
  • Ensuring that the individual gets the services they need
  • Providing the appropriate forms to the fiscal employer agent to start the process of establishing the EOR, and then review the manual with the chosen EOR.
  • Training the EOR
  • Documenting services required by DMAS
  • Submitting requests for service authorization to the appropriate service authorization contractor
  • Assisting the EOR when filling out paperwork for the fiscal employer agent
  • Conducting both the annual level of care review process and reassessment visits.

Primary Caregiver

Next, we have a primary caregiver. This is simply the primary person providing direct care and support to the individual in order for them to live successfully in their community. They do not receive compensation for this role.

DD Support Coordinator

A DD Support Coordinator is employed by the Department of Behavioral Health and Developmental Services (the DBHDS) in the various Community Services Board offices throughout the state of Virginia. They determine eligibility for BI, CL, and FIS waivers when funds for slots are available.

The support coordinators assess and plan services, link individuals to appropriate services, direct the individual to obtain and locate the needed resources, enhance community integration, monitor the individual to keep track of their ongoing progress, and counsel and educate to guide the individual into supportive relationships.

MCO Care Coordinator

Last but certainly not least, we have the MCO care coordinators. They are responsible for completing the Health Risk Assessments (HRA) for new members as well as reassessments every six months.

Learn More with Moms in Motion

Looking for more information regarding roles involved in waivers? Check out our blog for more on the subjects!

For even further answers, contact us today for any questions you may have!

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