Employer of Record MANUAL 2018-2019

EMPLOYER OF RECORD
MANUAL 2018-2019
Table of Contents
Overview ........................................................................................................... 5
Principles of Self-Determination ..............................................................................5
The Principles of Self-Determination are: ..............................................................6
Advantages of Individual and Family Directed Supports ............................................6
Services that may be Participant Directed are: .........................................................7
General Requirement for all Parties in Individual and Families Directed Supports .......7
People or Agencies that Provide Assistance with Individual and Family Directed
Supports ...............................................................................................................7
Participant .............................................................................................................8
Employer of Record................................................................................................8
Care Coordinator....................................................................................................8
Community Navigator .............................................................................................8
Representative.......................................................................................................9
1. Mandated Representative ..............................................................................9
2. Voluntary Representative ..............................................................................9
Financial Support Agency ..................................................................................... 10
The Financial Support Agency will provide the following services: ........................... 10
Step 1: Getting Started in the Employer of Record Model ............................ 12
Review of Initial Steps Prior to Employer of Record Model Approval ......................... 12
Representative Role: ......................................................................................... 12
Information that the Employer of Record Should Have When Starting to Self-Direct
Services ........................................................................................................... 13
Meeting with Community Navigator after Utilization Management Approval........... 13
Initial Meeting with Financial Support Services Agency Field Representative ......... 14
Post Financial Support Agency Start-Up Meeting Activities ................................... 15
Ordering Employer of Record Supplies ................................................................ 16
Step 2: Preparing to Hire Employees ............................................................. 18
Employee Qualifications........................................................................................ 18
Hiring Friends and Family: ................................................................................. 18
Job Descriptions ............................................................................................... 19
Employee Guidelines ......................................................................................... 19
Eastpointe| Employer of Record Manual 1

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Locating and Contacting Potential Employees ...................................................... 19
Private Employment Agencies ............................................................................ 20
Paid Advertisements .......................................................................................... 21
Developing Advertisements and Flyers................................................................ 21
Step 3: Screening and Interviewing Applicants ............................................ 22
Screening Applicants ............................................................................................ 22
The Personal Interview ...................................................................................... 22
Contacting Non-Selected Applicants ................................................................... 24
Step 4: Reference and Background Checks ................................................... 25
Information Needed for Required Waiver Background Checks ................................. 25
Required Waiver Background Checks and Employee Information ............................. 25
Required Waiver Background Checks..................................................................... 25
Criminal Background Checks ................................................................................. 26
Health and Human Services-Office of Inspector General List of Excluded Individuals
and Entities Database........................................................................................... 28
Step 5: Completing Hiring Process ................................................................ 29
Offering the Position to the Applicant .................................................................... 29
Completing the Hire Packet ................................................................................... 29
Role of the Financial Support Agency .................................................................... 30
Hepatitis B Vaccinations for New Employees .......................................................... 30
Step 6: Training Employees ........................................................................... 31
Initial Training ..................................................................................................... 31
On-Going Training................................................................................................ 32
Documentation o f Training.................................................................................. 32
Step 7: Implementing Services and Managing Employees ........................... 33
Scheduling Employees .......................................................................................... 33
Handling Conflicts and Issues ............................................................................... 33
Evaluating Employees........................................................................................... 34
Dismissing Employees .......................................................................................... 35
Some Grounds for Termination Include: ................................................................ 35
The Fair Labor Standards Act ................................................................................ 36
Employer Record Keeping ..................................................................................... 38
Time and Billing Forms ......................................................................................... 38
Direct Deposit of Employee Paychecks ................................................................... 40

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Taxes .................................................................................................................. 40
Income Taxes: ..................................................................................................... 41
Social Security and Medicare (FICA) Taxes: ........................................................... 41
Federal Unemployment Tax (FUTA): ...................................................................... 41
North Carolina Unemployment Tax (SUTA): ........................................................... 41
Monthly Employer of Record Report ...................................................................... 42
Step 8- Backup Staffing, Risk and Emergency Planning ................................ 44
Back-Up Staffing .................................................................................................. 44
Risk and Emergency Planning ............................................................................... 44
Primary Crisis Response........................................................................................ 45
Monitoring of Backup Plans................................................................................... 45
Step 9: Managing the Individual and Family Directed Services Budget ......... 46
Step 10: Service Documentation ................................................................... 49
Role of the Community Navigator ......................................................................... 49
Employer of Record Responsibilities ....................................................................... 49
Short-Range Goals and Strategies ......................................................................... 49
Types of Documentation....................................................................................... 50
Service Notes ................................................................................................... 50
Service Grid ...................................................................................................... 50
Signatures ........................................................................................................... 51
Frequency of Service Documentation ..................................................................... 51
Corrections in the Service Record .......................................................................... 51
Progress Summary ............................................................................................... 51
Specific Service Documentation............................................................................. 52
Community Navigator ....................................................................................... 52
Community Networking ..................................................................................... 52
Individual Directed Goods and Services .............................................................. 53
In-Home Intensive Supports(service ends 10/31/2017) ........ Error! Bookmark not
defined.
In-Home Skill Building(service ends 10/31/2017) ... Error! Bookmark not defined.
Natural Supports Education ............................................................................... 53
Personal Care Services (service ends 10/31/2017) . Error! Bookmark not defined.
Respite Services ................................................................................................ 53
Supported Employment ..................................................................................... 53

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General Records Administration ......................................................................... 54
How Long Records Must Be Kept ........................................................................... 54
Step 11: Quality Assurance and the Employer of Record Model ................... 55
Problems and Complaints Related to Work with the Financial Support Agency ......... 55
Plans of Correction ............................................................................................... 56
Incident Reports .................................................................................................. 56
Annual Reviews ................................................................................................... 57
Questions ............................................................................................................ 57

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Eastpointe Employer of Record Manual
FY 2018-19
Overview
The NC Innovations Waiver gives people with disabilities clear choice about how they
receive services. Participant Direction is a meaningful option for participants as well as
their families. In the NC Innovations Waiver, Participant Directed Services are called
Individual and Family Directed Supports. Participants can direct some or all of the
services that are paid through NC Innovations funding. This gives participants and
families more control over the way their services are provided, including the authority
to manage an Individual Budget and employee/manage workers who provide support.
Principles of Self-Determination
The Individual and Family Directed Supports Option is based on the principles of Self-
Determination. Self-Determination empowers individuals to gain control over selecting
the services or supports that meet their unique needs. It is a process that varies from
person to person according to what each individual feel are necessary and desirable to
create a satisfying and personally meaningful life. It is both person-centered and
person-directed.

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The Principles of Self-Determination are:
• Freedom – The ability of an individual, together with freely chosen family and
friends, to plan a life with necessary supports rather than purchase or conform to a set
program.
• Authority – The ability of a person with a disability (with a social support network or
circle if needed) to control a certain sum of money to purchase services.
• Autonomy – The arranging of resources and personnel -- both formal and informal -
- to assist an individual with a disability to live a life in the community rich in personal
and community affiliations.
• Responsibility – The recognition of a person’s valued role in the community

through competitive employment, organizational affiliations, spiritual development, and
general caring of others in the community as well as accountability for spending public
dollars in ways that are life-enhancing for persons with disabilities.
• Confirmation – The recognition of the importance of the leadership of self-

advocates in the Self-Determination movement.
Advantages of Individual and Family Directed Supports

• Increased independence and self-sufficiency
• Increased choice, flexibility, and control of services
• Improved quality of services
• Increased opportunities for a healthier and productive life with better personal
outcomes
• Increased satisfaction with services
• Increased use of people that the participant knows as employees
• Expanded information to assist in decisions around spending of resources
• Focused assistance to make participant direction possible
• Authority to hire, train, supervise, and, if necessary, fire employees
• Increased partnership between participants and professionals
• Increased meaningful relationships in the community
There are two Models of Individual and Family Directed Supports available, The Agency
with Choice Model and the Employer of Record Model. The Agency with Choice Model
is already being used at Eastpointe. The Employer of Record model allows the
participant or legally responsible person for the participant to be the individual who
legally can exercise authority over workers and assume the other responsibilities
associated with participant direction of services. Additionally, the Employer of Record
model gives you more control over your supports and the most responsibility. You will
have more control in choosing your own employee(s), direct control over who works
with you, setting your employees’ schedules/routines, determining how much to pay

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your employees and their benefits. The participant or the legally responsible person is
known as the “Employer of Record.”
This handbook is designed to assist and provide information for the Employer of Record
on the process of all aspects of self-directing supports/services under the Employer of
Record model. This handbook will also include information that can be useful in learning
how to recruit, interview, hire and train your employees.
If you have chosen the Employer of Record model, your care coordinator at Eastpointe
will assist you in revising your Individual Support Plan (ISP) to include the Individual
and Family Directed Supports. Your care coordinator will ensure that you are linked to
service providers and/or supports that will help assist and guide you through the
implementation of the Individual and Family Directed Supports option.
It is important for you to know that you as a participant or legally responsible person
can choose to direct one or more services under the Employer of Record model, and
may also choose to receive provider directed services.
Services that may be Participant Directed are:

• Community Networking Services
• Community Living and Supports
• Individual Goods and Services (in conjunction with at least one other self-directed services)
• Natural Support Education
• Respite Services
• Supported Employment Services
General Requirement for all Parties in Individual and Families Directed

Supports
Any party involved in Individual and Family Directed Supports, including Employers,
Representatives, Agencies with Choice, Provider Agencies, Financial Support Agencies
and employees shall not have been excluded from or suspended from participation in
the Medicare or Medicaid Programs. These parties shall not have been convicted of
Medicare or Medicaid fraud.
People or Agencies that Provide Assistance with Individual and Family

Directed Supports
It takes time for participants and their families to feel confident about directing their
own services. Eastpointe is committed to helping them acquire the skills needed to
direct services, and to handle the responsibilities that come with participant direction.
This assistance includes:
• Orientation, Information, and Training on Individual and Family Directed Supports
• Financial Support Services (required for individuals who elect the Employer of
• Record Model)

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• Community Navigator Services (based on needs and preferences; required for initial
training of Individual and Family Directed Supports).
An individual or family member may also need the assistance of a Representative to

assist in directing services. A Representative may be elected or may be required by
Eastpointe.
Participant
The Participant is the person approved to receive services under the NC Innovations
Waiver. The participant may or may not be the Employer of Record. If the participant is
not the Employer of Record, the Individual Support Plan (ISP) will include a statement
of how the participant will be involved in self-directing services.
Employer of Record
The Employer of Record is the individual that is recorded by and registered with federal
and state government agencies as the employer for legal purposes.
The adult waiver participant parent (s) of a minor waiver individual or legal guardian is
considered the Employer of Record (common law employer). The Employer of Record
must be at least 18 years old. Parent(s) of a minor child who is a participant on the
waiver can be the Employer of Record.
Care Coordinator
Care Coordination is provided to Individuals who participate in the Individual and
Family Directed Supports Option.
Responsibilities of the Care Coordinator include:

• Provides an Orientation to Individual and Family Directed Supports
• Refers the Individual to a Community Navigator Agency for training on Individual
and Family Directed Supports
• Completes the Individual and Family Directed Supports Assessment
• Completes the Process for Appointment of a Representative, when one is
• requested or needed
• Completes the Individual and Family Directed Supports Agreement.
• Provides any assistance needed to the prospective Employer in selecting
• a Financial Support Provider contracted by Eastpointe.
• Completes an ISP or Update(s) to the ISP
• Sends a copy of the approved ISP or Update to the ISP to the Community
Navigator and Employer if applicable.
Community Navigator
A Community Navigator is a paid provider that assists participants with locating and
coordinating community resources and activities as well as facilitating the integration of
the individual in the community. This service support participants, representatives, and
Employers who direct their services by providing direct assistance in their participant
direction responsibilities. Community Navigator services are intermittent and fade as

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community connections develop and skills increase in participant direction. If the
participant is self-directing their services, the Community Navigator functions will
include:
• Guidance with management of the Individual and Family directed budget
• Providing information on recruiting, hiring, managing, training, evaluating, and
changing support staff
• Assisting with the development of schedules and outlining staff duties
• Assisting with understanding staff financial forms, qualifications and record
keeping requirements
• Providing on-going information to assure that participants and their
families/representatives understand the responsibilities involved with participant
direction, including reporting on expenditures and other relevant information and
training.
Representative
A representative is a person who helps the Employer of Record manages their supports.
The Employer of Record is assessed to determine if help is needed to manage supports.
There are two types of representatives:
1. Mandated Representative: Person who is required to assist the Employer of

Record. (Eastpointe may decide that a Representative is required to assist the
Employer of Record)
2. Voluntary Representative: A Person who is not required to assist the
Employer of Record, but the Managing Employer still asks that a representative
be appointed.
The Representative may be a family member, friend, someone who has power of
attorney, income payee, or another person who willingly accepts responsibility for
performing tasks that the Employer of Record is unable to perform and must be at least
18 years old. The representative must be committed to follow the participant’s needs
and preferences while using sound judgment to act on the participant’s behalf.
Representatives must show evidence a personal commitment to waiver participants,
and must be willing to follow their wishes and respect their preferences while using
sound judgment to act on their behalf. Representatives receive no monetary
compensation, and may not serve as a service provider for the participant, with the
exception of providing guardianship services. The representative may not be known to
have any history of physical, mental, or financial abuse, or to have been excluded from
participation in the Medicare or Medicaid programs.
The Representative must also meet the following requirements:

• Demonstrate knowledge and understanding of the participant’s needs and
preferences, and respect those preferences.
• Agree to a predetermined level of contact with the participant
• Is at least 18 years of age

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• Is willing and able to comply with program requirements, including attending
required training, and reading manuals/handbooks that describe program
regulations
• Is approved by the employer to act in this capacity
Specific duties of the Representative are:

• Work with employer, care coordinator, Financial Support Agency and/or
• Community Navigator to assure that the employer responsibilities are completed
• Make all or some of the decisions for the employer, depending on the waiver
participant and employer’s desires and abilities to make those decisions
• Manage, with the employer, the Individual and Family Directed Supports Budget,
using it for services stated in the ISP
• Manage, with the Employer of Record, the employer functions
• Maintain records as required
Financial Support Agency

Financial Support Services is the umbrella service for the continuum of supports offered
to NC Innovations individuals who elect the Individual and Family Directed Services
Option, Employer of Record Model. Financial Support Services are provided to assure
that funds for self-directed services are managed and distributed as intended. The
service also facilitates employment of support staff by the Employer.
The Financial Support Agency will provide the following services:

• Manage all payroll functions
• Assure that Individual and Family Directed funds outlined in the ISP are
managed and distributed as intended.
• Filing claims for self-directed services and supports
• Payment of payroll to employees hired to provide services and supports;
• Deducting all required federal, state, and local taxes, including unemployment
fees, prior to issuing paychecks to employees;
• Ordering employment related supplies and paying invoices for other expenses
such as training of employees;
• Administering benefits for employees hired to provide services and supports;
• Maintaining ledger accounts for each individual’s funds;
• Producing expenditure reports that are required, including reports to the
• individual/employer/family, concerning expenditures of funds against their
budgets;
• Requesting criminal background checks, driver’s license checks, and health care
registry checks of providers of self-directed services;
• Tracking and monitoring individual budget expenditures;
• Facilitating Workers Compensation Application on behalf of the Employer of
Record; and/or
• Serving as the Internal Revenue-approved Fiscal Employer Agent

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Step 1: Getting Started in the Employer of Record Model
Review of Initial Steps Prior to Employer of Record Model Approval
Prior to approval by Utilization Management, the Employer of Record has:

• Completed the Orientation to Individual/Family Supports
• Attended Introductory Training on Individual and Family Directed Supports
provided by a Community Navigator
• Completed the Employer of Record Assessment with the Care Coordinator
• Appointed a representative if one is mandated (required) or desired. The
representative must have completed the same Introductory training as
the Employer of Record
• Chosen a Model of Individual and Family Directed Supports (Employer of Record)
• Completed the Employer of Record Agreement with the Care Coordinator. If
the employer has appointed a representative, the agreement indicates the
duties the representative will perform on behalf of the employer.
• Worked with the Care Coordinator to update the Individual Support Plan to
include the Employer of Record Model, including adding Financial Support
Services and Community Navigator Services needed for start-up of the Employer
of Record Model
Upon approval by Utilization Management, the Employer of Record receives notice of

Individual Support Plan Approval from the Care Coordinator.
Representative Role:
If an employer has appointed a representative, the Individual/Family Agreement defines
the functions that the representative may perform on behalf of the Employer of Record.
The Care Coordinator is informed if the Employer of Record needs to appoint a different
representative, remove a representative, or change the function of the representative.
The Employer of Record requests that the Care Coordinator provide a copy of the
Representative Appointment and Employer of Record Agreement to the Financial
Support Agency and the Community Navigator Agency.

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Information that the Employer of Record Should Have When Starting to Self-Direct
Services
The Employer of Record should have the following information at the time they are
approved to begin self-directing services:
• Orientation Fact Sheets (provided by Care Coordinator)

• Employer Handbook (provided by Community Navigator)
• Copies of Training Power Point Slide (provided by Community Navigator)
• Copy of the Training Certificate (provided by Community Navigator)
• Copy of Employer of Record Assessment (provided by Care Coordinator)
• Copy of Employer of Record Agreement (provided by Care Coordinator)
• Copies of Representative Appointment Forms, if a representative has been
appointed (provided by Care Coordinator)
• Copies of Service Definitions with Qualifications of NC Innovations Services the
Employer of Record is self- directing (provided by Care Coordinator)
• Copies of the approved Individual Support Plan and Budget (provided by Care
Coordinator)
• Budget-Calculator (provided by the Community Navigator; Community Navigator
obtains from Financial Support Services Provider)
Note: If the Employer of Record needs one of these documents, the employer should
ask the Care Coordinator or Community Navigator for a copy of the document.
Meeting with Community Navigator after Utilization Management Approval

When an employer is approved for participation in the Employer of Record Model, the
Community Navigator contacts the Employer of Record to set up an initial meeting. The
meeting is typically held in the home of the individual participating in NC Innovations
but can be held at another location, depending on the needs and preferences of the
Employer of Record. The meeting is held at a time that is convenient for the Employer
of Record.
At the meeting, the Community Navigator:
• Explains the start-up process for the Employer of Record Model

• Provides the Employer of Record with the Employer of Record Handbook
• Provides the Employer of Record Training Notebook to the Employer.
• Provides the Employer of Record Lock Box, including forms needed by the
Employer
• Explains that additional forms may be obtained from the Community Navigator
• Inquires if the Employer of Record has received a start-up letter from the
Financial Support Agency that includes a form to complete and return to the
agency. If this form has not been received by the Employer of Record, the
Community Navigator follows up with the Care Coordinator or Financial
Support Agency to make sure that the form has been mailed to the Employer
of Record.

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• Assists the Employer of Record in completing the form with start-up
information needed by the Financial Support Agency.
• Assists the Employer of Record in determining the number of Direct
Service Professionals (also known as employees, workers) to be hired by
the employer. This information is needed in preparation for start-up
meeting with Financial Support Agency. With several employees, there are
more choices in scheduling and more options for back up in emergencies.
Changing employees is easier with several employees.
• Assists the Employer of Record in completing a draft of the Auto Calculator
used to determine potential employee wages, benefits and funds available
for other expenditures in preparation for the start-up meeting with Financial
Support Agency.
• The Care Coordinator also develops/reviews short-range goals developed to
address Community Navigator long- range outcomes in the Individual
Support Plan. The Employer of Record signs these goals.
Initial Meeting with Financial Support Services Agency Field Representative

The Financial Support Agency sends a letter to the Employer of Record once the agency
has received an authorization to provide Financial Support Services on behalf of the NC
Innovations participant. This authorization is sent electronically to the agency when the
Individual Support Plan is approved.
The letter includes a form for the Employer of Record to complete and return to the
Financial Support Agency. The form contains basic information that the Financial
Support Agency needs to pre-fill forms that the Employer of Record will sign at the
Initial Meeting with a Field Representative. By having the Field Representative pre-
populate the forms with this information, the meeting can be conducted in a shorter
amount of time and the documents are readable with the correct information. One
important item is Previous EIN. If the employer has ever had an Employee
Identification Number (EIN), it is important that this information be provided to enable
the Financial Support Agency to accurately complete the work they will do on the
employer’s behalf. Also included with the letter will be an information release for the
Financial Support Agency to communicate with the individual’s Community Navigator.
When the completed form is returned by the Employer of Record, the Field Service
Representative contacts the Employer of Record to set up the Initial Meeting. This is
also known as the Kick off Meeting. The Community Navigator is also invited to attend
the meeting. The meeting is usually held in the home of the Employer of Record. The
purpose of the meeting is to explain how the Financial Support Agency will provide
services on behalf of the Employer of Record. In addition, important paperwork is
completed at the meeting.
The paper-work completed and signed at the Financial Support Start-Up Meeting allows
the state and federal government to keep track of whether laws are being followed and
that employment taxes are paid correctly. This includes information needed to obtain an
Employer Identification Number (EIN) on behalf of the Employer of Record, information

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needed to obtain Workers’ Compensation Insurance on behalf of the Employer of
Record, and completion of the Financial Support Agreement with the Financial Support
Agency. The Field Representative provides information and materials that the Employer
of Record will find helpful in hiring employees, completing employee payroll reports and
service billing. The process for hiring an employee is also reviewed, including the
Background Check Authorization Form and Sample Employee Packet.
The Final Version of the Budget-Calculator is completed at the meeting. The Employer
of Record signs a printed copy of the Budget-Calculator and gives it to the Field
Representative. If the employer or Community Navigator do not have access to a printer,
the Community Navigator arranges for a copy of the Budget-Calculator to be printed,
signed by the Employer of Record, and returned to the Financial Support Agency after
the meeting. While the Budget-Calculator can be updated (changed) at any time, it is
important that it be kept current and that a copy of the most recently completed Auto-
Calculator be sent to the Financial Support Agency. The Community Navigator also
sends a copy of completed Auto- Calculators to Eastpointe’s Finance Department.
The Field Representative answers any questions that the Employer of Record may have
about the forms being signed. Information is provided at that meeting about how to
contact the Financial Support Agency if the Employer of Record has additional
questions. Copies or originals of documents are available by request to a Financial
Support Services Customer Service Representative once everything has been processed.
The Financial Support Agency determines which documents are returned as originals or
copies, based on the content and purpose of the document.
Reminder:
• Employer Identification Numbers are requested in the name of the Employer
of Record.
• Employer Identification Numbers are not requested in trade or business
names.
• If the Employer of Record has previously had an Employer Identification
Number in a trade or business name, the Financial Support Agency will work
with the appropriate agency to change the name on the Employer
Identification Number to the Employer of Record’s name.
Post Financial Support Agency Start-Up Meeting Activities

After the Start-Up Meeting, the Financial Support Agency completes a number of tasks
on behalf of the Employer of Record. This includes obtaining the Employer Identification
Number (EIN) and Workers’ Compensation Insurance on behalf of the Employer of
Record. The Financial Support Agency notifies the employer of the receipt of the EIN,
and sends a copy of the Workers’ Compensation Insurance Policy with the effective date
of the Policy.
While the Employer of Record is free to interview prospective employees at any point,
no job can be offered to a prospective employee until the Financial Support Agency

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confirms that Workers’ Compensation Insurance has been obtained and a criminal
background check is obtained by the Financial Support Agency on the prospective
employee. Criminal background checks will not be completed prior to the effective date
of the Workers’ Compensation Insurance Policy.
Reminder:
✓ Individual and Family Directed Services, the Financial Support Agency and
Personal Income Taxes
✓ The Financial Support Agency does not advise Employers of
Record or assist in any way with the Employer’s personal
income taxes.
✓ Employers of Record should consult an accountant or tax
advisor for information related to personal taxes.
Ordering Employer of Record Supplies

Employer of Record supplies are requested through the Financial Support Agency by
using the Financial Support Request Form. The Community Navigator assists the
Employer of Record in completing the form and updating the Auto- Calculator as
needed.
Initially the Employer of Record requests/receives Start-Up Supplies. These are:

✓ 1 Box of Gloves
✓ 1 CPR Mask
✓ 1 First Aid Kit
The type of gloves, mask and kit the Employer of Record receives is standardized, as
recommended by the Financial Support Agency and approved by Eastpointe. These
items are paid out of the Individual Budget and the Care Coordinator includes them in
the Individual Support Plan and Individual Budget. If an Employer of Record wants a
different type of gloves, mask and/or First Aid Kit or additional supplies, the employer

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budgets these items in the Budget-Calculator and indicates the request in the Budget-
Calculator Section of the Request Form. For employee training or items included in the
Budget-Calculator Section of the form, the Employer of Record completes the Vendor
Section of the form. Additional purchasing information may be included by attaching
copies of pages from a catalog or narrative information on additional pages. The Form
is signed and dated. The Request Form
is mailed, faxed or attached to an e-mail and sent to the Financial Support Agency.
Once the Employer of Record receives an item, the packing invoice is mailed, faxed or
attached to an e-mail and sent to the Financial Support Agency. It is very important
that this be done so the vendor can be paid. If the item requested is included in the
Individual Budget, the authorized Eastpointe Financial Support Services Code is billed to
Eastpointe by the Financial Support Agency. If the item is included in the Service Rate
Section of the Auto- Calculator, the item is paid out of the Individual and Family
Directed Budget (Individual and Family Directed Services provided and billed).

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Step 2: Preparing to Hire Employees
The NC Innovations Waiver has rules about providing services to individuals
participating in the Waiver. Additionally, State regulations must be followed. While the
Employer of Record may be eager to begin self-directing services, it is important to
remember that the completion of Financial Support start-up activities does not mean
that employees may be immediately hired. The Employer of Record should also
remember that if there is a delay in hiring employees, the Care Coordinator must be
immediately notified so that the Individual Support Plan can be updated. The
Community Navigator can teach and assist the Employer of Record in all aspects of
this process.
Employee Qualifications
A Direct Service Professional (employee) is a person hired by the Employer of Record to
provide services to the waiver participant. The direct service employee cannot be:
• The minor participant’s parent or step-parent, or participant’s spouse
• The Employer of Record
• The Representative or anyone with Power of Attorney Status for the Individual or
Employer
• Anyone employed by Eastpointe, a Community Navigator, or Financial Support
Agency
• A relative of an individual 18 years or older living in the home of the participant
who has not been approved by Eastpointe.
If an Employer of Record considers hiring a relative as the direct service employee,

this should be carefully considered. If the relative lives in the home of the Individual,
the NC Innovations Relative as Provider Policy must be followed.
At a minimum, employee qualifications must include the General Requirements for
all NC Innovations Waiver Providers, service specific requirements, and any
qualifications specified in the ISP.
Hiring Friends and Family:

In hiring a family member or friend, the following should be considered:
Pros
• May be easier to find someone
• May be a more dependable relationship
• May be more flexible with work schedule
Cons
• May be harder to give criticism or to fire, if necessary
• May have trouble adjusting to new Employer/employee relationship
• May want to decide work schedules for themselves

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Questions to consider prior to hiring a relative or family member:
o Is this about the individual’s needs or about supplementing a family
member’s income?
o As an adult is it appropriate to have mom and dad with the individual
throughout the day?
o If a family member supports an individual from birth
onwards into adulthood, does the individual learn to
adapt to different people and increase independence?
o If an individual with a disability is always supported by
a family member, what happens when that caregiver
ages/dies?
o Can a family member be a barrier to increased
community integration or friendship development?
Job Descriptions
Before employees are hired, they should understand all aspects of the job, work hours,
salary, daily tasks, and needs of the individual. An essential part of getting the
employer-employee relationship off to the right start is clear expectations. The job
description is a way to make sure that there is clear communication between an
employer and employee. A good way to begin writing a job description is to decide what
the employees need to do. Checklists should be used to develop the job descriptions
that are consistent with the goals and supports listed in the Individual Support Plan
(ISP). It may also be helpful to make a more detailed checklist for each task listed on
the job description. Employees can use the checklists as guidelines for carrying out tasks
correctly. These lists will also be useful in developing strategies for goals/outcomes. The
information in the job description does not need to be permanent, and can be changed
if the individual’s needs change.
Employee Guidelines
There are some employee habits and behaviors that can be annoying. To address this
ahead of time, guidelines that the employee will be expected to follow should be
developed. These are not included in the job description but should be shared with
applicants. If an applicant has problems with the guidelines, this could present
problems if they are hired. Some employers choose to identify guidelines after the
employee has started work as situations arise. If this is done, the Employer of Record
should remember that it is important for the employee to know exactly what the
guidelines are and why they are there.
Locating and Contacting Potential Employees

Finding employees may be as simple as the Employer of Record and Representative
telling family and friends that they are looking for someone to hire. Current employees
may also know of individuals who are looking for work. When potential applicants are
encountered that are not sure that they want the job, it is important to “sell” them on
the merits of direct service work. The Employer of Record should be realistic but
upbeat, focusing on the rewards without minimizing the challenges. Also, it is important

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to discuss what makes working in a self-directed employment environment more
appealing than working for an agency.
Some of the ways to advertise for employees include:

• Community newsletters advertisements
• Posting flyers
• Advertisements in newspapers and local publications
• Word of mouth and networking
Reminder: Places Potential Employees Can Be Found

• Churches, synagogues mosques, and other places of worship
• Faith-based and other human service agencies
• Disability organizations and rehabilitation agencies
• Supermarkets, shopping centers, Laundromats, and other stores that allow
posting of flyers
• Community organizations that serve special populations including Senior Centers
• Neighborhood associations
• Cultural centers
• Health clinics
• Unemployment offices (public)
• Libraries
• Schools and local colleges with GED, nursing, social work, or other human service
programs, particularly those with student employment offices
Private Employment Agencies

The Employer of Record should be cautious before considering the use of a private
employment agency. These agencies will likely charge a fee to either the Employer of
Record or any employee that is successfully hired. Before using an employment agency
that charges a fee, the Employer of Record must discuss this with a Community
Navigator, as the Individual and Family Directed Budget will likely not contain enough
funds for the fee to be paid by the Employer of Record. Employers of Record are

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reminded that they may not be reimbursed for expenditures in the hiring process.
Authorized expenditures are paid by the Financial Support Agency directly to the vendor.
Paid Advertisements
Advertisements can be paid out of the Individual and Family Directed Supports Budget if
pre-arranged with the Financial Support Agency and budgeted in the Budget-Calculator.
The newspaper charges by the word or line, so ads should be brief with only essential
information. Advertising in neighborhood newspapers is cheaper than major city
newspapers, and are good to target potential employees.
Developing Advertisements and Flyers

Successful advertisements or flyers must be clear about the kind of support that is
needed; concise in the wording, i.e. short and to the point; and specific about what the
employee will be expected to do. The following is a list of suggestions for developing
advertisements or flyers:
• Read other ads for ideas.
• Include the basics of the job including hours, duties, name of the position, and
how to reach the Employer of Record. Employers of Record should be careful in
disclosing information about the contact person for the ad.
• Other things that are important to the Individual can also be listed such as
smoking preference but do not overload the ad with information.
• Be positive in describing the job.

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Step 3: Screening and Interviewing
Applicants
After advertising for possible employees, the Employer of Record should
be prepared to receive responses at any time. A folder should be
started that contains the application, forms, and notes made during the
application process. The following is a suggested screening/interviewing process.
Employers of Record are free to develop their own interviewing processes. The
Community Navigator can train and assist Employers of Record in all aspects of
screening and interviewing applicants.
Screening Applicants
Many of the responses from ads or flyers will be by telephone. The Employer of Record
must be prepared to “pre- interview” applicants when they call. The conversation will be
useful in helping to decide if they have the necessary skills and qualifications, and if the
Employer of Record is comfortable with them. Personal information about the individual
(name, address, etc.) is not shared during the telephone interview. Only questions
directly related to the job should be asked. Preparing a “script” of what will be said will
be helpful.
When beginning a telephone interview, it is important to give a brief description of the

position, number of hours that the job requires the amount of pay and any benefits
being provided. Sample telephone screening questions are located in
At the conclusion of all telephone interviews, the Employer of Record reviews notes
made, and decides which of the applicants that they would like to interview in person.
These areas should be considered in deciding which applicants to interview:
• Qualifications, experience, and ability to carry out assigned tasks

• Availability
• The feeling about the applicant’s answers to questions, including if the individual
is likely to enjoy spending time with the applicant
The Personal Interview

Once applicants are selected to be interviewed, they are called and face-to-face
interviews are arranged. When applicants are contacted, they should be reminded to
come prepared to complete an application form.
The safest way to interview someone that is not well known to the Employer of Record
is to have a friend or family member present for the interview if it is held in the home;
or have the interview in a public place (library, community center, etc.). If the meeting
is at a restaurant, the Employer of Record should be clear on who is paying for the meal
so there are no misunderstandings. Meals cannot be reimbursed from the Individual

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and Family Directed Supports Budget. The interview should be held at a time and place
where interruptions are not likely. It is very important that the interview be non-
discriminatory.
It is important to be well prepared for the interview. Items that should be available for
the interview include a blank application, job description, and background/reference
check release forms, which are provided by the Community Navigator.
The applicant should be greeted pleasantly, and helped to feel comfortable. The
individual’s support needs should be described. The job description is shared with the
applicant after the application is completed. The Employer of Record can review the
application while the applicant reviews the job description.
It is important to remember that there are some questions that may be discriminatory to
ask. Issues related to arrests, about children (number, names, ages, childcare
arrangements), marital status, questions about disabilities or physical conditions which
do not relate to the applicant’s fitness to perform the job, questions concerning
pregnancy and future child-bearing plans, direct or indirect questions that indicate an
applicant’s ancestry, national origin, race or color, questions about age (except to ask if
the person is of legal age to work), and any question that if answered, would reveal
religious affiliation, denomination, or holidays observed should be avoided. Only
questions that directly apply to the job requirements should be asked.
The work schedule, pay method, pay rate, any benefits, leave plan, and method of
evaluating employees are described. The applicant should also be given an opportunity
to ask questions. At the conclusion of the interview, the applicant should be thanked for
coming and for their interest in the position and told they will be contacted as soon as a
hiring decision is made.
Reminder: Evaluating Applicants

The Employer of Record evaluates each applicant on experience, the application,
answers given during the interview, availability to work the days and hours
needed, and general attitude. The evaluation determines the most promising
applicant(s) to select to conduct reference and background checks.
The following are areas that should be considered during this process:
✓ Were questions answered completely?

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✓ Did the applicant maintain eye contact and pay attention during the
interview?
✓ Did the applicant consistently hesitate or stumble with their answers?
✓ Did the applicant seem interested in all aspects of the job, or just the pay
and work hours?
✓ Can the applicant perform the needed tasks?
✓ Is the applicant available when needed?
✓ Does the applicant have a solid work history?
✓ Is the applicant positive, eager, and willing to learn?
✓ Would the individual be comfortable receiving support from the applicant?
Contacting Non-Selected Applicants

The Employer of Record contacts the applicants who were not selected for the position
to let them know that a hiring decision has been made. They should be thanked for
their interest and asked if their names can be kept on file for future reference. Most
applicants will accept the decision to hire another applicant without question, but some
might want to know why they were not chosen. A simple answer to this question is that
while the applicant’s experience and qualifications were impressive, the employee hired
seemed better suited to the individual’s overall needs. There is no obligation to offer
any further explanation.

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Step 4: Reference and Background Checks
Reference and background checks are valuable tools in the hiring process, and must be
completed prior to employees providing NC Innovations Services.
Information Needed for Required Waiver Background Checks

It is recommended that at least two references for each applicant under serious
consideration for employment be checked. Employment references usually provide
valuable information but personal references may also be obtained. Former employers
should be contacted, paying attention to length of employment at each job. Contacting
the applicant’s previous employers for the previous five years of work history may help
in verifying that an applicant has resided in North Carolina for five years, and assist in
determining the type of criminal record check needed. Some employers will not discuss
an applicant without having received a copy of a signed reference release form.
Required Waiver Background Checks and Employee Information

Prior to requesting the background checks, the Employer contacts the applicant and
obtains:
• Age verification (copy of driver’s license, other form of verification if not

transporting the participant)
• Automobile liability insurance if transporting the individual in their personal
vehicle (copy of information is sent directly to the Employer of Record)
• Copy of High School and/or College Diplomas (transcripts are sent directly to the
Employer of Record)
• Confirmation of the residency status of the applicant and how long the applicant
has resided in North Carolina (number of consecutive years). This allows the
Financial Support Agency to perform the correct Background Check, state or both
state/national. (See additional information on this page for further information on
Criminal Background Checks.)
• Copy of the applicant’s job application
• Signed consent for background check provided by the Financial Support Agency
Required Waiver Background Checks

When an applicant is being considered for employment, the Employer submits the age
verification and signed consent for the background check and request that the Financial
Support Agency obtain required background checks. Required background checks are:
• If transporting a waiver participant, driving record check

• Criminal record background check
• Health Registry Check
• Health and Human Services-Office of Inspector General List of Excluded
Individuals and Entities database
• Verification that the applicant is at least 18 years’ old

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Reminder: Employer of Record Responsibilities
The Employer of Record must obtain copies of and keep copies of the documents
that verify the prospective employee’s educational and other qualifications such
as the prospective employee’s high school diploma or GED as indicated in the
service definition qualification requirements. If the prospective employee is
expected to transport the individual in the employee’s automobile, the Employer
of Record obtains documentation that the employee has a reasonable amount of
automobile liability insurance.
Criminal Background Checks

North Carolina law requires a criminal background check on all potential unlicensed
employees who have direct access to individuals with developmental disabilities. The
law requires that for those potential employees who live in North Carolina less than five
consecutive years, a national criminal record check must be obtained. For those
prospective employees who have lived in North Carolina for more than five years, only a
state criminal record check is required. The employment application has a question that
addresses this issue. References should also be checked for the previous five years. If
the applicant provides inaccurate information about residency and the Employer of
Record discovers this at a later time, this would be grounds for dismissal. If the
applicant currently lives in another state, the applicant is subject to the national criminal
record check.
Reminder: Hiring Employees Who Have Not Lived in North Carolina for five
consecutive years
• The Employer of Record must clearly identify that the prospective employee has
not lived in North Carolina for five consecutive years when requesting
background checks from the Financial Support Agency.
• For prospective employees who have lived in North Carolina for five consecutive
years, a national criminal record check is obtained. For those prospective
employees who have lived in North Carolina for more than five checks, only a
state criminal record check is required.
• The Employer of Record must obtain Background Checks from the Financial
Support Agency.
• The Employer of Record may not obtain them from or through another source.

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The Financial Support Agency returns the results of the background check to the
Employer of Record. The Employer of Record carefully reviews the results of the
Background Check to determine if any reported convictions present a health and safety
risk to the individual, regardless of the Employer of Record’s relationship or knowledge
of the prospective employee. The Employer may not hire an applicant whose criminal
record check or Health Care Registry check poses a potential health or safety risk to the
individual. Guidance and questions about potential issues around criminal background
checks are to be discussed with the Community Navigator. Should specific information
be disclosed to an employee of Eastpointe or a Provider Agency under contract with
Eastpointe that indicates that an employee has been hired who has criminal record that
presents a potential to the safety or well-being of the individual being supported, the
employee or Agency will report this to the Quality Management Department.
A “hit” on either the state or federal background check is defined as a relevant offense,
meaning a county, state, or federal criminal history of conviction or pending indictment
of a crime, whether misdemeanor or felony, that bears upon an individual’s ability to
have responsibility for the safety and well-being of an aged or physically disabled
person or a person needing mental health, developmental disabilities, or substance
abuse services.
These crimes include:

• Counterfeiting and Issuing Monetary Substitutes
• Endangering Executive and Legislative Officers
• Rape and Other Sex Offenses
• Assaults, kidnapping, or abduction
• Malicious Injury or Damage by Use of Explosive or Incendiary Device or Material
• Burglary and Other Housebreakings
• Arson and Other Burnings
• Larceny, robbery, or embezzlement
• False Pretenses and Cheats
• Obtaining Property of Services by False or Fraudulent Use of Credit Device or
Other Means
• Financial Transaction and Crimes Act
• Frauds or forgery
• Offenses Against Public Morality and Decency
• Prostitution
• Perjury
• Bribery or misconduct in public office
• Offenses Against the Public Peace
• Riots and Civil Disorders
• Protection of Minors
• Protection of the Family
• Public Intoxication
• Computer Related Crimes
• Possession or sale of drugs and alcohol related offenses

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The Employer of Record is responsible for keeping Personnel Records that meet NC
Innovations requirements. Quality Management will review Employee Personnel Records
during the Annual Audit of the Employer of Record. Records are also subject to audit by
other State and Federal Agencies. The Community Navigator trains Employers of Record
in setting up Employee Personnel Records. The Employer of Record maintains the
criminal record check information in the applicant’s file, separate from other personnel
information about the applicant. Specific information about an applicant’s criminal
record check is not sent to Eastpointe or disclosed to anyone conducting monitoring or
an audit.
Employer of Record New Hire Packets will not be processed, nor will the employee be
paid for work performed prior to the request of the Background Check from the
Financial Support Agency for the applicant and the receipt and review of that
Background Check results by the Employer of Record.
Health and Human Services-Office of Inspector General List of Excluded

Individuals and Entities Database
The Health and Human Services-Office of Inspector General List of Excluded Individuals
and Entities Database is a database of individuals and entities excluded from
participation in the Medicaid and Medicare Programs. If a prospective employee appears
on this list, the Employer may not offer a position to or hire the applicant because NC
Innovations cannot be billed if the service is provided by an applicant excluded from
participating in the Medicaid Program. Concerns and questions about this database are
to be discussed with the Community Navigator.
Reminder: Hiring Employees

• A job offer may not be made to an applicant prior to requesting a background
check from the Financial Support Agency.
• A job offer may not be made to an applicant prior to receiving and reviewing
the background check from the Financial Support Agency.
• Background checks may not be obtained from any agency or other way
except through the approved process that is the responsibility of the Financial
Support Agency.
• New Hire Packages will not be distributed to Employers by the Financial
Support Agency until the Employer of Record has received and reviewed the
results of the Background Checks.

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Step 5: Completing Hiring Process
A final hiring decision is made after considering all the information gathered. The
following steps are suggested in making the final hiring decision:
• Review the application. Is the applicant qualified? Do they have the necessary
experience? Are there any unexplained gaps in their work history?
• Re-read the notes taken during the interview process. Was the applicant
attentive, positive, knowledgeable, and eager?
• Review the notes about the employment references. What did the applicant’s
past employers say about them? Were they trustworthy and competent? Did they
get along well with others?
• Review the notes about personal references. How long has the person known
the applicant? How did that person describe the applicant’s attitude and best
qualities?
• Review background checks and determine if there are any concerns with those.
Background checks must be considered in the context of the individual’s health
and safety. The applicant’s driver’s license should be current and overall driving
record should be considered. A person whose background check presents a
health and safety risk to the individual cannot be hired.
The hiring process may result in finding that none of the applicants are suitable. The
search for the right person continues until the right employee is found.
Offering the Position to the Applicant

The Employer of Record contacts the selected applicant, and offers the position to the
applicant. The starting salary, the pay schedule, the work schedule, training that must
be completed, and the work start dates are discussed. The role of the Financial
Support Agency is also described. If the applicant accepts the position, the Employer of
Record contacts the Financial Support Agency and requests a Hire Packet. A New Hire
Packet will not be sent to the Employer of Record until the Employer Identification
Number (EIN) and Workers’ Compensation Policy are in place and background checks
are received and reviewed by the Employer of Record.
Completing the Hire Packet

The Employer welcomes any applicant who accepts a position, and confirms the training
schedule and first day of work. A time is set for completion of the Hire Packet. The
Employer makes sure that the Hire Packet is completed, and that all forms are signed.
The Employer also makes sure that a copy of the individual’s social security card is
included for the Financial Support Agency’s files. The New Hire Packet is not submitted
until a copy of the Social Security Card is obtained to be submitted with the New Hire
Packet.

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The Employer of Record and employee also develop an Employee Support Agreement
that is signed by both parties. The Employee Support Agreement includes the
employee’s supervision plan. The supervision plan must be updated annually. Employee
Support Agreements are retained in the Employer of Record’s Personnel Files. These
are not sent to the Financial Support Agency. The Employer also arranges or provides
any initial training for the employee. (See Chapter 6 for information about training
employees.)
Role of the Financial Support Agency

The employee cannot be paid until the Financial Support Agency receives the completed
Hire Packet, including a copy of the employee’s social security card. Forms that are
mailed must be postmarked five days prior to the employee’s anticipated work start
date. The Financial Support Agency contacts the Employer to confirm that forms have
been received and that the employee can begin work.
Should the forms that the Financial Support Agency needs to put the employee on the
payroll be received after the employee begins work, there could be a delay in issuing
the employee’s first paycheck and/or there could be penalties for late filings of taxes
and other required withholdings. Penalties for late filings because the Employer of
Record did not return the forms to the Financial Support Agency on time will be
deducted from the Individual and Family Directed (Self-Directed) Budget. This could
mean that the Employer of Record would need to make adjustments to the Budget-
Calculator.
Hepatitis B Vaccinations for New Employees

Employers of Record offer employees the option to receive Hepatitis B vaccination
series. The Employer shares a notice about the vaccination series with the employee.
The employee accepts or declines the offer. If the new employee accepts the offer, the
Employer of Record arranges for the vaccination. Payment is requested from and made
by the Financial Support Agency using the Financial Support Request Form.

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Step 6: Training Employees
The Employer of Record is responsible for arranging for or training employees. The
amount of training will depend on the skills needed to perform the job, and the
employee’s experience. At a minimum, employees must meet requirements specified in
the NC Innovations Service Definitions and in the Individual Support Plan (ISP). It is
suggested that Employers of Record write down Individual’s routines or create training
manual before starting to train an employee.
Community Navigators are helpful in providing information about training resources for
Employers of Record. The Community Navigator assists the Employer of Record in
locating training curriculums or companies that offer training for employees.
Initial Training
During the hiring process, information is gathered about the employee’s qualifications.
After the applicant accepts the position, the Employer of Record develops a
training/supervision plan for the employee as part of the Employee Support Agreement.
The Employer of Record arranges or provides any initial training for the employee.
Training to be paid by the Financial Support Agency must be pre-arranged with the
Financial Support Agency by submitting the Purchase Request Form.
The employee may be paid for time spent attending training; however, NC Innovations
Services are not billed since the employee is not providing a service to the individual.
The employee gives a copy of the training certificate received at the completion of the
training to the Employer of Record who maintains copies in the employee’s personnel
file.
Reminder: Initial Training of Employees

In order to pay an employee for time spent in training or in classes, the employee
must be hired by the Employer of Record. This means that the Employee Start-
Up Package is completed correctly, submitted, and received/processed by the
Financial Support Agency. The training must be included in the Budget-Calculator
unless covered under Employer Expenditures in the Individual Support Plan. After
the employee is hired, paid training time is recorded on the employee’s time
sheet. The training time is recorded as non-billable to NC Innovations because
the Employee is not providing a NC Innovations Service. Request for payment for
employee training is submitted to the Financial Support Agency by using the
Financial Support Request Form.
The Employer of Record should also make clear any expectations for service provision to
the employee. Locations of items that the employee will be using should be specified. It
may be important for the employee to understand why a task should be performed a
particular way. The importance of the work schedule should be stressed. The employee
should be shown how to complete their time and billing form.

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On-Going Training
Some training for employees may be required to be repeated on a particular timeline
(for example annually). It is also possible that an employee may require additional
training after they have been working with the individual for some time. The employee
may develop a bad habit or forget something that they have already been told. The
individual may have a new need that requires additional training. An Employer of Record
may request payment for additional formal training for an employee by submitting the
Purchase Request Form to the Financial Support Agency. The Financial Support Agency
will pay the registration fee for the training as requested on the Financial Support
Request Form. The Budget should also include the cost of the on-going training. Travel
expenses for training and conferences for the employee are not reimbursable.
Documentation o f Training
Both initial and ongoing training must be documented and filed in the employee’s
personnel record. It is also critical that the supervision plan in the Employee Support
Agreement is followed, and that supervision be provided and documented as specified
in the Agreement. The Provider Monitoring staff will review employee training records at
the time of the Annual Employer of Record Audit. Community Navigators train
Employers of Record in setting up/maintaining training files for employees.

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Step 7: Implementing Services and Managing Employees
After employees are hired and trained, the Employer of Record implements the
Individual Support Plan (ISP). There will be successes and challenges as employees
provide services as written in the ISP. While the Financial Support Agency and
Community Navigator are available to assist the Employer of Record in completing many
employment tasks, there are still a number of responsibilities that must be met by the
Employer of Record to assure that the ISP is implemented as written.
Scheduling Employees
If there is only one employee, scheduling is simple. However, because of the hours of
services needed by an individual and the need to plan for back-up staffing, there likely
will be more than one employee, and scheduling is more difficult. Scheduling takes time
as does dividing tasks among employees. The schedule should be posted in a place that
all will see it. Ultimately the decision about scheduling is made by the Employer of
Record but relationships with employees will be better if they feel that their needs are
considered when the schedule is made. Employees need to know how much notice will
be given when the schedule is changed, as well as when the schedule might need to
change on short notice. The Employer of Record should inform employees what will
happen if they arrive late or do not come to work. It is equally important that
employees not be asked to stay late without notice. Employers and employees must
respect each other’s time.
Employers of Record schedule employees so that employees are available to deliver the
number of service hours specified in the Individual Support Plan. It is very important for
the Employer of Record to remember that services must be provided as written in the
Individual Support Plan. If more services are provided than approved in the ISP, the
Financial Support Agency will not be able to process the billing for the extra hours. This
means that the revenue needed to pay the employee’s paycheck was not counted in the
Budget-Calculator, and the budget could be overspent. If fewer services are provided
than approved, the Employer of Record documents the reason, and could need to
complete a Back-Up Staffing Incident Report. If fewer services are provided than
approved, the individual’s health and safety could be at risk.
In following the ISP and scheduling services, the Employer of Record must be aware of
how services are authorized (approved) for an individual participating in the Employer of
Record Model. When services are authorized per week, the week is defined as Sunday –
Saturday. If an individual is to receive an amount of a service per week and does not
receive the total hours of service for that week, the service cannot be rescheduled for
the following week. Community Navigators are helpful in explain how services are
authorized.
Handling Conflicts and Issues

Because Employers of Record deal with some very personal issues, they need good
communication skills. Employees need to be trained, praised and at times, corrected.

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Problems and misunderstandings are more likely to occur if people do not talk to each
other and know where they stand. Employers and employees may react to conflict in a
different way. Some are passive, and are scared to speak up for their own needs.
Others are aggressive, and may lash out at someone over small issues. The best
approach is to be assertive. Being assertive is being polite but insistent on what is
needed. When conversations are being held about important issues, reviewing the
Employee Support Agreement with the employee may be helpful.
Evaluating Employees
To insure that the best care is being provided to the individual, employees should be
evaluated regularly. If employees are new or if there are problems with an employee,
evaluations should be scheduled more frequently. Evaluations should be conducted at
least annually. A prepared evaluation form should be used for formal reviews. The form
should have similar items as the employee’s job description. The employee should be
allowed to give feedback, and to document their comments. These are attached to the
evaluation.
Some employees need more time to perform well. If feedback and evaluations do
not improve performance, a written warning may be given that things need to
improve by a certain date. A copy is kept in the employee’s file. If the written
warning does not work, then it may be necessary to issue a second warning with a
copy placed in the employee’s file. After the second warning, it should be clear that
things need to improve or the employee may be terminated (fired).
Reminder: General Supervision Tips

• Avoid stereotyping employees based on age, race, or gender.
• Be ready to train, and provide on-going training when things change.
• Communicate openly and directly with employees. Work directions should be
clear. Technical language and terms should be explained. Employees should
be encouraged to ask questions.
• Assume that employees want to do a good job.
• Praise good performance and initiative. Treating employees with respect
builds good working relationships.
• Be consistent.
• Monitor the work of the employees. If they are not doing tasks as trained,
additional training may be needed.
• Deal with problems. Issues should be addressed early and tactfully. When
dealing with problems, the Employer of Record should focus on the problems.
• Lead by example, and show respect and courtesy to employees. Employers if
Record should avoid talking about the employee to another employee.
• Supervising employees includes but is not limited to observing employees
delivering services, reviewing service documentation, and face-to-face
meeting with the employee.

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• All supervision is documented, provided as described in the Employee
Supervision Plan and maintained by the Employer of Record.
Dismissing Employees
An Employer of Record has the right to terminate employees with or without cause. If
there is a serious problem with an employee, the solution to the problem could be to
terminate (fire) the employee immediately. Examples of serious situations are:
• Hurting the individual or abusing the individual in any way
• Drinking or using street drugs on the job, or coming to work drunk or drugged
• Stealing from the individual
• Violating confidentiality
If an employee threatens the Employer of Record, the local law enforcement office may
need to be contacted, and the employee may be fired over the telephone. The
employee should be told that arrangements will be made to pay them any wages that
are owed. In cases of abuse to the individual, the Care Coordinator, the Department of
Social Services Protective Services Unit, and the Quality Management Department must
be notified.
If the problem is not serious, the Employer of Record may want to discuss the problem
with the Community Navigator who can offer advice about solving the problem. If the
problem is still unresolved, a change in employees may be necessary. The Employer of
Record is responsible for telling the employee that he/she is fired. The employee may
be terminated by phone or letter but doing it in person is more respectful.
If the Employer of Record is concerned that there will be problems with the employee
when the subject of firing comes up, a third party may be asked to be present during
the conversation. The conversation should be direct so that there are no
misunderstandings but it is not necessary to go into great detail with the employee. If
plenty of corrective feedback and regular evaluations have been given, the employee
should know what the problems are. Depending on the situation, the employee may be
given two weeks’ notice. This will give the employee the opportunity to start looking for
a new job and the Employer of Record will have time to start looking for a new
employee. There may be a need to use the emergency back-up plan while looking for a
replacement. If the emergency back-up plan costs more than regular services, the
Individual and Family Directed Supports Budget may need to be adjusted. The
Employer of Record contacts the Community Navigator should the Employer of Record
need help adjusting the Budget.
Some Grounds for Termination Include:

• The employee’s work is not good enough.
• The employee does not learn fast enough to meet the individual’s needs.
• The employee is late or fails to show up too many times.
• The employee’s personal habits bother the individual.
• The employee fails to pay attention to the instructions of the Employer of Record.

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• The individual and the employee are having too many disagreements.
• The individual is not comfortable with the employee.
• The employee has a schedule that is not flexible enough for the individual.
• The employee violates the employment conditions, seriously or often.
Reminder: Suggested Steps for Terminating an Employee

• Set a date for the termination, have the backup system ready to go, have
someone else present.
• Have the documentation and Employee Support Agreement out at the time.
• Make a list of anything the employee may have such as keys to the
individual’s home and ask for their immediate return.
• Let the employee know that their services are no longer needed. Suggested
methods of communicating the termination are: “I’m sorry, but I do not feel
you are appropriate for this job.” or “I won’t need your services anymore.” If
an explanation is requested, refer them to the discussions and the
Agreement. Do not argue with the employee.
• Have the employee sign the last time sheet and complete any documentation
that is not finished. Tell the employee when they can expect to receive their
last paycheck. Turn the time sheet and other paperwork in immediately to the
Financial Support Agency so that the paycheck can be issued.
• If the employee becomes angry or offensive, ask them to leave immediately
and call the police if they refuse to leave.
• Continue to maintain confidentiality related to employee issues, including the
termination.
• Analyze what went wrong to avoid similar situations in the future.
It is extremely important that the Employer of Record document all events leading up to
termination of an employee in the event an employee decides to file for unemployment
benefits, and to prevent the Individual and Family Directed Budget from being charged
an increased rate for unemployment taxes. The documentation will help defend actions
in a hearing with the Employment Security Commission, a complaint with the Equal
Employment Opportunity Commission (EEOC), or in a wrongful discrimination lawsuit.
The Employer of Record is responsible for responding to inquiries from the Employment
Security Commission should a terminated employee file for unemployment benefits.
The Fair Labor Standards Act

The Fair Labor Standards Act (FLSA) establishes minimum wage, overtime pay, record
keeping, and child labor standards affecting full-time and part-time workers. Employers
are required to follow the provisions of the FLSA. Covered employees are entitled to at
least minimum wage, and overtime pay at a rate of not less than one and one- half
times their regular rate of pay after 40 hours of week in a workweek.

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While FLSA does set basic minimum wage and overtime pay standards and regulates
the employment of minors, there are a number of employment practices that FLSA does
not regulate. These include:
• There is no federal requirement to pay overtime or premium pay for time worked
on weekends or holidays, or if more than the usual number of hours is worked on
a single day.
• There is no requirement to pay vacation, holiday, severance, or sick pay.
• There is no requirement to pay for meal or rest periods, holidays off, or
vacations.
• There is no requirement for pay raises or benefits.
• There are no regulations about discharge notices, reason for discharge, or
immediate payment of final wages to terminated employees.
More information can be obtained from the Federal Department of Labor at:
www.dol.gov
Investigators stationed across the U.S carry out enforcement of FLSA. They conduct
investigations and gather data on wages, hours, and other employment conditions or
practices, in order to determine compliance with the law. Where violations are found,
they also may recommend changes in employment practices to bring an employer into
compliance. It is a violation to fire or in any manner discriminate against an employee
for filing a complaint or for participating in a legal proceeding under FLSA. Violations
can result in criminal prosecution and/or fines. Employers who willfully or repeatedly
violate the minimum wage or overtime pay requirements are subject to civil money
penalties.
If the Employer has more than 15 employees, there may be other employment related
laws that the Employer of Record must follow. These include:
• Title VII of the Civil Rights Act of 1964, 42 U.S.C. §§ 2000e, et.seq. (applies to
employers with 15+ employees)
• Age Discrimination in Employment Act, 29 U.S.C. §§ 621, et.seq. (applies to
• The Americans with Disabilities Act, 42 U.S.C. §§ 12101, et.seq. (applies to
• The Family and Medical Leave Act, 29 U.S.C. §§ 2601, et.seq. (applies to
employers with 50 or more employees working 20 or more workweeks per year)

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The Community Navigator will provide the Employer additional information about these
laws as needed.
Employer Record Keeping

The Employer of Record is provided a Training Notebook and a portable file box that can
be locked when the Employer begins to participate in the Employer of Record Model of
Individual and Family Directed Supports by the Community Navigator. The Training
Notebook contains this Handbook Supplement and other resources that the
Employer of Record will find useful in self-directing services. The Employer of Record
will want to add the Orientation Materials and Employer Handbook to the Notebook that
were previously distributed to the Employer by the Care Coordinator and Community
Navigator.
The file box includes forms and other materials that are used in employer record
keeping. The Community Navigator trains Employers on the forms and answers
questions about the forms and record keeping responsibilities.
Additional copies of forms included in the box are provided by the Community Navigator.
The Community Navigator only provides copies of the forms in the box and does not
customize the forms for the Employer of Record. Forms are also available in electronic
form on the Individual and Family Directed Supports web site. The Community
Navigator assists the Employer of Record in accessing the web site and provides the
password for the site to the Employer of Record.
A separate file should be maintained on each employee. Copies of important

documents, such as the application, schedules, job duties, time sheets, evaluations, and
Employee Support Agreement are maintained in the file. Information about employees is
confidential and should be kept in a secure location. Employers of Record must not
release information about an employee without the written permission of that employee.
Records are subject to review by the Care Coordinator, Quality Consultant, and/or State
or Federal governments. Actual results of criminal record checks are maintained
separately and should not be released to a third party.
Time and Billing Forms

Employees complete the Time and Billing Form provided by the Financial Support
Agency and are submitted by the Employer of Record as indicated on the schedule
provided by the Agency. Copies of the employee’s Time and Billing Forms are kept by
the Employer of Record. The form is signed both by the employee and Employer of
Record. Time sheets that are incomplete or that have inaccurate information should not
be signed. For example, should the employee record hours worked on a day off, this is
pointed out to the employee. The form would be corrected by the employee prior to the
Employer of Record signing it.
The Financial Support Agency provides the Employer of Record with a method of
confirming receipt of Time and Billing Forms. Employers of Record are strongly advised

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to confirm receipt of Time and Billing Forms by the Employer of Record by a method
suggested by the Financial Support Agency. Employee pay could be delayed if Time and
Billing Forms are not received by the Financial Support Agency.
The Financial Support Agency pays the employee based on information on the time
sheet. The Financial Support Agency contacts the Finance Department if NC Innovations
Services are not billable for the time reported on the Time and Billing Form. Should
hours reported on the employee’s time sheet not be billable to NC Innovations, this
could mean less money in the Individual and Family Directed Budget in the future and
could result in termination from the Employer of Record Model if the Individual and
Family Directed Budget is overspent.
The Financial Support Agency reviews time and billing forms as they are submitted. The
Agency has a policy that is followed when errors are discovered on time and billing
forms. There are instances when the time and billing forms are returned to the
Employer of Record for correction. If time sheets are submitted or resubmitted after the
deadline established by the Financial Support Agency, employees are not paid until the
next scheduled pay date.
Reminder: Employer Record Keeping

• The Employer of Record may choose to complete documents electronically,
The Financial Support Agency has policies and a form that must be
completed and signed if the time and billing form is to be completed and
submitted electronically by e-mail attachment.
• Employers of Record are not reimbursed for computers, software, printer
cartridges, paper, and/or similar items except when the Individual is the
Employer and is allowed to receive a specific item or items according to a NC
Innovations service definition.

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• The Community Navigator Agency and/or Eastpointe will not print or
reimburse for printing of documents that the Employer chooses to customize.
• If an Employer of Record chooses to submit forms to the Financial Support
Agency via mail, the Employer should request self-addressed stamped
envelopes from the Agency.
Direct Deposit of Employee Paychecks

Employee paychecks are typically deposited in the employee’s bank account. As part of
the New Hire Packet, the employee completes paperwork to authorize the employee’s
check to be deposited in a bank account that includes the employee’s name. Paychecks
will not be deposited in third party bank accounts. Should the employee not have a
bank account, the Financial Support Agency will issue the employee’s pay in the form of
a Pay Card at the employee’s mailing address. Employee paychecks are never given to
the Employer of Record for distribution.
The Financial Support Agency requires documentation that the employee’s name is
included on the bank account where payment of wages is requested. This is usually
done by providing the Financial Support Agency with a copy of a voided check that lists
the employee’s name on the account. If the employee is unable to provide the Financial
Support Agency with a voided check, the employee may provide a statement from the
bank (on bank letterhead) that confirms that the employee’s name is on the account. If
this information is not provided to the Financial Support Agency, the employee’s pay will
be issued in the form of a Pay Card.
Taxes
Employers of Record need to be aware of responsibilities that they have regarding
taxes. The Financial Support Agency withholds taxes as required by law from the
employee’s pay. The Financial Support Agency provides written information and
answers questions about tax withholdings.
Reminder: Correspondence from the Internal Revenue Service, NC

Department of Revenue or other Agency
• Should an Employer of Record receive a correspondence from the Internal
Revenue Service, NC Department of Revenue, or other Agency about tax or

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other withholdings related to the Employer of Record Model, the
correspondence should immediately be forwarded to the Financial Support
Agency, and followed up with a telephone call to the Financial Support
Agency to confirm receipt of the correspondence.
• Any delay in reporting of such correspondence to the Financial Support
Agency could result in monetary penalties to the Employer of Record.
The Financial Support Agency needs information in the New Employee Hire Packet, in
order to withhold and pay the proper taxes on behalf of the Employer of Record.
Employment Taxes that the Financial Support Agency will withhold on behalf of the
Employer of Record are:
Income Taxes:
Federal income taxes are usually paid on employee income. Ordinarily,
employers are required to do income tax withholding. Publication 15 from the
Internal Revenue Services, Circular E Employers Tax Guide, includes information
regarding withholding and payment of federal taxes. There is an exception that
may apply to certain relatives providing services to the individual. The Financial
Support Services gathers information from the employee to determine if this
exception should be applied. The telephone book has the number and location of
the nearest IRS office or branch. Information can also be found at
http://www.irs.gov./ State income taxes are also withheld by the Financial
Support Agency. Information about North Carolina state income taxes can be
found at http://www.dor.state.nc.us/index.html
Social Security and Medicare (FICA) Taxes:

Social Security and Medicare (FICA) Taxes set aside living and medical expense
monies for employees to use when they retire. Federal regulations require
employers to withhold and pay Social Security and Medicare taxes.
Federal Unemployment Tax (FUTA):

The Federal Unemployment Tax (FUTA) compensates workers who lose their
jobs. Employers of Record must file federal unemployment taxes (FUTA) on
behalf of employees. Employers receive a credit for taxes paid toward state
unemployment taxes.

North Carolina Unemployment Tax (SUTA):
The State Unemployment Tax (SUTA) compensates workers who lose their jobs.
State Unemployment Taxes work very much like Federal Unemployment Taxes.
Employers with stable employment records receive credit for this in reduced tax
rates after a qualifying period. The experience rate includes the number of
employees who are terminated from the Employer who file for and receive SUTA
benefits.

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The Financial Support Agency files taxes electronically in aggregate on behalf of
all Employers of Record. It is not possible for the Agency to provide each
Employer a copy of the actual filing since it includes names of other Employers.
However, the Financial Support Agency provides Employers of Record with
notifications of taxes paid on behalf of the Employer of Record as part of the
Employer of Record Monthly Report. Eastpointe audits the Financial Support
Agency annually. Included in this audit is a review of taxes paid on behalf of
Employers of Record.
As previously stated it is extremely important that the Employer provide the

Financial Support Agency any correspondence from the Internal Revenue Service,
NC Department of Revenue, or other Agency about tax or other withholdings
related to the Employer of Record Model. Receipt of this correspondence does
not mean that the Financial Support Agency has not paid taxes on behalf of the
Employer of Record. It could mean; however, that the taxes have not been
properly credited to the correct account. The Financial Support Agency would
follow up to make sure that the taxes or other expenditures are properly
credited.
Reminder: Unemployment Taxes

• If an employee quits or is dismissed from employment, Employers of Record
should respond to all inquiries about the dismissal from the NC Employment
Security Commission.
• The Employer of Record’s Unemployment Tax Rate could be higher if former
employees receive unemployment benefits.
• Community Navigators can provide information and assistance if there is an
inquiry from the NC Employment Security Commission.
• It is important to use the current Budget-Calculator provide to the Employers
of Record (through their Community Navigators) by the Financial Support
Agency so that the correct FUTA/SUTA rates are used.
Monthly Employer of Record Report

Each Employer receives a Monthly Report completed by the Financial Support Agency
that shows the revenues to the account (billing of NC Innovations services to
Eastpointe), and expenditures (payments made that include employee pay, employer
taxes, purchases made on behalf of the Employer) The Financial Support Agency
provides each Employer with a companion to the report that explains the format of the
Report. The report is in the same format as the billing and time reports. Both have
color coded numbering. The monthly report includes a payroll register and notifications
of taxes paid.
The Monthly Report is sent to the Employer with copies to the Finance Department,
Care Coordinator, and Community Navigator. All parties review the Monthly Report
for accuracy/problems. Unresolved concerns about the Report are reported to
Finance by the Care Coordinator.

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Step 8- Backup Staffing, Risk and Emergency Planning
The Care Coordinator shares the results of the Risk/Support Needs Assessment
completed prior to the development of the Individual Support Plan (ISP) with the
Employer of Record. Each identified risk is addressed in the Individual Support Plan, if
needed. Employees must be trained to implement risk strategies that are specifically
related to the individual’s needs.
Emergency plans are also developed for weather and other environmental emergencies.
Examples of emergency plans that should be developed include:
• Power outages
• Severe weather conditions such as tornados, hurricanes, floods, and snow/ice
storms, including emergency water and food supply location
• Situations that would require evacuation including emergency evacuation routes,
shelter locations, and medications, supplies, and important papers to take in case
of evacuation
Back-Up Staffing
As an Employer of Record and/or Representative, planning for employee vacancies and
absences is important as you direct your services. There will be times when your
regularly scheduled employee cannot work. You must make arrangements for “back up”
employees to fill in when your regular employee is not available and for emergency
situations. It is important to ensure adequate support coverage is available to meet the
participant’s needs. The Individual Support Plan (ISP) must describe how the participant
will get their needs met if an employee is absent or any unforeseen circumstance that
prevents the participant from functioning as usual. Eastpointe will maintain a contract
with a provider agency to provide emergency backup staffing for individuals
participating in the Employer of Record model.
Risk and Emergency Planning

Risk and Emergency Planning is important and should be made to address potential
emergency situations that can create safety issues or barriers to care delivery. Having a
plan for dealing with different types of emergencies, such as medical emergencies,
hospitalizations, power/electrical outages, severe weather, fires,
evacuation planning (including evacuation routes and shelter
locations, supplies, etc.) and other natural disasters can help
keep you safe and reduce the risk of injury. Potential emergency
needs for the participant are identified as part of the Risk/Support
Needs Assessment process that is used in developing the ISP.
You will need to include in your plan a way to test your plan and
document the tests. Employees should be trained on the plan and
what to do in an emergency.
The Crisis Plan section of the ISP should state how each identified
risk will be managed and identifies training needs of any
individual responsible for implementation of managing a risk management strategy or

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strategies. A back up plan needs to be developed to address absence of staff and who
to call when back up staffing is needed. The plan should be tested/reviewed at least
quarterly. Eastpointe will maintain contract with an identified provider in Eastpointe’s
provider network to provide emergency backup staffing for Employer of Record. This is
optional and should be discussed with your care coordinator to ensure services can be
provided within your budget. The contracted agency will make every effort to provide
backup employees, dependent on amount of notice you give to the agency.
Primary Crisis Response

If the Employer of Record is self-directing In-Home Intensive, In-Home Skill Building,
and/or Personal Care Services, the Employer of Record must choose a Primary Crisis
Response Agency. The Back-Up Staffing Agency may also be chosen as the Primary
Crisis Response Agency by the Employer of Record. The Employer of Record is free to
choose any other Primary Crisis Response Provider within Eastpointe’s Provider Network
Monitoring of Backup Plans

Eastpointe’s I/DD Care Coordination staff and Provider Monitoring staff will monitor
Back-Up and Emergency Plans as a part of monitoring of services. Any situation that is
identified as a health and safety issue for the participant is immediately addressed with
the Employer of Record or Representative (if applicable).

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Step 9: Managing the Individual and Family Directed
Services Budget
NC Innovations funds are Medicaid dollars that the Employer of Record and Eastpointe
must use wisely. Laws and regulations must be followed, and funds must be used to
obtain services in the Individual Support Plan (ISP). The Employer of Record must be a
careful purchaser of services, and remember to use existing personal and community
resources before using NC Innovations and other public funds.
The Employer of Record has control over how the Individual and Family Directed
Supports Budget is spent within NC Innovations Guidelines. Medicaid payment rates are
two parts: the administrative portion and a direct service portion.
• The Administrative portion of the rate is used to pay for billing, required staff
training, forms, and items to meet other regulations. A portion of the rate is
retained to pay for these expenditures.
• The direct services portion of the rate that is used to pay costs for staffing and
benefits is available to the Employer of Record to negotiate staff salaries and
benefits.
Community Navigators assist Employers of Record in developing the budget and train
Employers of Record in using the Budget. The Community Navigator also provides the
Finance Department with a copy of the completed Budget. The Finance Department
reviews, but does not approve, the Budget. Finance may be able to identify
problems with the completion of the Budget. If problems are identified, Finance notifies
the individual’s Care Coordinator who notifies the Community Navigator.
Additionally after the Budget is completed, a print-out of the budget is signed by the
Employer of Record and submitted to the Financial Support Agency by mail, fax or e-
mail (scanned document with signature of the Employer of Record). The Community
Navigator assists with this process and may need to print the Budget and bring it to the
Employer of Record for signature. The Budget must be updated at a minimum if the
following occur:
• Anytime an Individual Support Plan is updated that results in a change in

frequency and/or duration of services
• Service revenue is less than projected. For example, the individual is approved in
their Individual Support Plan to receive 20 hours of In-Home Skill Building each
week. The individual goes on a trip with family and does not receive the 20
hours of In-Home Skill Building. The Community Navigator works with the
Employer of Record to deduct the 20 hours of In-Home Skill Building from the
projected revenue portion of the budget, and make any other adjustments that
need to be made as a result of the reduced Individual and Family Directed
Budget.

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• Anytime the Financial Support Agency notifies Employers of Record that the
Employment Tax or Workers’ Compensation Insurance rates have increased. If
this happens, information will be provided about how to do this, and/or new
Budget instructions.
• Annually, no later than the time of the Annual Plan development
• Prior to requesting a Bonus for an employee
• Prior to granting a pay raise for an employee
• When an employee uses overtime that is not included in the Budget. Using over-
time on a regular basis will likely result in over spending of the Individual and
Family Directed Services Budget. This could result in termination from Individual
and Family Directed Supports.
• Anytime a new Budget form is issued by the Financial Support Agency
• Use of the Back-Up Staffing Agency that was not previously included in the
budget
• Training for employees not covered under Employer of Record Expenses that are
listed in the Individual Support Plan that was not previously included in the
Budget
• Blood borne Pathogen Gloves/First Aid Supplies in Excess of those covered in
Employer Expenses that were not previously included in the Budget
• Employment Ads that were not previously included min the budget
• Training materials directly related to the training of a habilitation service (does
not include personal items) that were not previously included in the budget
• Anytime additional benefits are provided to employees that will have an impact
on the Individual and Family Directed Budget.
There are rules that must be followed for using NC Innovations funds. The most
basic rules are that everything purchased must be related to the individual’s needs
and that the funds are used for services allowed by the NC Innovations waiver. The
following are guidelines for determining allowable expenditures in Individual and
Family Directed Supports:
• The expense is related to the Individual’s disability needs.

• The expense must only be for the waiver participant.
• The expense is needed to maintain the health, safety and well-being of the
Individual.
• The expense is not covered by another funding source.
• The expense is directly related to a service in the current ISP.
• The expense is the actual cost of the item after all applicable credits, including
refunds, rebates, and discounts.
• Any service provided out of state must receive prior approval by the Utilization
Management Department.
• The expense is not associated with any room and board charges.
• The expense is adequately justified.

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• Payment is not made directly to the individual, Employer of Record,
Representative, or family but to the person or business providing the service,
supply, or other item.
• The expense is not prohibited under other federal, state, local laws or regulation.
Reminder: Examples of items that cannot be paid from NC Innovations

Funds
• Gifts for or loans to workers, family, or friends
• Rent or mortgage payments
• Payments for someone to be the Representative
• Clothing except as specified in the Assistive Technology Definition
• Alcoholic beverages and/or tobacco products
• Televisions, radios, DVD/VCR Players, MP3 players, game systems
• Services that are available without charge from community organizations
• Items that are illegal

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Step 10: Service Documentation
Employers of Record are required to have employee’s document services following
State established criteria. Services must be documented prior to submitting time and
billing claims to the Financial Support Agency. The documentation is stored in the
individual/family home, and must be maintained in a secure location. The minimum
service documentation requirements for services provided through the NC
Innovations Waiver are contained in this Chapter and the DMH/DD/SAS Records
Management and Documentation Manual 45-2. A Community Navigator can provide
information about documentation requirements and assist the Employer of Record in
locating this document on the DMH/DD/SAS website, or ordering a hard copy of the
Manual. The Quality Management training provides information and answers
questions about documentation requirements.
Role of the Community Navigator

A Community Navigator or Community Navigator Agency provides a start-up lock box
containing documentation forms to the Employer of Record. The lock box is a secure
place to maintain service documentation. If the Employer of Record wants to use a
different format for documentation than the one approved by Eastpointe, the Employer
of Record must obtain approval from the Quality Management Department prior to using
the form. The Employer of Record must also supply these different forms for employee
use. The Community Navigator Agency only provides approved Eastpointe forms to the
Employer of Record. It is extremely important that the Employer of Record
monitor all service documentation by direct service employees.
Employer of Record Responsibilities

The Employer of Record must maintain the following documentation:
• The Individual Support Plan (ISP) and all revisions to the ISP, including long-
range outcomes, the Individual Budget and all revisions to the Budget
• Short-Range Goals to meet long-range outcomes
• Strategies for completion of Outcomes/Goals in the ISP
• Any related correspondence from Eastpointe
• Required Service documentation
Short-Range Goals and Strategies

The Employer of Record and/or Representative are responsible for developing and
implementing short-range goals and task analyses/strategies for achieving long-range
Individual Support Plan outcomes. Community Navigators train Employers of Record on
development of short-range goals and task analysis/ strategies.
Short-range goals are steps taken to achieve the long-range outcomes. They are
statements describing a proposed behavior, or what the participant will do. Short-
range goals are based on wants/needs of the participant. They are based on the
individual’s preferences or needs, not staff convenience or preference.

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A strategy is a long-term plan of action designed to achieve a particular outcome.
Strategies are used to make a problem easier to understand and solve. A strategy is
adaptable rather than a rigid set of instructions, for example to assist a participant with
behavioral issues.
A task analysis is a process for determining in detail the specific behaviors required of
staff to assist the individual with the implementation of an outcome. Task analysis
includes a detailed description of any unique factors involved in or required for one or
more people to perform a given task. For example, a task analysis would be used to
assist an individual with a specific daily living skill.
Short-range goals, strategies and/or task analysis must be in place prior to service
delivery. This includes having the signature of the individual and/or legally responsible
person for initial plans and all updates prior to implementing the goals. If a signature
page is developed for the strategies or task analysis, this signature page could serve as
the signed document and therefore each page of the strategies or task analysis would
not require a separate signature.
Types of Documentation
There are two types of documentation that are used in Individual and
Family Directed Services: Service Notes and Service Grids.
Service Notes
For Service Note requirements, the Employer of Record refers to the DMH/DD/SAS
Records Management and Documentation Manual 45-2 (chapter 8 & 9). The
following NC Innovations Individual and Family Directed Service require a service
note, which includes items 1 through 13, under Contents of a Service Note, Chapter
8 of the DMH/DD/SAS Records Management and Documentation Manual 45-2:
• Community Navigator
• Individual Directed Goods and Services (required for service component)
• Natural Supports Education
Service Grid
For Service Grid requirements, the Employer of Record refers to the DMH/DD/SAS
Records Management and Documentation Manual 45-2 (chapter 8 & 9).
A service grid should include all elements 1 through 10, under Required Elements of a
Service Grid, Chapter 8 of the Record Management and Documentation Manual. A
service grid shall be completed daily or per activity to reflect the service provided and
may only be used for the following Individual and Family Directed Services:
• Community Networking
• Community Living and Supports
• Respite Care
• Supported Employment

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Signatures
All entries in the service record shall be signed with a full signature. A full signature is
to include the credentials, degree or licensure for professional staff or the position of the
individual who provided the service for paraprofessional staff. Please refer to the
DMH/DD/SAS Records Management and Documentation Manual 45-2 (chapter 9) for
signature requirements.
Frequency of Service Documentation

All NC Innovations services require a daily or per activity service note or grid. The
person who provided the service shall write and signed the service note or grid. The
service note or grid shall be documented on the day that the service was provided or no
later than the next work day. If a service or grid is not documented on the day the
service was provided, it shall be considered a “late entry”. The entry shall be noted as a
“late entry” and at a minimum the date the documentation was made and the date for
which the documentation should have been documented, for example, “Late Entry made
on 2/15/12 for 2/14/12.” The late entry must include a dated signature. (See
Corrections in the Service Record below for information about late entry timelines for
billing purposes.)
Service notes shall be made at the frequency necessary to indicate significant changes
in the individual’s status, needs, or changes in the Individual Support Plan.
Corrections in the Service Record

Changes or modifications in the original documentation for the purpose of making a
correction can be made at any time, when appropriate. Whenever corrections are
necessary in the individual’s record, service providers should refer to the procedures as
noted in the DMH/DD/SAS Records Management and Documentation Manual 45-2
(chapter 9). However, for quality assurance and reimbursement purposes all necessary
documentation or corrections to support billing shall be properly completed within seven
(7) working days. Therefore for billing purposes, corrections must be made within the
prescribed timeframes.
Progress Summary
Employers of Record are required to complete progress summaries for habilitation
services to reflect the individual’s progress toward the short-range goal and long-range
outcomes that have been implemented in the Individual Support Plan for the following
services: Community Networking, In-Home Intensive Supports, In-Home Skill Building,
and Supported Employment. ( In-Home Intensive Supports, In-Home Skill Building and
Personal Care will remain as services to self direct until the current authorization ends
or a the latest, 10/31/2017.)
The Progress Summary shall contain at a minimum:
• The individual’s name

• Date of the quarterly review an dates that the review covers
• The goals reflected in the current Individual Support Plan

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• Progress towards goals
• Recommendations for continuation, revision, or termination of an outcome
• Signature of the individual who completed the review.
The Progress Summary is completed monthly for the first three months the individual
participates in Individual/Family Directed Supports and then quarterly thereafter. The
quarterly progress summary is documented within seven (7) working days of the close
of the quarterly progress period. If a quarterly progress summary is not documented
within seven (7) working days of the close of the service period, it shall be considered a
“late entry.” The documentation shall be noted as a “late entry” and includes the date
the documentation was made and the date when the documentation should have been
entered. For example, “Late Entry made on 4/21/12 for 3/31/12.”
The Employer of Record is responsible for using the documentation from employees and
writing and signing a note that outlines the individual’s progress during that service
period.
Specific Service Documentation
Community Navigator
Maintain service notes signed by the individual providing the service that documents the
date of the service, the amount of time involved in the service and a description of the
activities related to the Long Range goals and short range goals. A daily per event
service note should be completed.
Community Networking
• Maintain service note or grid signed by the individual providing the service that
documents the date of the service, the amount of time involved in the service and a
description of the activities related to the long-range outcomes and the short-range
goals.
• For conferences, classes, and related materials purchased in conjunction with these
an invoice will be required.
• For Community Networking Transportation that is not part of the provision of a
staffed service with an established per trip rate, maintain a record with a signature
of a representative providing the transportation.
• For Community Networking Transportation that is not part of the provision of a
staffed service with a per mile charge, maintain a record that documents the date
service was provided, the specific activity that the person is being transported
to/from, and the mileage related to the transportation of the person. The person
providing transportation shall sign the record.

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Individual Directed Goods and Services
An invoice from the supplier that shows the date the Good was provided to the
Individual, and the cost including related charges (for example, applicable delivery
charges) shall be maintained by the Financial Support Agency. Services will require a
service note signed by the individual providing the service that documents the date of
the service, the amount of time involved in the service and a description of the activities
related to the long-range outcomes and the short-range goals.
Natural Supports Education

Maintain service note signed by the individual providing the service that documents the
date of the service, the amount of time involved in the service and a description of the
activities related to the long-range outcomes and the short range goals. For
conferences and classes and related materials purchased in conjunction with these an
invoice will be required.
Community Living and Supports

Maintain service note documentation signed and dated by the individual providing the
service that documents the date of the serve; the amount of time involved in the
service, and a description of the activities related to the Long Range goals and short
range goals, personal assistance activities, and transportation provided to the person.
Respite Services
Documentation shall be documented on a daily basis, and the documentation must
contain the following components: Name of the individual, the record number, the
service provided, the date of service, duration of service, task performed including
comments on any behaviors, which are considered relevant to the individual’s
continuity of care, that special instructions were followed, and signature of the
individual providing the service (initials if the full signature is included on the page
when the use of a grid is used for documenting). A grid may be used to document
this service.
Supported Employment
Maintain service note documentation signed and dated by the individual providing
the service that documents the date of the service, the amount of time involved in
the service and a description of the activities related to the long- range outcomes
and short range goals, and transportation provided to the Individual. A grid may be
used to document this service.

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General Records Administration
Employers of Record will make service documentation available to the Care
Coordinator, Eastpointe staff, DMH/DD/SAS, DMA, and/or CMS to review the
documentation to support a claim for NC Innovations services rendered, when
requested. Records must be accessible for inspection, and must be brought to a
designated location for review when requested by the Provider Monitoring Department,
State of North Carolina, and/or Federal Government.
How Long Records Must Be Kept

Employment related documentation must be kept for at least five years after the
employee ends employment with the Employer of Record, and until all outstanding
lawsuits, claims, and audits are resolved. Service specific documentation must be
maintained by the NC Innovations Employer of Record for 11 years after the date of the
last encounter or for minors, 12 years from the 18 th birthday. All participant specific
documentation must be given to the Quality Management Department if a Participant is
terminated from the NC Innovations Waiver or from the Individual and Family Supports
Option. Records must be brought to the Quality Management Department within 30
Days of termination

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Step 11: Quality Assurance and the Employer of Record
Model
Problems and Complaints Related to Work with the Financial Support Agency
For problems identified related to an Employer of Record’s work with the Financial
Support Agency, the following process is followed:
Problem is identified:
• For any unsigned forms or incorrectly completed forms, or other type of problem,
the Financial Support Agency makes one additional request to the Employer of
Record for completion/correction. This includes time sheets and billing forms. If
the problem is not corrected, the Community Navigator is notified.
• If there is no Community Navigator, the Care Coordinator is notified. The
Community Navigator assists the Employer of Record in resolving the issue.
• If the Financial Support Agency believes that a Procedure should be changed or
modified for an Employer of Record, Finance must be consulted prior to making
that change or modification.
• Both the Financial Support Agency and Community Navigator Agency document
the problem, with the Community Navigator Agency documenting the outcome of
the Community Navigator’s intervention with the Employer of Record.
• If the same form or type of form is unsigned or incorrectly completed a second
time, or other type of problem the Financial Support Agency reports the issue to
the Community Navigator.
• The Care Coordinator is also notified of the problem and that this is the second
time the issue has been reported to the Community Navigator.
• The Community Navigator assists the Employer of Record in resolving the issue
and notifies the Care Coordinator of the resolution of the issue.
• The Financial Support Agency, the Community Navigator and the
Care Coordinator document the problem, with the Community
Navigator Agency documenting the outcome of the Community
Navigator’s intervention with the Employer of Record.
• If the same form or type of form is unsigned or incorrectly completed a third time
or other type of problem identified a third time, the Financial Support Agency
reports the issue to the Community Navigator.
• The Care Coordinator is also notified of the problem and that this is the third time
the issue has been reported to the Community Navigator.
• The Community Navigator assists the Employer of Record in resolving the issue
and notifies the Care Coordinator of the resolution of the issue.
• The Care Coordinator notifies Quality Management.
• Quality Management investigates the issue.
• Depending on the investigation results, Quality Management follows up.
• Actions may include:
o Required Plan of Correction.

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▪ The Community Navigator assists the Employer of Record in
developing and implementing the Plan of Correction.
▪ Recommendation for additional training by the Community
Navigator.
▪ Recommendation to Utilization Management for mandated
Community Navigator Services or appointment of a mandated
Representative.
▪ Recommendation for change of Individual/Family Directed Services
model or return to Provider Directed Services. NC Innovations
waiver processes are followed, including consultation with the
Division of Medical Assistance.
• For complaints by an Employer of Record or Representative, the Financial

Support Agency reports all concerns and complaints to the Care Coordinator.
• The Care Coordinator responds to the issue, involving the Community Navigator,
Community Partners, Utilization Management, and any others as needed.
• If other Departments receive complaints or identify concerns, Care Coordination
is notified.
• The Care Coordinator follows up with the Employer of Record as needed.
Plans of Correction
Plans of correction are helpful when mistakes occur for the first time, are due to
misunderstandings, and can be corrected. An example of using a plan of correction to
address minor problems might be not submitting time sheets by the deadline for payroll.
More serious problems include overspending the budget and not having adequate funds
to meet payroll or lack of documentation for services provided by an employee. A plan
of correction may be as simple as requiring an Employer of Record to discuss issues
with a Community Navigator. Or, a plan of correction may be more detailed and
prescriptive such as requiring an Employer of Record to spend a certain amount of the
budget on staff training. If additional Community Navigator services are needed,
Provider Monitoring will involve the Care Coordinator who prepares an Individual
Support Plan revision and submitting it to the Utilization Management Department for
approval and authorization
Incident Reports
Incident Reports must be completed and submitted to the Provider Monitoring
Department as required by State Rule.
The Back-Up Staffing Incident Reporting Form (located on Eastpointe’s website) is
completed and submitted to the Provider Monitoring Department any time the Individual
does not have paid back-up staff. The Employer of Record, or Representative, as
needed, indicates how the Individual’s needs were met in the absence of paid staff.
(See Chapter 7 for further information about the Backup Staffing Incident Reporting.

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Incident Forms are included in the Employers box that is obtained from the Community
Navigator or the Community Navigator Agency. The Quarterly Incident Report Form is
submitted by the Employer of Record to the Quality Management Department.
Annual Reviews
Eastpointe will also conduct an annual review of services provided under the Individual
and Family Directed Supports Option. The Employer of Record is notified of the
scheduled review.
Annual Reviews may include:

• Interviews
• Record reviews (both individual and employee records)
• Employee interviews
• Incident report reviews
• Reviews of training and supervision documentation
The Employer of Record is provided a copy of the Annual Review Report.
Questions
If you have additional questions regarding any part of this manual please contact
Eastpointe at 800-513-4002 and ask to speak with your assigned Care Coordinator.

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Employer of Record MANUAL 2018-2019

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EMPLOYER OF RECORD

Eastpointe| Employer of Record Manual 1

Eastpointe| Employer of Record Manual 2

Eastpointe| Employer of Record Manual 3

Eastpointe| Employer of Record Manual 4

Eastpointe| Employer of Record Manual 5

• Responsibility – The recognition of a person’s valued role in the community

• Confirmation – The recognition of the importance of the leadership of self-

Advantages of Individual and Family Directed Supports

Eastpointe| Employer of Record Manual 6

Services that may be Participant Directed are:

General Requirement for all Parties in Individual and Families Directed

People or Agencies that Provide Assistance with Individual and Family

Eastpointe| Employer of Record Manual 7

An individual or family member may also need the assistance of a Representative to

Responsibilities of the Care Coordinator include:

Eastpointe| Employer of Record Manual 8

1. Mandated Representative: Person who is required to assist the Employer of

The Representative must also meet the following requirements:

Eastpointe| Employer of Record Manual 9

Specific duties of the Representative are:

Financial Support Agency

The Financial Support Agency will provide the following services:

Eastpointe| Employer of Record Manual 10

Prior to approval by Utilization Management, the Employer of Record has:

Upon approval by Utilization Management, the Employer of Record receives notice of

Eastpointe| Employer of Record Manual 12

• Orientation Fact Sheets (provided by Care Coordinator)

Meeting with Community Navigator after Utilization Management Approval

At the meeting, the Community Navigator:

• Explains the start-up process for the Employer of Record Model

Eastpointe| Employer of Record Manual 13

Initial Meeting with Financial Support Services Agency Field Representative

Eastpointe| Employer of Record Manual 14

Post Financial Support Agency Start-Up Meeting Activities

Eastpointe| Employer of Record Manual 15

Ordering Employer of Record Supplies

Initially the Employer of Record requests/receives Start-Up Supplies. These are:

Eastpointe| Employer of Record Manual 16

Eastpointe| Employer of Record Manual 17

If an Employer of Record considers hiring a relative as the direct service employee,

Hiring Friends and Family:

Eastpointe| Employer of Record Manual 18

Locating and Contacting Potential Employees

Eastpointe| Employer of Record Manual 19

Some of the ways to advertise for employees include:

Reminder: Places Potential Employees Can Be Found

Private Employment Agencies

Eastpointe| Employer of Record Manual 20

Developing Advertisements and Flyers

Eastpointe| Employer of Record Manual 21

When beginning a telephone interview, it is important to give a brief description of the

• Qualifications, experience, and ability to carry out assigned tasks

The Personal Interview

Eastpointe| Employer of Record Manual 22

Reminder: Evaluating Applicants

Eastpointe| Employer of Record Manual 23

Contacting Non-Selected Applicants

Eastpointe| Employer of Record Manual 24

Information Needed for Required Waiver Background Checks

Required Waiver Background Checks and Employee Information

• Age verification (copy of driver’s license, other form of verification if not