Professional Documents
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Employer of Record MANUAL 2018-2019
Employer of Record MANUAL 2018-2019
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
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.
• 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.
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
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.
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.
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
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:
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.
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.
The Employer of Record should have the following information at the time they are
approved to begin self-directing services:
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.
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
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.
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
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.
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
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).
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.
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.
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.
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:
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
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: 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.
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.
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.
• 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.
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.
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.
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.
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.
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).
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.
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.
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
employers with 20+ employees)
• The Americans with Disabilities Act, 42 U.S.C. §§ 12101, et.seq. (applies to
employers with 15+ employees)
• 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)
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.
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
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.
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.
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
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.
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.
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:
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 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 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.
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
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.
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 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.
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.
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.
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.
• 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.
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.
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.