consumer directed service agency (cdsa) compliance monitoring guide dads form 1722 and instructions

Consumer Directed Service Agency (CDSA)

Compliance Monitoring Guide

DADS Form 1722 and Instructions

DADS Form 1722

Demographic Information

1.1. Consumer and EmployerConsumer and Employer

2. CDSA Provider Agency2. CDSA Provider Agency

3.3. Monitor,Monitor, Review Date, Review Review Date, Review

Period, Review TypePeriod, Review TypeContract Monitoring Guide - Page 1

STANDARD 1 Orientation and Service AgreementOrientation and Service Agreement1. ORIENTATION

• Face-to-Face by CDSA Representative• Consumer’s Residence• Employer and Designated Responsible party

(if applicable) must attend• Documented (DADS Form 1736, Documentation of

Employer Orientation)

2. Service Agreement• CDSA and Employer (DADS Form 1735)• Documents Incorporated in Agreement

Contract Monitoring Guide - Page 1

STANDARD 1 Orientation and Service AgreementOrientation and Service Agreement

2. The following documents are incorporated in the Service Agreement by Reference

a) Form 1726, Relationship Definitions in Consumer Directed Services

b) Form 1733, Employer and Employee Exemption from Nursing License for Certain Services

c) Form 1736, Documentation of Employer Orientation

d) Form 1738, Rules Acknowledgement


STANDARD 2 Budget DevelopmentBudget Development

1. Employer/DRP and CDSA Participationa) Budget must be developed using the DADS CDS

Budget Workbookb) Budget must be “VALIDVALID”

2. Each Service Plana) Must be current. Revisions with changes to the

Consumer’s Service Plan affecting CDS servicesb) Must have a CDS Budget for each service category

delivered through CDS

3. Approved by CDSA / Acknowledged by the Employer/DRP


Definitions / ClarificationCONSUMER - Individual

receiving program services and participating in Consumer Directed Services (CDS)

MINOR - Individual UNDER the age of 18

ADULT - Individual OVER the age of 18

DESIGNATED RESPONSIBLE PARTY – Willing adult that agrees to assist the Employer with responsibilities for CDS

PARENT – Natural, Legal, Adopted, Step-Parent, Foster Parent, Court Appointed Guardian

SPOUSE –Married with Formalities (Legal) or Married without Formalities (Common Law) Texas Family Code

STANDARD 3 Employer and Employer-Agent RegistrationEmployer and Employer-Agent Registration

EMPLOYEREMPLOYERCONSUMER – Age 18 or more; Does NOT have a court appointed guardian

PARENT – of a minor-aged Consumer (Consumer is under 18 years of age)

CONSUMER – Consumer, under 18 years of age, but has been

(1) Emancipated by the court OR

(2) Is legally married

GUARDIAN – Court Appointed Guardian, regardless of the Consumer’s age


POWER OF ATTORNEY = Designated Responsible Party

Designated Responsible Party (DRP) is NOT the Employer.

STANDARD 3 Employer and Employer-Agent RegistrationEmployer and Employer-Agent Registration

FEDERAL GOVERNMENT

INTERNAL REVENUE SERVICE (IRS)

Employer: Employer Identification Number (EIN)

CDSA: Employer Appointment of Agent (Employer-Agent)

STATE GOVERNMENT

TEXAS WORKFORCE COMMISSION (TWC)

Employer: Employer TWC Account Number

CDSA: Authorization to Represent Employing Unit (“Employer’)


STANDARD 4 CDSA Responsibilities, Federal and State AgenciesCDSA Responsibilities, Federal and State Agencies

1. WITHHOLDINGS

2. DEPOSITS

EMPLOYEE EMPLOYEE CONTRIBUTIONS:CONTRIBUTIONS:

Income Tax

Social Security Tax

Medicare Tax

Voluntary Benefits

Garnishments

Wage Attachments

Optional Benefits

EMPLOYER EMPLOYER CONTRIBUTIONS:CONTRIBUTIONS:

Match:

Social Security Tax

Medicare Tax

Total Amount:

Unemployment Tax

Total Amount or Share:

Benefits



3. Workers’ Compensation and Employee Work-Related Injuries

a) Texas Workers’ Compensation Commission (TWCC)

b) Liability Insurance – Homeowner/Renter

4. Deductionsa) Garnishments – Court Ordered (Child Support)

b) Wage Attachments – Government Agency Directive (Guaranteed Student Loan Payment)

c) Optional Deductions – Insurance Premiums, 401K,



5. Annual Tax-Related Forms - a) IRS Form W-2, Wage and Tax Statement;

b) IRS Form W-3, Transmittal of WAGE and Tax Statements;

c) IRS Form 1099-MISC, Miscellaneous Income

TAX REPORTING ANNUALLY: Calendar Year, January 1 – December 31

CDSA DUE DATES:

To Employee: W-2 by January 31

To IRS and Employer: W-3, with copy of Form(s) W-2 by the last day of February

To Contractor: 1099MISC by January 31

To IRS and Employer: 1099MISC by the last day of February



Records Records – Federal and State Agencies– Federal and State Agencies


6. Provide Copy or Original of Employer-Related Forms and Reports to Employer

7. Retain Copy or Original of Employer-Related Forms and Employer-Agent Forms and Reports

STANDARD 5 CDSA Responsibilities, Payroll and CDSA Responsibilities, Payroll and

Accounts PayableAccounts Payable

1. Payroll Payments – Based on complete, accurate, Employer-approved Timesheets

2. Payroll Distribution – Two times each calendar monthly in accordance with posted payday schedule.

3. Invoice Payments –

4. Receipt Payments –

a.) Based on complete, accurate, Employer-approved invoice or receipt

b.) Distribute payment within 30 DADS’ workdays of receipt by the CDSA of the acceptable invoice or receipt


STANDARD 6 CDSA Responsibilities, Payroll Status CDSA Responsibilities, Payroll Status

Monitoring and ReportingMonitoring and Reporting

1. Account Balances – Each Service Area; Ongoing Balances; Based on All Transactions; Complete and Accurate Records

Provide Summaries at Least Quarterly:

2. To Employer

3. To Consumer’s Case Manager


STANDARD 7 CDSA Responsibilities, Ongoing TrainingCDSA Responsibilities, Ongoing Training

Ongoing Training – Training, Support, Assistance by CDSA

Based on – • Employer/DRP Documentation, Performance, and

Compliance;

• Budget Compliance

• Employee and Contractor Documentation


STANDARD 8 CDSA Responsibilities, CDSA Responsibilities,

Criminal Conviction History CheckCriminal Conviction History Check


1. Report obtained: From the Texas Department of Public Safety

(DPS), Before applicant was hired, or contractor

retained, and Before service delivery by the individual

2. Employer Notification by CDSA before individual was hired/retained by the Employer (if check was conducted by the CDSA)

STANDARD 8 - CDSA Responsibilities, CDSA Responsibilities, Criminal Conviction History CheckCriminal Conviction History Check


3. Copy of Report on File at CDSA: Report from the Texas Department of Public Safety CDSA must not make payment to an individual

barred from employment based on Criminal Conviction History Check

(Note as a Financial Error if Applicable)

4. Offers of Employment / Retain Contractor -

Individuals barred from employment by Chapter 250, Health and Safety Code, must not deliver services or receive payment for services.

STANDARD 9 CDSA Responsibilities, ComplaintsCDSA Responsibilities, Complaints


1. CDSA

(a) maintains a log of all complaints and

(b) makes records and resolution of complaints accessible to DADS Staff

Contracting Requirements:Contracting Requirements: §§ 49.17(d)(3) Complaint 49.17(d)(3) Complaint ProceduresProcedures

STANDARD 9 CDSA Responsibilities, ComplaintsCDSA Responsibilities, Complaints


2. Each complaint received from any source must be:

(a) Documented, and (b) Resolved

Contracting Requirements: § 49.17(d)(3) Complaint Procedures

3. Based on documentation, did CDSA: (a) Investigate and resolve each complaint in

5 DADS’ workdays? (b) Provide written complaint procedures

initially and at least annually thereafter?

CASE REVIEW SUMMARY


Transfer results of Case ReviewCase Review to Form 3853, Provider Agency Evaluation Summary.

Standard Met Not Met N/A Standard Met Not Met N/A

Standard 1 Standard 5




TOTAL:

DADS Form 3853, Provider Agency Evaluation Summary

Texas Department of Aging and Disability Services

Contract/Program ComplianceProvider Agency Evaluation Summary

Form 3853September 2001

Region No.

Type of Review Review

PeriodDate

Other

Reason for Review

Provider Agency Name Vendor No.

Routine Monitoring Complaint

A B C D ESTANDARDS NUMBER MET NUMBER NOT MET NUMBER N/A TOTAL (A + B) % MET

TOTALS

DADS Form 1722, Compliance Monitoring Guide

Consumer Name

Sue Smith Medicaid No.

123456789 Consumer's Region/Catchment Area

07

Address

125 East Blue Bird Avenue City

Austin ZIP Code

78795 Telephone No.

(512) 123-4567

Employer Name (Verify employer status – see form instructions.)

James Smith

Employer Relationship to Consumer

Consumer Parent of Minor X Guardian

Consumer's Date of Birth

01/25/1965 Consumer's Age

39 Guardian

X Yes No

Designated Responsible Party

Yes X No

Agreement Signed by Employer/CDSA (Date)

May 15, 2005


CONSUMERCONSUMER = INDIVIDUAL RECEIVING SERVICES

EMPLOYEREMPLOYER = Consumer, Parent of Minor, or Court Appointed Guardian



CDSA =CDSA = CONUSMER DIRECTED SERVICE AGENCY (CDSA)

MONITORMONITOR = DADS CONTRACT MANAGER/MONITOR

REVIEWREVIEW = REVIEW PERIOD AND TYPE

CDSA Provider CDSA Vendor No. CDSA Location

ACB CDSA 100100456 Austin Name of Monitor Date of Review Review Period

Amy Brown 12/05/05 From: May 1, 2005 To: July 31, 2005 Type of Review

X Formal Administrative Other:


STANDARD 2 – Budget Development YES NO Review each item in Standard 2 regardless of when the activity occurred within or outside of the review period. Response to each item must be yes or no.

1. Did the CDSA assist the employer in budget development for each service area authorized for CDS, including use of DADS CDS Budget Workbook and related worksheets? ……………………………………………………………………………………. X

2. Is the budget calculated based on each service plan in effect during the review period? …………………........................................................................................................ X

3. Have the employer and CDSA agreed (signed and dated) with each service budget?. X

Reference: 40 TAC §41.103(1)-(3) If any item is marked NO, Standard 2 is NOT MET. Standard 2 is: ......................................... X MET NOT MET

Monitoring Guide - Page 1


Monitoring Guide – Page 2

STANDARD 3 – Employer and Employer-Agent Registration YES NO N/A

Did the CDSA ensure that (1) the employer and (2) the employer-agent (CDSA) are registered within required time frames established by CDS rules and IRS and TWC regulations? If a registration has not yet been required, or is not required for this employer, mark the item as N/A.

1. Employer Registration: a. Federal: IRS – Employer Identification Number (EIN) X X Form SS-4 – Date Signed: May 15, 2005 , or Other verification, if acquired through telephone or electronic registration: Date EIN: 987654321 b. State: TWC – Employer Registration X X Form C-1 – Date Signed: May 16, 2005 , or Other verification, if acquired through electronic registration:

Date: TWA ID/Account No.: 01-98432 2. Employer-Agent Registration:

a. X Federal: IRS – Employer Appointment of Agent (Written Authorization to Represent Employing Unit) X

Form 2678 – Date Signed: May 15, 2005 b. State: TWC – Written Authorization to Represent Unit in its Relations with Texas Workforce Commission X X Form C-42 – Date Signed:

May 16, 2005

(notarized or completed per current TWC instructions)

Reference: 40 TAC §41.103(4)(A)-(B) If any item is marked NO, Standard 3 is NOT MET. Standard 3 is: .......................................X MET NOT MET N/A



STANDARD 7 – CDSA Responsibilities, Ongoing Training YES NO N/A

Did the CDSA conduct the following activity as required and/or indicated by need:

Did the CDSA provide ongoing training pertaining to the CDSA's responsibilities/employment and employer-related issues?……………… X

Note: Refer to each standard in this and other monitoring activities to determine if employer was non-compliant (adhering to budgets, time sheets, credentialing of employees and providers, providing required documents to the CDSA within established timeframes, etc.). Did the CDSA document that additional training was provided to the employer? Mark this standard as Not Met if the CDSA did not provide ongoing training to the employer related to any problem or non-compliance. Reference: 40 TAC §41.103(2), (3), (4)(L)-(M) If any item is marked NO, Standard 7 is NOT MET. Standard 7 is: ……… MET X NOT MET N/A

Notes/Comments: The CDSA did not document that ongoing training was provided to the Employer for:

1. Timesheets submitted after posted CDSA due dates on 3 occasions; (May 30; June 16, July 1)

2. One Employee did not sign his timesheet on or after the last date of service documented for 2 pay periods (May 31 and June 15) ;

3. The CDSA did not document that the Employer had been notified that the consumer’s CDS Budget for attendant services had exceeded the program authorized number of hours for 3 consecutive pay periods (May 30, June 15, June 30)



Standard Met Not Met N/A Standard Met

Not Met N/A

Standard 1 X Standard 5 X



Standard 4 X Standard 8 X TOTAL: 7 1 0

Case Review Summary:

Transfer results of case review to Form 3853,

Provider Agency Evaluation Summary.

DADS Form 3853, Provider Agency Evaluation Summary

ABOVE COMPLIANCE–Your agency is performing at or above 90%, which is the minimum compliance level. Please review the “Findings” section (below), if appropriate, for areas of concern.

BELOW COMPLIANCE–Your agency is

performing BELOW 90%, which is the minimum

compliance level. The major reasons for

noncompliance of standards are noted in the

“Findings” section (below).

CDSA Compliance Monitoring

Comments

Q & A

consumer directed service agency (cdsa) compliance monitoring guide dads form 1722 and instructions

Documents

employer dads

original of employer

cdsa responsibilities

employeragent forms

service agreement cdsa

state agencies standard

service agreement standard

cdsa provider agency