informational - public partnerships...informational pages the following portion of this packet is...

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Guide to Tax Exemptions Based on Age, Student Status, and Family Relationship Employee Copy – Keep for your records

Employees providing domestic services such as personal assistance may be exempt from paying certain federal and state taxes based on the employee’s age, student status or family relationship to the employer. In some cases, the employer may also be exempt from paying certain taxes based on the employee’s status. IMPORTANT: Please see IRS Publication: #926 – Household Employer’s Tax Guide, and IRS website article: “Foreign Student Liability for Social Security and Medicare Taxes” for additional information. IMPORTANT:

• These exemptions are not optional. If the employee and employer qualify for these tax exemptions they must be taken.

• If the employee’s earnings are exempt from these taxes, the employee may not qualify for the related benefits, such as retirement benefits and unemployment compensation.

• The questions regarding family relationship refer to the relationship between the employee and the employer of record (common law employer). In some cases, the program participant is the employer of record. In other cases, the employer of record may be someone other than the program participant. Check program rules.

• Program rules may prohibit some types of employees. For example, most Medicaid-funded programs do not permit a spouse to be paid as an employee for providing services to a spouse. Check program rules.

• PCG Public Partnerships will determine the tax exemptions that apply to the employee and employer based on the information provided by the employee. PCG Public Partnerships cannot provide tax advice.

Tax Exemptions for Non-Resident Students

For a non-resident student in the United States on an F-1, J-1, M-1, or Q-1 visa admitted to the US for the purpose of providing domestic services, the employer and employee are exempt from paying FICA (Social Security and Medicare taxes) and the employer is exempt from paying FUTA (Federal Unemployment Tax) on wages paid to this employee. The employer may also be exempt from paying State Unemployment Insurance, depending on the rules in the state.

Tax Exemptions for Children Employed by Parent

For a child under 21 employed by his or her parent, the employer and employee are exempt from paying FICA (Social Security and Medicare taxes) and the employer is exempt from paying FUTA (Federal Unemployment Tax) on wages paid to this employee until the child (employee) turns 21 years of age. The employer may also be exempt from paying State Unemployment Insurance, depending on the rules in the state.

Tax Exemptions for Spouses Employed Spouses

For a spouse (husband, wife, or domestic partner in some states) employed by his or her spouse, the employer and employee are exempt from paying FICA (Social Security and Medicare taxes) and the employer is exempt from paying FUTA (Federal Unemployment Tax) on wages paid to this employee. The employer may also be exempt from paying State Unemployment Insurance, depending on the rules in the state.

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Tax Exemptions for Parents Employed by Children

For a parent employed by his or her child and answering “No” to any of the additional questions under Question #6 regarding caring for a grandchild or step grandchild, the employer and employee are exempt from paying FICA (Social Security and Medicare taxes) and the employer is exempt from paying FUTA (Federal Unemployment Tax) on wages paid to this employee. The employer may also be exempt from paying State Unemployment Insurance, depending on the rules in the state.

For a parent employed by his or her child and answering “Yes” to all of the additional questions regarding caring for a grandchild or step grandchild, the employer is exempt from paying Federal Unemployment Tax (FUTA) on wages paid to this employee. The employer may also be exempt from paying State Unemployment Insurance, depending on the rules in the state.

Tax Exemptions for Employee under Age 18

For employees under the age of 18 or turning 18 in the calendar year: If the employee is a student, domestic services are deemed not to be the employee’s principle occupation and the employer and employee are exempt from paying FICA (Social Security and Medicare taxes).

Employment Relationship Status

Federal Insurance Contributions Act - Social

Security and Medicare Taxes

Federal Unemployment Tax Act

State Unemployment Insurance

(FICA) (FUTA) (SUI) Foreign Student on VISA in US for Purpose of Providing Domestic Service

FICA exempt FUTA exempt See footnote (1)

Child Employed by Parent FICA exempt only until 21st birthday

FUTA exempt only until 21st birthday

See footnote (2)

Spouse Employed by Spouse FICA exempt FUTA exempt SUI exempt (3)

Parent Employed by Child FICA exempt only if not also caring for dependent child of the

employer (employee’s grandchild)

FUTA exempt SUI exempt except in NY and WA. See footnote (4)

Employee Under 18 or Turning Age 18 in Calendar Year

FICA exempt through year of 18th birthday only if enrolled as a full-

time student

Not Applicable Not Applicable

(1) Foreign student in the United States on F-1/J-1 VISA is exempt from SUI in the following states: PA, WA. (2) Child under 18 employed by parent is SUI exempt in the following states: CA, IL, MA, ME, NJ, NV, OH,

OR, PA, SC, TN, WA, WV. Child under 21 employed by parent is SUI exempt in the following states: AZ, GA, IN, KS, NY, OK, VA, WY, and District of Columbia.

(3) For California only, a registered domestic partner employed by his/her registered domestic partner is SUI exempt.

(4) Parent employed by child is SUI exempt in all states and the District of Columbia with the exception of NY and WA.

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LLeevveell 22 BBaacckkggrroouunndd SSccrreeeenniinngg RReeqquuiirreemmeennttss The Direct Service Worker (DSW) of a participant utilizing PDO services must have a Level 2 Background Screening check conducted through the Florida Agency for Health Care Administration (AHCA) before they may begin providing services.

If you have evidence of prior Level 2 Background Screening (fingerprinting) in the last 5 years AND you have not been unemployed for more than 90 days:

Sign the enclosed Affidavit of Compliance with Background Screening Requirements; attesting that you meet the requirements for qualification of employment.

PPL will verify that AHCA has record of your background check on their Clearinghouse database.

Otherwise:

Sign the enclosed Privacy Policy Acknowledgement Form; attesting that you understand and agree with the guidelines of the Level 2 Background Screening.

Complete the enclosed Direct Service Worker Information and Attestation Form and submit it to Public Partnerships (PPL).

o PPL registers the DSW for fingerprinting through Cogent

(www.cogentid.com). o PPL contacts the DSW and provides fingerprinting registration information. o DSW visits a live‐screen vendor to have fingerprinting processed

electronically. o Prints are submitted to the Florida Department of Law Enforcement

(FDLE); results are forwarded to AHCA. AHCA staff review the results for any existing offenses and report the findings. Total processing time is 5‐7 business days from the date of fingerprinting.

o Findings of the background checks will be posted electronically. o The managed care plan will pay the fees associated with the Level 2

Background Screening for one DSW, per service type, per year.

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To Employees: • Your Employer is registered with the Florida Department of Revenue as an employer who

is liable under the Florida Reemployment Assistance Program* Law. This means that You,as employees, are covered by the Reemployment Assistance Program.

• Reemployment taxes finance the benefits paid to eligible unemployed workers. Those taxesare paid by your employer and, by law, cannot be deducted from employee’s wages.

• You may be eligible to receive reemployment assistance benefits if you meet the followingrequirements:

1. You must be totally or partially unemployed through no fault of your own.2. You must register for work and file a claim.3. You must have sufficient employment and wages.4. You must be Able to work and Available for work.

• You may file a claim for partial unemployment for any week you work less than full time due tolack of work if your wages during that week are less than your weekly benefit amount.

• You must report all earnings while claiming benefits. Failure to do so is a third degree felonywith a maximum penalty of 5 years imprisonment and a $5,000 fine.

• Any employee who is discharged for misconduct connected with work may be disqualified from1 to 52 weeks and until the worker has earned in new work, at least 17 times the weeklybenefit amount of his or her claim.

• Any employee, who voluntarily quits a job without good cause attributable to the employer,may be disqualified until the worker has earned in new work, at least 17 times the weeklybenefit amount of his or her claim.

• If you have any questions regarding filing a claim for reemployment assistance benefits, callthe Department of Economic Opportunity, Reemployment Assistance Program at800-204-2418 or visit the website: www.floridajobs.org/

Department of Economic Opportunity Division of Workforce Services

Reemployment Assistance Program MSC 229

107 East Madison Street Tallahassee, Florida 32399-4135

This notice must be posted in accordance with Section 443.151(1), Florida Statutes, of the Florida Reemployment Assistance Program Law.

*Formerly Unemployment Compensation Program

RT-83 R. 09/12

Pay Period START DATE

Pay Period END DATE

Timesheet ReceivedBy 5:00 PM

Payment

IssuedSUNDAY SATURDAY TUESDAY FRIDAY

12/11/2016 12/24/2016 12/27/2016 1/6/201712/25/2016 1/7/2017 1/10/2017 1/20/20171/8/2017 1/21/2017 1/24/2017 2/3/20171/22/2017 2/4/2017 2/7/2017 2/17/20172/5/2017 2/18/2017 2/21/2017 3/3/20172/19/2017 3/4/2017 3/7/2017 3/17/20173/5/2017 3/18/2017 3/21/2017 3/31/20173/19/2017 4/1/2017 4/4/2017 4/14/20174/2/2017 4/15/2017 4/18/2017 4/28/20174/16/2017 4/29/2017 5/2/2017 5/12/20174/30/2017 5/13/2017 5/16/2017 5/26/20175/14/2017 5/27/2017 5/30/2017 6/9/20175/28/2017 6/10/2017 6/13/2017 6/23/20176/11/2017 6/24/2017 6/27/2017 7/7/20176/25/2017 7/8/2017 7/11/2017 7/21/20177/9/2017 7/22/2017 7/25/2017 8/4/20177/23/2017 8/5/2017 8/8/2017 8/18/20178/6/2017 8/19/2017 8/22/2017 9/1/20178/20/2017 9/2/2017 9/5/2017 9/15/20179/3/2017 9/16/2017 9/19/2017 9/29/20179/17/2017 9/30/2017 10/3/2017 10/13/201710/1/2017 10/14/2017 10/17/2017 10/27/201710/15/2017 10/28/2017 10/31/2017 11/10/201710/29/2017 11/11/2017 11/14/2017 11/24/201711/12/2017 11/25/2017 11/28/2017 12/8/201711/26/2017 12/9/2017 12/12/2017 12/22/201712/10/2017 12/23/2017 12/26/2017 1/5/201812/24/2017 1/6/2018 1/9/2018 1/19/2018

PAYROLL SCHEDULE

FLORIDA Participant Directed Option

FAX SIGNED TIMESHEETS TO PPL AT 1.855.843.8685 or mail to: Public Partnerships, LLC, One Cabot Road, Suite 102 Medford, MA 02155

All of your Direct Service Worker's should follow this assigned pay schedulePlease Note: Timesheets due on a Holiday should still be submitted by this day! HOLIDAY

#CNSMR

Served

#CNSMR

Served

Direct Service Worker Signature:Date (mm/dd/yyyy):

/ / 2 0

Begin: Sunday (mm/dd/yyyy) / / 2 0

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End: Saturday (mm/dd/yyyy) / / 2 0Week 2

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Participant/Representative Signature:Date (mm/dd/yyyy):

/ / 2 0

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Participant ID:

Direct Service Worker ID:

E

Participant: (Last Name, First Name)

Direct Service Worker: (Last Name, First Name)

FAX to 1-855-843-8685

*USE BLACK INK, PRINT ONE CHARACTER

PER BOX, TRY NOT TO TOUCH THE LINES!!!

By signing below, I certify that I have provided the services to the participant during the

times described on this timesheet.By signing below, I certify that the participant has received the hours of service as

reported above.

CORRECT

INCORRECT

Sub-Total HoursTime Out AM/PMTime In AM/PM Sub-Total HoursTime Out AM/PMAM/PMTime In

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*SUBMIT YOUR TIMESHEET ONLINE! GO TO

HTTP://FMS.PUBLICPARTNERSHIPS.COM FOR FAST, SECURE, REAL-TIME

VALIDATION

PUBLIC PARTNERSHIPS, LLC FL MCO Simply Healthcare DIRECT SERVICE WORKER TIMESHEET

Service Code:

33673

33673

Whether you have used other timesheets or not, you are probably wondering, “How in the world am I supposed to fill out this timesheet?” This worksheet should provide you with clear instructions for doing so.

PPL accepts electronic timesheets through the PPL Web Portal or paper timesheets by fax or mail.

There are 14 required fields on our timesheet. These are described below.

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Required Fields

All of these fields MUST be completed for the timesheet to be paid. This list corresponds to the picture above.

1. DSW’s Name. Enter the name of the person providing services.

2. Participant’s Name. Enter the name of the person receiving services.

3. DSW’s ID. This is the ID given to the DSW by PPL. The unique ID number willconsist of a capital “E” followed by a five digit number. The system will generate thisunique identifier. DSWs will receive the unique identifier once all paperwork has beensubmitted and verified by PPL. Please call Customer Service if you want to verify yourDSW ID.

4. Participant ID Number. This is your Simply PDO ID.

5. Service Type. Fill in the boxes with the service code (e.g., S5125). Please note thatyou will need to select the service based on your relationship to the Participant you areserving.

6. Begin Date. This is the first day of the pay period. The payroll schedule will list thesedates for you.

7. End Date. This is the last day of the pay period. The payroll schedule will list thesedates for you.

8. Time In/Time Out. This is the time the DSW started working and the time the DSWfinished working. Please see instructions below for entering overnight time and multipletimes per day.

9. AM/PM. Fill in the circle indicating if the work was done in the AM or PM.

10. Total Hours. Enter in the total number of hours worked. You do not need to roundtime to the closest 15 minutes.

11. Date of DSW’s Signature. This is the date the DSW signed the timesheet.

12. DSW Signature. This is the signature of the DSW.

13. Date of Participant Signature. This is the date that the Participant or Participant’srepresentative signed the timesheet.

14. Participant Signature. This is the Participant or Participant representative’ssignature. An ‘X’ or a mark is accepted as a signature.

Special Situations

1. Working overnight. When you work overnight, there are special instructions forcompleting the timesheet. You must complete one line for work you did before midnight and another line for work you did after midnight.

For example, say you worked overnight Friday night from 9:00 PM to 6:00 AM. Enter the start time as 9:00 PM as seen below. Enter the end time for that day as 11:59 PM. Now, you did not finish working at 11:59 PM, you just finished working on Friday at that time. Enter the rest of your time on Saturday as shown below – 12:00 AM to 6:00 AM.

2. Working multiple times in one day. Many DSWs work with someone multiple times in aday. You can enter two different in and out times on one timesheet, but you must enter each on a separate line. If you need to enter more than two in and out times, you would need to move onto a second timesheet for the same pay period.

For example, say you started working for Sally at 9:00 AM. You helped her until 10:05 AM. You left to run an errand, came back at 11:15 AM, and stayed until 12:30 PM. You would enter one line for each time you were providing services as shown below.

General Suggestions

Below are some general suggestions for successfully completing timesheets:

• Fill in the timesheet clearly. Your Employer will need to be able to read thetimesheet clearly or your payment may be delayed.

• Fill in all the required fields. You will not be paid unless all of the fields are filled in.

• Use dark ink.

• Use separate timesheets for different Participants. If you work with more than oneParticipant, make sure you use separate timesheets.

• Do not round time. Write the exact time. Our systems will round your time for you.

• If you make a mistake, use a new timesheet.

• Make sure the timesheets you submit are good copies. You can make copies of thetimesheets, but be sure that they are straight (not tilted) and full-sized.

Obtaining Timesheets

1. You can make copies of the timesheets we give you, but again, please make sure theyare full-sized.

2. You can download copies of the timesheets online at www.publicpartnerships.com. Clickon ‘Log In to Your Program.’ Where it says ‘Please choose your location,’ you shouldclick on the down arrow and select ‘Florida.’

Participant Directed Option

PPL Web Portal

Instructional Manual

Table of Contents

Online User Registration for Participants & DSWs…………………………………...3

How DSWs Create & Submit Electronic Timesheets………………………………….8

How Participants Approve/Reject Electronic Timesheets…………………………17

You can download additional instructions online at www.publicpartnerships.com.

Go to the Simply FL PDO program, click on “Program Login” in the upper‐right corner,

select “Florida” from the drop‐down menu, click on the “Simply PDO” link

How to Guide for the PPL Web‐PortalHow to Register Online

Online Registration Page 3

Welcome to the PPL Web Portal system!

How do I register online? This document will outline for you how to set up your Username and Password so that you can begin using the PPL Web Portal. The process for online registration is the same for both Participants & DSWs.

1. The first thing you should do is type in the web address provided below intoyour browser: (we recommend saving this as a favorite, so that you don’t haveto keep typing it in).

https://fms.publicpartnerships.com/PPLPortal/login.aspx?

2. A log in screen will appear. You will use this screen to log into the Web Portalafter you have registered.

As a Participant once you are registered you will be able to use the PPL Web Portal for

Managing your Authorizations Approving your Direct Service Worker’s E-Timesheets Viewing the status of your Direct Service Worker’s E-Timesheets

As a DSW once you are registered you will be able to use the PPL Web Portal to:

Creating Timesheets Reviewing your Timesheet Payment Status



3. Select the Online User Registration hyper link below the login button on theLogin Screen.

4. This will bring you to the New User Registration screen. It will ask you tochoose your state.

5. You should select FLORIDA from the drop down list.

6. After you select your state two new data fields will appear: Program and RoleSelect your Program – FL MCO Simply



Select your Role – (if you choose the incorrect role the system will not be able to verify your information.

If you are the Participant or Representative select the PARTICIPANT role. If you are the Direct Care Worker select the Direct Service Worker role.

7. After you have selected your role hit the NEXT button to continue on toregistration.

By choosing the correct role the system now knows which information to look up for your account.

VERY IMPORTANT!! If you do not choose the correct role the system will be unable to find your account in order for you to complete your registration.

8. You will be brought to the STEP 2. Verify Credentials screen. You are nowrequired to verify who you are by completing the three data fields below :

PPL ID: This number has been generated by PPL and is unique to each participant in the program. It may also be referred to as your Participant or DSW ID. Last Name: This is the Participant’s or DSWs last name



D.O.B: This is the Participant’s or DSWs date of birth, which we have onfile in the system already.

Please note IMPORTANT for users registering under the Participant Role ONLY! Even though you are representing the Participant, you still put the D.O.B of the Participant in the system, not yours. Please enter the date of birth in the format below:

Ex. Correct = 12/12/1988 Ex. Wrong = 12/12/88

If the system is unable to verify your information there are potentially two issues:

1. The Participant’s or DSWs information was inaccurately entered at thetime of enrollment. In order to resolve this:

You should call Customer service and provide the Participant/DSW ID so that PPL can verify the demographic information we have on file.

2. You will now be brought to Step 3: User Information page. This is thepage in which you will actually register yourself as a user in the system.You will be asked for the following information:



Username- PPL suggests that you use the first letter of your first name and your last name.

i. Ex. Mary Poppins = MPoppins1. Please note, if the user name you selected is already in

use you will need to select a different username.

Password- Your password must be at least 6 characters long and contain at least 1 numerical character, 1 capitalized character and 1 lower case character. Please be aware that your password will be case sensitive.

Confirm Password- Here, you need to retype the password you created.

Email Address- Your email address is an optional field. PPL will use this to send information pertaining to your timesheets to your email account. Please note: If you provide an email address you will receive an email confirmation of your username and password.

Security Questions- You should choose three questions from the drop down menu. Put the answers to these questions in the data field next to it.

i. If you ever needed to change your username or passwordthese questions provide a layer of security to protect yourprivacy. So that only YOU can change your user registrationinformation.



3. If you are happy with all of your information hit the SUBMIT button.

CONGRATULATIONS! You are now registered and ready to Log In to the Web Portal!

How To Guide for the PPL Web‐PortalHow to Create & Submit an Electronic Timesheet

Create & Submit Timesheets Page 8

Direct Service Worker (DSW): How to Create and Submit a timesheet

1. Log in to the PPL Web Portal using your pre assigned username and password

https://fms.publicpartnerships.com/PPLPortal/login.aspx?

2. You will default on the “Timesheets” page.

3. Here, you will see two options in the gray header bar.a. Create Timesheetb. Search Timesheet

4. Select the option for “Create Timesheet” by clicking on the words. You will seethe “Participant Search” page below:

5. The participant search page will show all of the participants you work for.a. In the example above you work for “ASSOC CONSUMER” if you would

like to submit a timesheet for Mr. CONSUMER the blue hyperlink to theright of the page.



b. If you are trying to submit a timesheet for a different participant andthey do not appear here, you may not be associated with thatparticipant in the system. You should call Customer Service todetermine what the next step is.

i. This can happen if PPL has not received/or processedyour paperwork for this participant yet.

6. After selecting the blue hyper link you will see the “Submit Timesheet” pagebelow:

a. This is the beginning of the timesheet creation process.

7. In this first screen you should click on the calendar box to select the pay periodyou are submitting time for.



8. After selecting the correct pay period you will be taken to the screen below:

9. This page is where you will enter in the time you worked for the pay period.a. If you didn’t work on one day, that’s ok, just leave it blank.

10. At the top of the page you should confirm that you are putting together atimesheet for the right participant.

a. You also have the option of selecting a “Common Service”.

b. This dropdown feature is used by direct service workers who providethe same service throughout the entire pay period.

c. The common service drop down lets you populate every line of thetimesheet at once instead of filling in each day individually.

d. The common service drop down is optional; you do not have to usethis feature.



If you choose to use it you will see something similar to the example below:

If you choose not to use the “Select Common Service” feature. You should enter in the service type for each of the days worked.

11. To enter the service per day click on the “Service” drop down bar on the dayyou worked.

Every day you work must have a service selected.

If you worked a service that does not appear in your drop down menu please contact customer service. This typically means we did not receive a rate or enrollment paperwork required for that service type.

12. Next you should select the hours in the day that you worked.



a. To select the time of day you started click on the “Time In” dropdown:

b. To select the time of day you ended click on the “Time Out” dropdown:

c. You can also select minutes if you would like.

If you worked multiple shifts in one day select the “There are more hours” button.

After selecting the “There are more hours” button an additional line will be created for the day worked.

o You will need to enter in the:service type (which can be different)the hours worked

o You may also remove time if you need to. To removetime select the “Remove Time” button.



13. You also have the option to copy and paste each line individually. To copy aline.

a. First click on the “Copy” button of the line you would like to copy. Inthis case the line on top.

Next click on the “Paste” button of the line you would like to put the copied information in. In this case the line at the bottom.

14. When you have finished entering in the days worked scroll to the bottom ofthe page and click on the “Next” button.

15. You will be taken to the “Confirm Timesheet” page. In this page you shouldreview the timesheet you entered for completeness and accuracy.



16. Next scroll to the bottom of the “Confirm Timesheet” page. You will see thefollowing attestation that the hours are accurate:

Before you may submit your timesheet you must check the box.

After acknowledging that the timesheet is accurate and truthful, the “SUBMIT” button will become available to select.

17. If the timesheet is incorrect and you would like to edit it. Click on the “Edit”button to return to the previous screen.

18. If the timesheet is correct but incomplete you can save your work. Click on the“Save My Work” button.

a. Some direct care workers like to enter their time every day rather thanat the end of the pay period.

b. This feature allows you to enter time as you work it without submittingit for approval until the very end.



19. If the timesheet is correct and complete you should submit it to theParticipant/Employer/Authorized Representative for approval. Click on the“Submit” button to submit it to the Participant/Employer/AuthorizedRepresentative.

20. After you haves selected the Submit button the following page will appear:

21. If there is a problem with your timesheet that would cause it to not be paid,than the Web Portal will not allow the timesheet to be submitted for approvaluntil the problem is fixed.

Examples: a. Overlapping timeb. Missing paperworkc. Missing DSW Rates

22. On the top of your timesheet you will see red alerts that tell you what iswrong with your timesheet. If you do not understand any or even one of themessages, please call customer service.

a. As you can see in the example below on 4/1/10 we are missing theEmployment packet.

b. On 4/2 the employee submitted time for a service type but it appearsthat we do not have a rate in the system.



c. If you feel that any of the alert messages in red are incorrect, please callcustomer service.

d. If you believe they are correct please submit the missing information toPPL as soon as possible so that PPL staff can enter it into our system.Then resubmit your timesheet for approval.

23. Once you have successfully submitted your timesheet for approval, it will beup to the Participant, or Representative to approve the timesheet.

24. You can monitor the approval status by searching on your timesheets andreviewing the status name.

a. As long as the timesheet is in the “Submitted” status it has not beenapproved.

Important Note: Do not assume that if you submitted your timesheet it will be paid. You will want to monitor the status of your timesheet until it has reached “APPROVED” status.

Once the timesheet has an “Approved” status, it has been sent to PPL for payment.

How To Guide for the PPL Web‐Portal How to Approve/Reject & Submit E‐Timesheets

Approve/Reject Timesheets

Participant/Representative: How to approve/reject & submit e‐timesheets for payment.

25. You will default on the “Timesheet List” page when you log in.

26. In this page you can search for timesheets based on:a. Timesheet Status

b. Timesheet Start Datec. Timesheet Submitted Dated. Check Numbere. Direct Service Worker Name

i. You may want to use this search feature if you have multipledirect care workers and you want to view all of their submittedtimesheets.



Note: To search ALL timesheets be sure to select “ALL”. If you just want to see the ones which you need to approve select “SUBMITTED”.

27. Below is an example of the search results screen.

You will be able to View a timesheet anytime you like. You will notice when a timesheet has been submitted to you for approval, it will have a status of “Submitted” you will need to either approve or reject a timesheet.

PPL cannot pay timesheets unless they have been approved by you. By using the Web Portal to approve timesheets, we log an electronic signature based upon your unique username and password.

28. Select the “Approve/Reject” button.

29. After selecting the “Approve/Reject” button the screen below will appear.



The timesheet will appear so that you can review it while you Approve/Reject. At the bottom of the page you will see three options “Show Printable Version (PDF)”, “Approve”, “Reject”.

30. The “Show Printable Version (PDF)” button allows you to print your timesheetso that you can keep a hard copy for your records.

You do NOT need to print your timesheet if you don’t want to. Timesheets will always be maintained electronically for your review.

31. After you have reviewed your timesheet and determined that it is accurateyou should approve the timesheet for payment.

TIMESHEET APPROVAL

32. To approve the timesheet select the “Approve” button.



33. After selecting the “Approve” button you will see the screen below.You will still have the option to print a paper copy of the timesheets for your records. You can print the approved timesheet by selecting the “Show printable version (PDF)” at the bottom of the screen.

Your timesheet will now be in “Approved” status. PPL will process all “APPROVED” timesheet according to your pay schedule.

TIMESHEET REJECTION

34. If you have reviewed the timesheet and you have determined that it is notcorrect you can choose to reject the timesheet.

35. Scroll to the bottom of the page and select the reason why the timesheet hasbeen rejected. You are also able to add additional notes if you would like to.

When a timesheet is rejected it is sent back to the direct care worker for correction and review. Your direct care worker will see the reasons you entered for rejection and will correct the timesheet based upon your reasons.

36. After entering your rejection reasons select the “Reject” button.



37. Your DSW will need to make the correction and submit their timesheet againfor approval. Remember! PPL will not pay for timesheets that are notapproved.

By approving the timesheet, it is automatically entered into PPL payroll system for payment. You can track the progress of the timesheet status any time you want!

When it has been paid the timesheet status will show “PAID”. If it has a status of “IN PROGRESS”, it means that PPL’s payroll team is in the

process of cutting the check to your direct care worker.

You can download additional instructions online at www.publicpartnerships.com.

Go to the FL PDO program, click on “Program Login” in the upper‐right corner, select “Florida” from the drop‐down menu, click on the “Simply FL PDO” link, enter the following:

Congratulations! You now know how to approve or reject your timesheets!

AHCA Form # 3100-0008, August 2010 Section 59A-35.090(3)(b)2, Florida Administrative Code Page 1 of 3 Form available at: http://ahca.myflorida.com/Publications/Forms/HQA.shtml

Authority: This form may be used by all employees to comply with:

the attestation requirements of section 435.05(2), Florida Statutes, which state that every employee required to undergo Level 2 background screening must attest, subject to penalty of perjury, to meeting the requirements for qualifying for employment pursuant to this chapter and agreeing to inform the employer immediately if arrested for any of the disqualifying offenses while employed by the employer; AND

the proof of screening within the previous 5 years in section 408.809(2), Florida Statutes which requires proof of compliance with level 2 screening standards submitted within the previous 5 years to meet any provider or professional licensure requirements of the Agency, the Department of Health, the Agency for Persons with Disabilities, the Department of Children and Family Services, or the Department of Financial Services for an applicant for a certificate of authority or provisional certificate of authority to operate a continuing care retirement community under chapter 651 if the person has not been unemployed for more than 90 days.

This form must be maintained in the employee’s personnel file. If this form is used as proof of screening for an administrator or chief financial officer to satisfy the requirements of an application for a health care provider license, please attach a copy of the screening results and submit with the licensure application.

Direct Service Worker Name:

Participant Name:

Address of Participant:

I hereby attest to meeting the requirements for employment and that I have not been arrested for or been found guilty of, regardless of adjudication, or entered a plea of nolo contendere, or guilty to any offense, or have an arrest awaiting a final disposition prohibited under any of the following provisions of the Florida Statutes or under any similar statute of another jurisdiction:

Criminal offenses found in section 435.04, F.S

a) Section 393.135, relating to sexual misconduct withcertain developmentally disabled clients and reporting ofsuch sexual misconduct.

(b) Section 394.4593, relating to sexual misconduct withcertain mental health patients and reporting of such sexualmisconduct.

(c) Section 415.111, relating to adult abuse, neglect, orexploitation of aged persons or disabled adults.

(d) Section 782.04, relating to murder.

(e) Section 782.07, relating to manslaughter, aggravatedmanslaughter of an elderly person or disabled adult, oraggravated manslaughter of a child.

(f) Section 782.071, relating to vehicular homicide.

(g) Section 782.09, relating to killing of an unborn quickchild by injury to the mother.

(h) Chapter 784, relating to assault, battery, and culpablenegligence, if the offense was a felony.

(i) Section 784.011, relating to assault, if the victim of theoffense was a minor.

(j) Section 784.03, relating to battery, if the victim of theoffense was a minor.

(k) Section 787.01, relating to kidnapping.

(l) Section 787.02, relating to false imprisonment.

(m) Section 787.025, relating to luring or enticing a child.

AFFIDAVIT OF COMPLIANCE WITH Background Screening

Requirements


(n) Section 787.04(2), relating to taking, enticing, orremoving a child beyond the state limits with criminal intentpending custody proceedings.

(o) Section 787.04(3), relating to carrying a child beyond thestate lines with criminal intent to avoid producing a child at acustody hearing or delivering the child to the designatedperson.

(p) Section 790.115(1), relating to exhibiting firearms orweapons within 1,000 feet of a school.

(q) Section 790.115(2)(b), relating to possessing an electricweapon or device, destructive device, or other weapon onschool property.

(r) Section 794.011, relating to sexual battery.

(s) Former s. 794.041, relating to prohibited acts of personsin familial or custodial authority.

(t) Section 794.05, relating to unlawful sexual activity withcertain minors.

(u) Chapter 796, relating to prostitution.

(v) Section 798.02, relating to lewd and lascivious behavior.

(w) Chapter 800, relating to lewdness and indecentexposure.

(x) Section 806.01, relating to arson.

(y) Section 810.02, relating to burglary.

(z) Section 810.14, relating to voyeurism, if the offense is afelony.

(aa) Section 810.145, relating to video voyeurism, if the offense is a felony.

(bb) Chapter 812, relating to theft, robbery, and related crimes, if the offense is a felony.

(cc) Section 817.563, relating to fraudulent sale of controlledsubstances, only if the offense was a felony.

(dd) Section 825.102, relating to abuse, aggravated abuse,or neglect of an elderly person or disabled adult.

(ee) Section 825.1025, relating to lewd or lascivious offenses committed upon or in the presence of an elderly person or disabled adult.

(ff) Section 825.103, relating to exploitation of an elderly person or disabled adult, if the offense was a felony.

(gg) Section 826.04, relating to incest.

(hh) Section 827.03, relating to child abuse, aggravated child abuse, or neglect of a child.

(ii) Section 827.04, relating to contributing to thedelinquency or dependency of a child.

(jj) Former s. 827.05, relating to negligent treatment of children.

(kk) Section 827.071, relating to sexual performance by a child.

(ll) Section 843.01, relating to resisting arrest with violence.

(mm) Section 843.025, relating to depriving a lawenforcement, correctional, or correctional probation officermeans of protection or communication.

(nn) Section 843.12, relating to aiding in an escape.

(oo) Section 843.13, relating to aiding in the escape of juvenile inmates in correctional institutions.

(pp) Chapter 847, relating to obscene literature.

(qq) Section 874.05(1), relating to encouraging or recruiting another to join a criminal gang.

(rr) Chapter 893, relating to drug abuse prevention and control, only if the offense was a felony or if any other person involved in the offense was a minor.

(ss) Section 916.1075, relating to sexual misconduct with certain forensic clients and reporting of such sexual misconduct.

(tt) Section 944.35(3), relating to inflicting cruel or inhuman treatment on an inmate resulting in great bodily harm.

(uu) Section 944.40, relating to escape.

(vv) Section 944.46, relating to harboring, concealing, oraiding an escaped prisoner.

(ww) Section 944.47, relating to introduction of contraband into a correctional facility.

(xx) Section 985.701, relating to sexual misconduct injuvenile justice programs.

(yy) Section 985.711, relating to contraband introduced into detention facilities.

(3) The security background investigations under thissection must ensure that no person subject to this sectionhas been found guilty of, regardless of adjudication, orentered a plea of nolo contendere or guilty to, any offensethat constitutes domestic violence as defined in s. 741.28,whether such act was committed in this state or in anotherjurisdiction.

Criminal offenses found in section 408.809(4), F.S

(a) Any authorizing statutes, if the offense was a felony.


(b) This chapter, if the offense was a felony.

(c) Section 409.920, relating to Medicaid provider fraud.

(d) Section 409.9201, relating to Medicaid fraud.

(e) Section 741.28, relating to domestic violence.

(f) Section 817.034, relating to fraudulent acts through mail,wire, radio, electromagnetic, photoelectronic, or photoopticalsystems.

(g) Section 817.234, relating to false and fraudulentinsurance claims.

(h) Section 817.505, relating to patient brokering.

(i) Section 817.568, relating to criminal use of personalidentification information.

(j) Section 817.60, relating to obtaining a credit cardthrough fraudulent means.

(k) Section 817.61, relating to fraudulent use of creditcards, if the offense was a felony.

(l) Section 831.01, relating to forgery.

(m) Section 831.02, relating to uttering forged instruments.

(n) Section 831.07, relating to forging bank bills, checks,drafts, or promissory notes.

(o) Section 831.09, relating to uttering forged bank bills,checks, drafts, or promissory notes.

(p) Section 831.30, relating to fraud in obtaining medicinaldrugs.

(q) Section 831.31, relating to the sale, manufacture,delivery, or possession with the intent to sell, manufacture,or deliver any counterfeit controlled substance, if the offensewas a felony.

If you are also using this form to provide evidence of prior Level 2 screening (fingerprinting) in the last 5 years and have not been unemployed for more than 90 days, please provide the following information. A copy of the prior screening results must be attached.

Purpose of Prior Screening: Screened conducted by: Date of Prior Screening:

Agency for Health Care AdministrationDepartment of Health Agency for Persons with Disabilities Department of Children and Family Services Department of Financial Services

Affidavit

Under penalty of perjury, I, , hereby swear or affirm that I meet the requirements for qualifying for employment in regards to the background screening standards set forth in Chapter 435 and section 408.809, F.S. In addition, I agree to immediately inform my employer if arrested or convicted of any of the disqualifying offenses while employed by any health care provider licensed pursuant to Chapter 408, Part II F.S.

Employee/Contractor Signature Title Date

RICK SCOTTGOVERNOR Better Health Care for all Floridians ELIZABETH DUDEK

SECRETARY

PRIVACY POLICY ACKNOWLEDGEMENT FORM

I acknowledge that I have received a copy of the privacy policies from the Florida Department ofLaw Enforcement and the Federal Bureau of Investigation, which describe the exchange ofinformation where criminal record results will become part of the Care Provider Background Screening Clearinghouse.

I understand and agree that I will read and comply with the guidelines contained in the privacy policies.

Employee/Contractor Name (Printed)

Employee/Contractor Signature

Date

2727 Mahan Dr i ve , MS#40Ta l l ahassee, F lo r i da 32308

V is i t AHCA onl i ne atAHCA.MyFlor i da.com

FLORIDA DEPARTMENT OF LAW ENFORCEMENT

NOTICE FOR APPLICANTS SUBMITTING FINGERPRINTS WHERE CRIMINAL RECORD RESULTS WILL BECOME PART OF THE CARE PROVIDER BACKGROUND SCREENING CLEARINGHOUSE

NOTICE OF:

SHARING OF CRIMINAL HISTORY RECORD INFORMATION WITH SPECIFIED AGENCIES,RETENTION OF FINGERPRINTS,PRIVACY POLICY, ANDRIGHT TO CHALLENGE AN INCORRECT CRIMINAL HISTORY RECORD

This notice is to inform you that when you submit a set of fingerprints to the Florida Department of Law Enforcement (FDLE) for the purpose of conducting a search for any Florida and national criminal history records that may pertain to you, the results of that search will be returned to the Care Provider Background Screening Clearinghouse. By submitting fingerprints, you are authorizing the dissemination of any state and national criminal history record that may pertain to you to the Specified Agency or Agencies from which you are seeking approval to be employed, licensed, work under contract, or to serve as a volunteer, pursuant to the National Child Protection Act of 1993, as amended, and Section 943.0542, Florida Statutes. "Specified agency" means the Department of Health, the Department of Children and Family Services, the Division of Vocational Rehabilitation within the Department of Education, the Agency for Health Care Administration, the Department of Elder Affairs, the Department of Juvenile Justice, and the Agency for Persons with Disabilities when these agencies are conducting state and national criminal history background screening on persons who provide care for children or persons who are elderly or disabled. The fingerprints submitted will be retained by FDLE and the Clearinghouse will be notified if FDLE receives Florida arrest information on you.

Your Social Security Number (SSN) is needed to keep records accurate because other people may have the same name and birth date. Disclosure of your SSN is imperative for the performance of the Clearinghouse agencies’ duties in distinguishing your identity from that of other persons whose identification information may be the same as or similar to yours.

Licensing and employing agencies are allowed to release a copy of the state and national criminal record information to a person who requests a copy of his or her own record if the identification of the record was based on submission of the person’s fingerprints. Therefore, if you wish to review your record, you may request that the agency that is screening the record provide you with a copy. After you have reviewed the criminal history record, if you believe it is incomplete or inaccurate, you may conduct a personal review as provided in s. 943.056, F.S.,and Rule 11C8.001, F.A.C. If national information is believed to be in error, the FBI should be contacted at 304-625-2000. You can receive any national criminal history record that may pertain to you directly from the FBI, pursuant to 28 CFR Sections 16.30-16.34. You have the right to obtain a prompt determination as to the validity of your challenge before a final decision is made about your status as an employee, volunteer, contractor, or subcontractor.

Until the criminal history background check is completed, you may be denied unsupervised access to children, the elderly, or persons with disabilities.

The FBI’s Privacy Statement follows on a separate page and contains additional information.

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I. UPDATE QUALIFIED DS(Complete this section when there is a change in your qualified DS

Check All Boxes That Apply:

□ Change in Name □

Qualified DSW Name:_____________________________________________

Address:_____________________________________________________________

City: ___________________

Phone Number: _______________________________________________________

Qualified DSW Signature:___________________________________________

I I . QUALIFIED DSW TERMINATION NOTICE(Complete this section when a qualified DSDCW who works for you.)

Check One: □ Voluntary Termination

Qualified DSW Name:______________________________________________

Forwarding Address: ___________________________________________________

Termination Date:______________________________________________________

Reason for Termination: ____________________________________

_____________________________________________________________________

_____________________________________________________________________

Instructions for Last Pay Check:

_____________________________________________________________________

_____________________________________________________________________

Employer Name (Please print or type)

Employer’s Signature: ________________________

UPDATE QUALIFIED DS W INFORMATION is a change in your qualified DSW’s information.)

Check All Boxes That Apply:

□ Change in Address □ Change in Phone Number

_____________________________________________

:_____________________________________________________________

_____________ State:_________________ Zipcode: ______________

_______________________________________________________

___________________________________________Date:____________

TERMINATION NOTICE this section when a qualified DSW voluntarily stops working for you or if you terminate a qualified

Voluntary Termination □ Involuntary Termination

______________________________________________

___________________________________________________

______________________________________________________

________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Instructions for Last Pay Check:_________________________________________

________________________________________________

_____________________________________________________________________

(Please print or type): ___________________________________________

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Participants, Representatives, Direct Service Workers and Case Managers can reach the customer service center by calling toll-free 1-877-908-1749. The Customer Service Center is open between 8:00 am and 8:00 PM EST, Monday through Friday and Saturdays 9:00 am to 1:00 pm. At all other times, a messaging system is available.

Our customer service staff is also available by email at [email protected].

PPL has a separate phone line (1-800-360-5899) that connects callers to our TTY system. This is for people with hearing and/or speech impairments who use text telephones.

We use our Customer Service Center voicemail system as a back up during regular business hours. The voicemail system is also available during times when the office maybe closed such as nights, weekends, and holidays. PPL will return all calls left on voicemail during business hours within one business day of receiving the message.

PPL’s Customer Service Center has experienced Customer Service Representatives. Customer Service representatives are trained to communicate with a diverse population of people. Over half of our Customer Service team are fluent in both Spanish and English. We also have access to translation services through our Language Line. The language line helps people who speak other languages. PPL does not charge callers for translation services.

PPL enters all calls received, including any complaints that we may receive, directly into our computer system. We identify the caller, the reason for the call, and the date received. We also track how we addressed the issue and the date it was resolved. This allows for easy reporting and tracking of calls so that we can provide the best service to you possible.

Please call us at 1-877-908-1749 if you have any questions. We look forward to working with you!

Simply FL PDO Program Public Partnerships, LLC One Cabot Road, Suite 102 Medford, M A 02155

Toll Free Nu mbers Phone: 1-877-908-1749 TTY : 1-800-360-5899 E-mail : [email protected]

informational - public partnerships...informational pages the following portion of this packet is...

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