What is Participant-Direction?
Participant-direction, sometimes called “self-direction”, is an optional service delivery model that allows people on an HCBS waiver to take a more active part in deciding how they receive services. The program allows participants to choose and hire someone to help with daily activities such as bathing, dressing, and meal preparation rather than having a traditional agency come to their home to provide services. The participant (or a person they choose to act in their place) takes on the responsibility of managing hired employees and staying within the assigned budget. To learn more, please review the information on this page and talk to your case manager.
| You, as an HCBS waiver participant, have the same rights as anyone else who is getting services. Talk with your case manager about your rights and responsibilities. They can go through them with you and answer any questions you may have. |
You Have the Right To:
- Be supported & respected;
- Be informed about your rights before receiving services;
- Have input in the development of your service plan and decide who, when, where, and how services are provided;
- Receive services without discrimination from qualified, willing providers;
- Refuse services and be informed of the consequences of your decision;
- Privacy and confidentially of your personal records, within the scope of Wyoming statute and HIPAA requirements;
- Voice & submit grievances and complaints related to your rights and services;
- Request a fair hearing and be informed of how to access that process;
- Be informed about specific services, and any changes to your services or budget.
Case Manager
Your case manager will assist you with determining if the participant-direction model is right for your unique situation and needs. Case managers should review participant-employer responsibilities, program rules, and expectations with you, your authorized representative, and your designated-employer (when applicable). Case managers are responsible for:
- Making referrals to the FMS
- Providing program forms and materials
- Providing information on service plans, budgets, and authorizations
- Communicating, coordinating and educating
FMS – ACES$
The State of Wyoming works with a Financial Management Service (FMS), currently ACES$, to handle enrollment, payroll, and other tasks for the participant-direction program. The FMS assists with:
- Employee background screenings
- Budget and payroll support
- Electronically Verified Visits (EVV) & shift information
- Tracking compliance with contract & applicable program rules
Employer
AKA: Employer of Record (EOR), Participant-Employer, Designated-Employer
You, or a person you designate, will work with your employees to ensure that services are provided as expected. Employers are responsible for:
- Hiring, training, managing, and terminating employees
- Authorizing and approving employee schedules and shifts
- Verifying the accuracy of service delivery information
- Setting employee wages within program and service plan limits
- Monitoring budgets and maintaining compliance with State and Federal Waiver Rules
Employee
AKA: Service Provider
These are the people who provide the services (in your service plan) that you need. They are your staff and are paid through the waiver program by the Financial Management Service (FMS) using the funds set aside for theses services in your waiver budget. Employees must:
- Complete and maintain training and certification requirements
- Pass initial and ongoing background screenings
- Provide services as approved in the service plan
- Make sure the participant’s preferences and needs are met
- Communicate with the participant and the employer (if distinct) about the services provided
| Shifts must be signed by both the employer and employee before being submitted to the FMS for payment. It is best to do this at the time of service. |
Electronic Visit Verification (EVV)
Electronic Visit Verification (EVV) is a way services billed by providers are validated by the FMS and Medicaid program. EVV safeguards against fraud and improper spending of your plan’s budget. EVV is used to:
- Confirm visit and service delivery information in real-time: date, location of check-in/check-out, type and length of service, participant, and person providing the service
- Validate hours employee(s) work
- Avoid billing errors
| Use of EVV for services provided through HCBS waiver programs is a federal requirement for participant-directed employees. |
| Participant-direction is a service delivery model that enhances existing HCBS Waiver programs. It is not its own program. Requirements for employees and employers vary by program as listed in the table below. |
| CCW Program | DD Waivers Program | |
| Who can you choose as the employer? | You, as the waiver participant. Another person of your choosing over age 18 who can manage and understand the responsibilities assigned to them and is familiar with your special circumstances and preferences. | You, as the waiver participant, if you are over age 18, or your legally authorized representative (parent, step-parent, guardian, power of attorney). |
| Who cannot be the employer? | Your case manager or anyone for whom it would create a conflict of interest (e.g.: your employee). | Anyone who is not legally authorized to make binding decisions on your behalf (see above). |
| Who can be your employee? | Any person over age 18 who has passed required background screenings and can provide the services you need as outlined in your person-centered service plan. If you (as the participant) act as the employer, you may be able to hire your spouse if they are not legally authorized to make financial decisions on your behalf, and if your circumstances make it necessary. | Any person over age 18 who has passed required background screenings, and can provide the services you need as outlined in your plan of care. |
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Who cannot be your employee?
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Your employer or your employer’s spouse (if you have delegated that role to someone else), anyone who is legally authorized to make financial decisions on your behalf, anyone for whom being employed by you would create a conflict of interest (e.g.: your case manager, your case manager’s spouse), and anyone who is under age 18, or does not pass the required background screenings. | Your legally authorized representative (parent, step-parent, guardian, power of attorney), except in situations reviewed and approved by the HCBS Program through the ECC process. Anyone for whom being employed by you would create a conflict of interest (e.g.: your case manager, your case manager’s spouse), and anyone who is under age 18, or does not pass the required background screenings. |
| What training(s) or certifications do the employer and employees need? | The HCBS Participant-Direction Trainings for employees and employers must be completed during FMS enrollment and again every 2 years. These trainings are available on the Training tab of this page. A written Summary of Training form is required for each training module. | CPR and First Aid certification, which includes in-person hands-on skills tests must be in place at the time of FMS enrollment and must be renewed before the certification expires. |
Employee & employer training requirements differ between waiver programs. Be sure you understand which apply to you.– DD WaiverS Employee Training –
– Community Choices Waiver (CCW) training –The program trainings listed below are required for CCW employees and employers, but are strongly encouraged for anyone interested in participant-direction. CCW employees must renew the training every two (2) years.
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For Employees
- Participant-directed employees are required to take the following training before delivering services.
- You must complete an HCBS Training Summary Form for EACH training module and submit it to your employer.
- You must also complete the ACES$ Program Training Attestation Form (found in the ACES$ FMS Document Center) and submit to ACES$.
- Your employer is required to retain these documents in your employee file in order to demonstrate your participation in each training. The forms must be made available upon request of the Division.
- This is an ongoing requirement that must be renewed every two years.
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- Ageism, Disability, and Cultural Awareness
Recorded Training/22:58 - Identifying and Reporting Abuse, Neglect, and Exploitation
Recorded Training/13:01 - Roles and Responsibilities in Participant Direction
Recorded Training/23:59 - Infection Control, Health, and Safety
Recorded Training/20:52
- Ageism, Disability, and Cultural Awareness
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For Employers (EORs)
- Employers are required to take the following training before managing participant-directed services.
- Complete and retain the HCBS Training Summary Form.
- You must also complete the ACES$ Program Training Attestation Form (found in your employer enrollment packet) and submit to ACES$.
- You will be required to demonstrate your participation upon request of the Division.
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- Participant Direction Employer Training
Recorded Training/1:09:16
- Participant Direction Employer Training
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Employee Background Screenings
| Background screenings are required for employees who provide services to a waiver participant through the participant-directed service delivery model. |
Participant-Directed Employers (EORs) should follow the instructions outlined in their employer enrollment packet to initiate screenings on participant-directed employees. Doing so will help to ensure that screening costs are covered by the State. There are several parts to a complete background screening (see below).
QUESTIONS?
Contact ACES$ at (844) 500-3815 or supportWY@mycil.org
Background Screening Steps
IMPORTANT: The FMS performs Steps 1-3; Step 4 is initiated by employers and completed by employees.
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- National Criminal Background Screening based on Name & Social Security Number
- United States Department of Health and Human Services, Office of Inspector General (OIG), List of Excluded Individuals/Entities
- United States Department of Justice, National Sex Offender Public Website
- Wyoming Department of Family Services (DFS) Central Registry Check*
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- The Central Registry Check must be initiated by employers and completed by employees. Results are sent electronically to ACES$. Follow instructions provided in the FMS employer enrollment packet.
| Please note that the process flow will be different for previously hired employees. There are additional forms required to ensure the screening costs can be paid for by the State. |
Contact your case manager
or visit the Participant-Direction Tab of the HCBS Document Library linked below.
PLEASE NOTE THAT MANY DOCUMENTS & FORMS ARE PROVIDED BY OUR
Financial Management Service (FMS), ACES$.
For these items, please visit the ACES$ FMS Document Center linked below.
HCBS Document Library
Participant-Direction Tab