E-2-a: Participant - Has the State specified the participant’s employer status under the waiver as: Employer Authority Participant/Co-Employer? Are the types of agencies that serve as co-employers specified as Agency E-2-a-i. Participant with Choice FMS? Yes No Employer Status Participant/Common Law Employer? Both? (Complete only when the waiver offers the Employer Authority opportunity as When co-employer option is available, the State has mechanisms in place to indicated in E-1-b.) ensure that individuals maintain authority and control over employees, and that the agency with choice service delivery model truly reflects the key elements of self-direction. Yes No N/A E-2-a-ii. Participant In order for the waiver to be considered to offer Employer Authority to participants, the participant must have the authority to conduct the following Decision Making Authority functions at a minimum: Recruit workers? Yes No Hire and discharge staff (common law employer)? Yes No (Complete only if Refer for hire and discharge from providing services (co-employer)? Yes Employer Authority is No indicated in E-1-b.) Specify qualifications? Yes No Determine staff duties? Yes No Schedule staff? Yes No Supervise staff? Yes No Evaluate staff performance? Yes No Note: For IP designation the participant must have the authority to conduct the full range of employer functions that are listed and supports must be available for each function. E-2-b: In order for the waiver to be considered to offer Budget Authority to participants, Authority the participant must at a minimum have the authority to: Determine the amount paid for each service in accordance with the state's E-2-b.i Participant policies? Yes No Decision Making Schedule when services are provided? Yes No Authority Identify service providers and refer for enrollment? Yes No Review and approve provider invoices? Yes No (Complete only if
E-2-a: Participant - Employer Authority E-2-a-i. Participant Employer Status (Complete only when the waiver offers the Employer Authority opportunity as indicated in E-1-b.) Has the State specified the participant’s employer status under the waiver as: Participant/Co-Employer? Are the types of agencies that serve as co-employers specified as Agency with Choice FMS? Yes No Participant/Common Law Employer? Both? When co-employer option is available, the State has mechanisms in place to ensure that individuals maintain authority and control over employees, and that the agency with choice service delivery model truly reflects the key elements of self-direction. Yes No N/A E-2-a-ii. Participant Decision Making Authority (Complete only if Employer Authority is indicated in E-1-b.) In order for the waiver to be considered to offer Employer Authority to participants, the participant must have the authority to conduct the following functions at a minimum: Recruit workers? Yes No Hire and discharge staff (common law employer)? Yes No Refer for hire and discharge from providing services (co-employer)? Yes No Specify qualifications? Yes No Determine staff duties? Yes No Schedule staff? Yes No Supervise staff? Yes No Evaluate staff performance? Yes No Note: For IP designation the participant must have the authority to conduct the full range of employer functions that are listed and supports must be available for each function. E-2-b: Authority E-2-b.i Participant Decision Making Authority (Complete only if In order for the waiver to be considered to offer Budget Authority to participants, the participant must at a minimum have the authority to: Determine the amount paid for each service in accordance with the state's policies? Yes No Schedule when services are provided? Yes No Identify service providers and refer for enrollment? Yes No Review and approve provider invoices? Yes No
CMSInstrumentforReviewingHCBSWaiverApplications-January2015.docx