You or your DR must ensure that services provided through the CDS option:
- are included on your service plan and, if required by the program rules, included on any other plan such as the habilitation plan or implementation plan;
- are budgeted;
- are provided only to you;
- are not provided if you become ineligible for program services; and
- meet requirements for payment according to program rules
If nursing services, or MDCP respite or flexible family support are included on the service plan, you or your DR must:
- Obtain a completed Form 1747, Acknowledgment of Nursing Requirements, from the RN before the RN provides services, if you or your DR hire an RN;
- Obtain a completed Form 1747-LVN, Licensed Vocational Nurse Supervision Certification, from the LVN before the LVN provides services, if you or your DR hire a LVN;
- Keep completed Forms 1747 and 1747-LVN in the individual’s home and send a copy of the completed forms to the FMSA before delivery of nursing services or MDCP respite or flexible family support; and
- Require that your program provider’s nurse complete the initial and annual nursing assessment, if program rules apply.
- Provide a copy of the program provider’s nursing assessment, including the number of nursing hours authorized, to the CDS nurse; and
- If the CDS nurse disagrees with the number of authorized nursing hours, ensure the CDS nurse provides justification to the Service Planning Team for consideration and a possible service plan revision.
If DADS determines that you or your DR is not in compliance with this section, DADS may require you to develop and implement a correction action plan.
How to Look for People to Work for You
There are many ways to find people who want to work for you and who can do a good job. Do not discount any possibility. Below are some suggestions for finding prospective employees.
Following are samples of advertisements that you could use as a guide:
Personal attendant - Needed to assist male with quadriplegia with personal care, shopping, and light housekeeping. Part-time 4 days/week. Flexible schedule available. Driver’s license preferred. This is an ideal position for a college student. Prime location near Rice University. $8.00/hr. Call (212) 111-111 evenings for more information.
Personal assistant - Female, nonsmoker, needed to live-in with person with disabilities to assist with personal care, housekeeping. Free rent, hours and days negotiable, salary included. At least 6 months experience preferred Call (555) 555-1212 to leave a message.
Classified ads in newspapers are a good way to reach many people. Neighborhood newspapers are cheaper than major citywide newspapers, and are a good way to find potential assistants who live closer to your home.
Sometimes you can put short ads in newsletters of disability groups and other community organizations such as churches.
Colleges and Universities
Colleges can be great places to find personal assistants. Many students are looking for extra income to help them through college. It is often possible to find students who are interested in a live-in arrangement. Students who have majors in the area of health and human services are often looking for work experience. To advertise a position, contact the school’s career placement office, or student housing office. You might also try social, education and health-related departments, such as social work, special education, physical therapy, occupational therapy and nursing.
Word of Mouth
Don’t forget to ask family, friends and neighbors if they know of anyone who would make a good assistant for you. Let them know just what you are looking for, and ask them to tell others about the job too.
Social service organizations, such as independent living centers or disability organizations, often keep a registry or list of assistants who may have already completed some basic training or have work experience.
Bulletin Boards in High-traffic Areas
Hang flyers on bulletin boards in high-traffic areas, such as grocery stores, banks, apartment buildings, restaurants, community centers, churches and laundromats.
Local Employment Offices/Rehabilitation Agencies
Two sources often overlooked are the Texas Workforce Commission and the Texas Department of Assistive and Rehabilitation Services. Some colleges have rehabilitation and disability offices on campus.
Exchange of information, names, resources, and services between individuals.
Locate eligible service providers through the Yellow Pages, newspaper advertising, social media websites, and state and local professional organizations, etc.
If you decide to run an ad, below are some suggestions of what to include. The more complete the information, the better your chances of finding applicants who are truly interested and potentially qualified for the job. It is a good idea to include:
- Your first name (it is recommended that you not use your last name).
- Job title and a short description of the job.
- Phone number.
- Hours (Is the job hourly or live-in?).
- Qualifications required - must show a current license (if you are
- looking for a professional). Must have experience with people with disabilities or particular condition.
- Wages and benefits offered.
- General location (e.g., southwest Houston).
Do NOT include your address or other private information in the ad.
You may want to do a phone interview before meeting the applicant face to face.
You may want to have your first meeting with an applicant in a public place rather than in your home.
Give a brief description of the duties of the position, number of hours the job requires, and the hourly pay and any benefits you will provide.
Talk about the services needed and ask about the applicant’s experience with providing home health services.
Ask about the applicant’s experience in working with people who have disabilities.
If the applicant is interested, ask your questions, and record answers.
Will you give me your name, address, and phone where you can be reached?
What days/hours are you available to work? Are there days you cannot work?
Have you ever assisted or worked for a person with disabilities before? If yes, tell me a little about the kinds of tasks you performed.
Do you have reliable transportation?
Are you at least 18 years of age?
Do you have a valid Social Security number?
Do you smoke?
Are you allergic to pets? (if you have a pet in your home)
Are there tasks you do not want to perform? (e.g., bathing, toileting, and dressing)
Do you have any experience in transferring and positioning? Do you have any physical limitations that would prevent you from transferring and positioning?
Can you cook and would you mind doing housework?
If you are interested in a face-to-face interview, tell the applicant you will call back to make an appointment for an interview (consider meeting outside of your home for safety purposes). Ask the applicant to bring a Texas identification card or driver’s license and proof of their address when they come for an interview. If you are hiring a professional, ask him or her to bring a copy of a current professional license. If you are hiring a licensed vocational nurse (LVN), inform the applicant that he or she will need to get their own supervision based on Texas Board of Nursing rules.
Even if the person is not right for the job, always thank them for their interest.
Important: Good screening and evaluations can reduce employee turnover, which will keep your paperwork and unemployment rate low.
If hiring a professional, such as a nurse, ask the applicant to bring a copy of a current license.
Inform the applicant the FMSA will run a criminal background check and check the Nurse Aide Registry and Employee Misconduct Registry. Explain these checks are required in order to be hired.
Tips for Interviewing
Ask the applicant to fill out an application. Applications are a good way to keep track of the people you have interviewed and make record-keeping simple. They provide quick access to the information you will need to make a final decision. They will give you ideas about questions to ask during the interview and will also be a good resource for backup or substitute attendants.
Take notes during the interview, or have someone there to help you remember what is said.
Explain that you will be the employer.
Tell the applicant about the services you need (based on your service plan) and give the applicant a copy of the job description. Ask if he or she can safely perform the duties of the job. (i.e., lifting, transferring, etc.).
Discuss the days and the times of the day you need help.
Explain how the FMSA will be handling payroll, writing the checks, and withholding taxes. Successful applicants, including professionals such as nurses, will be hired as employees, not as independent contractors. This means that taxes will be taken out of their paychecks. Talk about what the job pays and any benefits you will offer.
Ask applicants why they want to work with you. Be sure to ask questions about work history, their reasons for leaving other jobs, any experience with personal assistance and why they are interested in this position.
Ask them why they think they would be good at working with you.
Tell them you are required to do a background check. Ensure that their date of birth, Social Security number and full name are accurate for criminal history results. If any of their documents do not match, find out why.
Ask them if there are situations that would prevent them from coming to work and how they would handle those situations. How often do they think this might happen?
Ask them how they might handle a situation in your daily life that is important to you.
Give the applicant an opportunity to ask questions.
Tell the applicant you will call as soon as you make a decision. Be sure to contact the applicant even if you decide not to hire him or her. Thank them for their interest and time.
IMPORTANT: When interviewing applicants, use the same standards in your job applications—ask only about things that are directly related to the job requirements. Do not ask personal questions that do not apply directly to the job. You cannot discriminate against or turn down an applicant because of things like race, age, or religion. For example, it is illegal to ask:
- someone’s age;
- someone’s gender;
- someone’s race or national origin;
- someone’s religion;
- if the applicant is pregnant, or
- if the applicant has children.
Additional information about discrimination is available from the U.S. Equal Employment Opportunity Commission.
Before you decide who to hire, check the work and personal references. Some people present themselves very well in an interview, but you always want to find out how they can do the job.
Questions for checking references:
- What are the applicant’s strengths?
- What are the applicant’s weaknesses?
- Would the reference recommend the applicant to work with you?
Hiring Your Provider
It is important that you understand:
- which DADS forms need to be completed;
- when the forms need to be completed; and
- who needs a copy of each form.
At the initial orientation meeting, the FMSA will provide the employer a “New Employee Packet Cover Sheet” (Form 1724), a checklist of activities and forms that need to be completed. Form 1724 tells you how many copies of each form are needed and which forms need to be sent to the FMSA. Use this form as a guide during the hiring process.
Before an applicant can be hired, the following forms need to be completed. One copy must be sent to the FMSA and you keep the other.
DADS Form 1725 — Criminal Conviction History and Registry Checks (the FMSA will run these checks)
DADS Form 1729 — Applicant Verification for Employees
DADS Form 1734 — Service Provider and Employer Certification of Relationship Status for CDS
Citizenship verification, including Form I-9
DADS Form 1728 — Liability Acknowledgment
License verification (if hiring a professional). In other words, make sure they have a current license. You may have to call the licensing board for that profession.
Let’s review each of these forms.
To be Completed Before the CDS Employer Hires a Provider
Criminal History and Registry Check — Form 1725
People who might become employees must be checked against the Texas Department of Public Safety criminal history conviction website, the Nurse Aide Registry, the Employee Misconduct Registry, and the state and federal Office of Inspector General List of Excluded Individuals/Entities.
The applicant must sign Form 1725, giving permission for a criminal conviction and registry check.
The criminal history check is run by the FMSA using the secure site and will provide arrest information as well as convictions, which will allow CDS employers to make a more informed decision about hiring a particular applicant. This covers criminal history in Texas only.
40 TAC, §41.225 allows that the cost of criminal history checks are to be allocated in the CDS employer’s budget, except for a applicants or current employees in Community First Choice Personal Assistance Service/Habilitation (CFC PAS/HAB).
The FMSA can verbally provide you with the criminal history check results, or can send the original criminal history check by certified mail or secured e-mail for the sole purpose of making a hiring decision.
Criminal history results are privileged information. Sharing this information is a Class A misdemeanor. The CDS employer must not show the criminal history results to anyone, including applicants, family members, friends, case managers, or utilization review staff.
If the CDS employer requests the criminal history results, the CDS employer must destroy the criminal history results within five calendar days after making a hiring decision, whether hired or not. Paper records should be destroyed by shredding, pulping, or burning. Electronic records should be destroyed by destroying the media or using specialized software to copy over the data.
If an applicant has been convicted of an offense that would legally prevent him or her from being hired, as defined in the Texas Health and Safety Code Chapter 250, the applicant cannot be hired, even if he or she is a family member. There are no exceptions. To find the list of these offenses, see Appendix II, List of Excluded Individuals and Entities.
Applicant Verification — Form 1729
- For any person you want to hire, you MUST submit this form and the accompanying documents to the FMSA so that the FMSA can make sure that the person can be hired.
- All applicants must be at least 18 years old to be hired as an employee in the CDS Option.
- Depending on the specific program, certain family members and other people cannot be hired.
- The employer cannot offer employment until the FMSA indicates on Form 1729 that the person can be hired.
Service Provider and Employee Certification of Relationship — Form 1734
This form documents the service provider’s and CDS employer’s acknowledgment of the relationship criteria for employers and service providers in the CDS option. If any criterion is marked “Yes” on this form, the CDS employer must not hire the service provider.
Employment Eligibility Verification — Form I-9
This form verifies U.S. citizenship requirements for employees.
Liability Acknowledgment — Form 1728
This form acknowledges that, as the employer, you alone are responsible for any negligent acts committed by you, your employee, or your designated representative. You will tell the applicant of any subscription to workers’ compensation insurance, homeowner’s insurance, or other insurance.
If your program allows you to hire a nurse or professional therapist, his or her license must be current.
Forms to Be Completed When the CDS Employer Hires a Provider (At Time of Hire)
IRS Form W-4
This is an employee’s withholding allowance certificate. It is due before the first payroll check is calculated and must be provided to the FMSA on the date of hire.
Texas Employer New Hiring Reporting Form
CDS employers are required to report new hires within 20 calendar days of their being hired. The Texas Employer New Hire Report Form can be found in PDF format on the Office of the Attorney General website.
Remember: The FMSA must approve the service provider’s eligibility, in writing, to you. Services provided before the service provider’s eligibility is approved will not be paid for. The FMSA must not pay for eligible services delivered by an eligible service provider until after the service provider (employee, contractor, entity or vendor) has signed the service provider agreement and the FMSA has a signed service provider agreement.
Wage and Benefit Plan — Form 1730
You must get the new employee’s signature on Form 1730, Wage and Benefit Plan. The information on this form must match the approved CDS employer’s budget workbook.
- is your primary document to record the employee’s hourly pay, hourly overtime rate (if necessary), benefits, payroll deductions and the payroll process/distribution policy;
- lets the FMSA know of the optional benefits the employee will have for payroll;
- documents that your employee is aware of his/her Wage and Benefits Plan; and
- lets the FMSA and the employee know of changes to the Wage and Benefits Plan for each employee.
Employee Work Schedule and Assigned Tasks — Form 1731
This is your primary document to record your employee’s daily work schedule and assigned tasks. Note: tasks or activities that your employee does MUST match those listed on your approved service plan. You will also use it to note changes to the employee’s work schedule or to the employee’s assigned tasks, or both.
Programs, especially those for children, may require two different schedules (e.g., summer or holidays).
Employer and Employee Service Agreement — Form 1737
- This form is the agreement between you and your employee. It outlines employer responsibilities, employee responsibilities, and responsibilities that both the employer and the employee agree to.
- The employee cannot provide services before this form is signed.
Service Provider Agreement — Form 1739
This form is used to record the service provider agreement between the FMSA on behalf of HHSC (the state Medicaid agency), DADS (the state operating agency), and a service provider (employee, contractor, entity, vendor) providing services through the CDS option. The FMSA must not make payment to a service provider until the service provider agreement is signed and received.
Employer and Entity Service Agreement — Form 1749
This form is used to document the service agreement between a CDS employer and an entity providing services to an individual. Examples of agreements with entities include purchasing day habilitation in the HCS program.
CPR, Drivers License, Auto Insurance
If applicable, verify licensure before service delivery.
Exposure to Bloodborne Pathogens — DADS Form 1727
This form is used to document the employee’s acknowledgment of federal Occupational Safety and Health Administration (OSHA) standards related to the Hepatitis B vaccination as well as their choice to receive or decline the Hepatitis B vaccination.
Notice Concerning Workers Compensation in Texas (Texas Workers Compensation Notice #5)
The Texas Department of Insurance requires all potential employees to sign this form.
Acknowledgment of Nursing Requirements — Form 1747
This form is completed by a registered nurse (RN) hired by an employer using the CDS option to provide skilled nursing, or respite or flexible family support in the Medically Dependent Children Program (MDCP). The form must be completed before the RN can provide services.
LVN Supervision — Form 1747-LVN
If you are hiring a Licensed Vocational Nurse (LVN), the LVN must be supervised by a RN, an advanced practice registered nurse, a physician’s assistant, or a physician.
Hiring a Professional Provider
How to Look for a Nurse or Therapist
- Ask someone you know
- Call a local disability organization
- Advertise in the newspaper or Craig's list
- What to include:
- Must provide a current license
- Have experience with individuals with disabilities or particular condition
- What days and times to deliver services
- Contact phone number
- What not to include:
- Address or that you live alone
Supervision, as Defined by Licensing Boards
The professional you hire must understand and practice the supervision requirements of his or her respective profession.
For example, it is important to remember that an LVN cannot work without the supervision of an RN and there are certain tasks that only an RN can perform.
Documentation of Supervision
Your LVN MUST complete DADS 1747-LVN before payment can be made.
- Texas Board of Nursing
- Executive Council of Physical Therapy and Occupational Therapy Examiners
- State Board of Examiners for Speech — Language Pathology and Audiology
The Recruitment and Hiring Process
The nurse or therapist you hire will be hired as your employee and will have unemployment taxes taken out of his/her paycheck.
Nurses must be hired as employees. If you want to hire your physical, occupational or speech therapist as a contractor, you will need to review and adhere to guidelines related to contractors vs. employees in on the Texas Workforce Commission (TWC) website.
You can find a nursing toolkit, which was developed for the Home and Community-based Services program, in Appendix B of this manual. This was developed for a CDS employer to give to their CDS nurse for assessment.
Your FMSA must notify you that they have verified the license and that the applicant has passed all background checks BEFORE you sign the Employer-Employee Agreement.
Verifying Continued Eligibility
Provide documentation to the FMSA within 30 calendar days after the renewal date of the service provider's license, certification or other permission.
Documenting Service Delivery
You must use either Form 1745 Service Delivery Log with Written Narrative/Written Summary or a timesheet to document service delivery. This gives you documentation of what occurred.
Your nurse or therapist records the time of the visit.
Your nurse of therapist records what occurred during the visit.
Activities must match the plan of care. Send the Form 1745 or timesheet to your FMSA for payment to your nurse or therapist.
Service Delivery Notes
Ensure that your nurse keeps the original nursing notes in the home for access to any other health care professionals to review as well. Each profession is required to write these in a certain way.
Your case manager or service coordinator may ask to review these notes or your plan of care when they visit to ensure that you are receiving your services according to program rules.
Ongoing Evaluation and Management of Your Provider
- Management of Service Provider — Form 1732
- Time sheets or Form 1745
Management and Training of Service Provider — Form 1732
This form documents the initial training required by the individual’s program, evaluations, conflict resolutions, warnings and anything else that occurs while managing and supervising service providers (service provider or contractor) in CDS.
An employer or DR must use Form 1732 to document:
- initial training provided to a new employee including:
- training related to the individual’s condition;
- tasks the service provider will perform; and
- any required training described in an applicable addendum to Form 1735, Employer and Financial Management Services Agency Service Agreement;
- on-going training of a service provider;
- on-going management of a service provider; and
- an evaluation of the service provider’s performance at least annually after the date of hire.
An employer or DR must mail or fax a copy of the completed Form 1732 to the FMSA within 30 calendar days after:
- hiring a service provider; and
- each annual evaluation of the service provider.
A Word about Required Training
Each program has its unique training requirements.
To see the requirements for each program, see Service Provision Requirement Addendum to Form 1735. You, as the employer, or your DR are responsible for training. If you want to allow your current provider or someone else to do the training, you may.
Management and Training of Service Provider Addendum — Form 1732-EMR
This form documents the employee’s acknowledgment of the Employee Misconduct Registry (EMR) and must be completed within five days of employee’s first day of work.
Time Sheets or Form 1745
Services delivered must be documented by either:
- timesheet (the FMSA will have a timesheet the employer can use) or
- Form 1745
- Electronic Visit Verification (EVV) documentation is also an option for documentation, but is not required.
Corrective Action Plans - Form 1741
A corrective action plan may be requested by your FMSA (related to employer responsibilities), your case manager or service coordinator (related to program issues), or DADS staff (related to CDS or program).
The Employer/DR must develop and implement a required corrective action plan to correct any non-compliance with either the CDS rules (e.g., not sending your timesheets to the FMSA on time) or program rules (e.g., wanting to hire a relative who is prohibited from employment by program rules). Your Service Planning Team may intervene to consider the employer’s ability to manage the CDS option when corrective action plans are not implemented.
The Support Advisor may help develop and implement the corrective action plan.
Here is a sample corrective action plan, Form 1741: