Medicaid waivers; consumer-directed services, employer of record.

Plain English Breakdown

The official source material does not provide specific details on how DMAS will determine eligibility for using an existing EIN.

Medicaid Waivers; Consumer-Directed Services

This bill directs the Department of Medical Assistance Services (DMAS) to modify Medicaid rules for consumer-directed services, allowing individuals receiving these services to act as their own employer and designate someone else to manage their care when needed.

What This Bill Does

• Allows people getting Medicaid help to be their own boss for their care.
• Lets them choose another person to handle the work if they can't do it themselves.
• Limits how often someone can change who manages their care each year.

Who It Names or Affects

• People receiving Medicaid consumer-directed services
• The Department of Medical Assistance Services

Terms To Know

Employer of Record (EOR)

A person who is officially responsible for managing the employment relationship and payroll for another individual.

Employer Identification Number (EIN)

A unique number assigned by the IRS to identify a business or organization for tax purposes.

Limits and Unknowns

• The bill does not specify how DMAS will determine eligibility for using an existing EIN.
• It is unclear what happens if someone reaches the limit of changing their care manager twice in a year but still needs to do so.
• The effectiveness and implementation timeline are not detailed.

Official Summary Text

Department of Medical Assistance Services; Medicaid waivers; consumer-directed services; employer of record.
Directs the Department of Medical Assistance Services (DMAS) to modify the program rules for consumer-directed services available through certain Medicaid waivers to allow an individual receiving services to serve as the employer of record (EOR) for his own service delivery and designate another individual to perform all or a portion of the duties of the EOR on the individual's behalf when the individual receiving services is unable to perform such duties or direct his own care. The bill specifies that when an individual (i) has not yet reached the age of majority, (ii) is ineligible to use his existing employer identification number (EIN) to facilitate the taxation of benefits, or (iii) is otherwise determined to be ineligible by DMAS by administrative rule, the EIN shall be assigned to the individual receiving services and shall not be transferred to another individual. Under the bill, DMAS has the authority to limit such amendments to specify that an individual receiving services may make such designation no more than twice per calendar year.

Current Bill Text

A BILL to direct the Department of Medical Assistance Services to submit state plan amendments to the Centers for Medicare and Medicaid Services to seek to modify the program rules for consumer-directed services available through certain Medicaid
waivers
.

Be it enacted by the General Assembly of Virginia:

1.
§ 1.
That the Department of Medical Assistance Services (DMAS) shall seek federal authority through the necessary state plan
or 1915(c) waiver
amendments
submitted to the Centers for Medicare and Medicaid Services
under Titles XIX and XXI of the Social Security Act to modify the program rules
for
consumer
-
directed services available through

certain
1915(c) Home and Community
-
Based Services Medicaid
W
aivers
to allow
an
individual
receiving services
to
serve as the

e
mployer of
r
ecord
(EOR)
for
his
own service delivery
and

designate another individual to perform all or a portion of the
d
uties of the
EOR
on the individual
'
s behalf when the individual receiving services is unable
to perform such duties or direct
his
own care.

In seeking federal authority
to modify such rules
, DMAS shall ensure that
the
employer identification number (
EIN
)
shall be assigned to the individual receiving services and shall not be transferred to another individual except

w
hen an individual (i) has not yet reached the age of majority, (ii) is ineligible to use
his
existing
EIN
to facilitate the taxation of benefits, or (iii)
is
otherwise determined
to be ineligible
by
DMAS
by administrative rule.

DMAS

shall have the authority to
limit
such state plan or 1915(c) waiver
amendments to
specify that

an individual receiving services may make
such
designation

no more than twice per calendar year.