MissouriSelf-Directed Support (SDS)Employee HandbookAcumen Fiscal AgentRevised 01-24-22

Last Updated: January 2022Missouri Self-Directed Support Employee HandbookINTRODUCTIONYou have been chosen to be an employee for an individual in the Missouri Self-DirectedSupports (SDS) Program. Individuals and their families in this program wish to exercisemore choice, control, and authority over their services. As an employee for anindividual, you are playing an important role in supporting this choice.IndividualEmployerDesignated RepresentativeIt is important that you carefully read this handbook. You will be required to sign andacknowledge that you have reviewed and understand its contents before you startworking. If there is any information that you do not understand, you should talk withyour employer/designated representative for clarification before signing theacknowledgement on the Employee Agreement form.The purpose of this handbook is to provide additional training on the concepts andresponsibilities required for you to provide services. It is in everyone’s best interest toemploy the best and most qualified employees and to make sure they receive trainingand information on how to be successful. The employer/designated representative youwork for is committed to providing a work environment that is fair, free fromdiscrimination, and that adheres to all applicable employment laws and Self-DirectedSupports (SDS) program requirements.This handbook will provide an overview of the Missouri Self-Directed Supports (SDS)program. Each section will walk you through important information that you will need toknow as an employee and outlines your role in helping to create and provide qualitysupport services.Additionally, this handbook will explain the role of Acumen Fiscal Agent (Acumen), theFinancial Management Services (FMS) entity. An FMS is the entity that helps performemployer related activities for individuals enrolled in the Missouri Self-DirectedSupports (SDS) program. Acumen is responsible for assisting with employeeenrollment, processing approved time submissions, issuing payments, filing taxes, andmany other activities you will find described in this handbook.All employees are required to receive training prior to working with an individual. Thishandbook is a tool for your employer/designated representative to meet some of thetraining requirements. Your employer may have additional expectations related to youremployment which are not included in this handbook.If you have any questions about the information explained in this handbook you shouldtalk to your employer/designated representative.2

Last Updated: January 2022Missouri Self-Directed Support Employee HandbookTABLE OF CONTENTSSection 1: Self-Directed Supports . 4A. Guiding Principles of Self-Determination . 4Section 2: Roles and Functions within SDS. 5Section 3: Individual Rights and Responsibilities . 7Section 4: Individual Support Plan (ISP) . 8Section 5: Individual Back-up Plan . 8Section 6: Types of Employees and their Roles: . 9A. Personal Assistant (PA). 9B. Enhanced Medical PA . 10C. Community Specialist . 10D. Employment Requirements . 11Section 7: Employee Training Requirements. 11Section 8: Financial Management Services . 13A. Enrollment Information . 14B. Payroll Information . 15Payroll Schedule . 15Electronic Visit Verification (EVV) . 16Time Submissions and Service Documentation Entry . 16Payment . 18C. Tax Information . 19D. Workers’ Compensation . 20E. Changing Information . 20F. Customer Service . 21Section 9: Employment “At Will” . 21Section 10: Service Documentation . 22Section 11: Confidentiality . 23Section 12: Mandated Reporting . 233

Last Updated: January 2022Missouri Self-Directed Support Employee HandbookSECTION 1: SELF-DIRECTED SUPPORTSSelf-Directed Supports (SDS) is an option for service delivery for persons withdevelopmental disabilities and their families who wish to exercise more choice, control,and authority over their supports. SDS is founded on the principles of selfdetermination.A. Guiding Principles of Self-DeterminationSelf-Determination is a broad concept that means individuals have overall control oftheir lives and services and are part of the community. It is based on five basicprinciples:FreedomTo live a meaningful life in the community and make their own choices. Itmeans having the freedom to decide: What choices they want to have in their life The kind of services and supports they need and how to best utilizethem.AuthorityTo have control over the money they use for services and supports. Thismeans having the authority to manage a budget used to provide for theservices they need.SupportResponsibilityConfirmationTo live the life they want. This means they have a circle of supports made upof family, friends, both paid and unpaid supports, and other natural supports.The individual may want or need support/assistance to: Care for themselves Be active in their community Take care of their homeTo use their individual budget wisely, find their own supports and give back tothe community. Also to assume responsibility for seeking employment whenpossible and for developing their own unique gifts and talents.To be recognized for who they are and what they can contribute as animportant part of their community. For example, they may have a leadershiprole in the design of government and the services used to support all peoplewith developmental disabilities.4

Last Updated: January 2022Missouri Self-Directed Support Employee HandbookSelf-Determination is Not an ExcuseAs an employee you support theFor more information on Selfindividual you serve to exercise selfDetermination, visit the Missouridetermination. Self-determination is notDepartment Health (DMH), Division ofDevelopmental Disabilitiesan excuse for leaving someone in an(Division of DD) website:unsafe situation on the grounds that he she “chose” it. It is not acceptable toself-determinationoffer a choice with either too manyrestrictions or no support at all. SelfDetermination means becoming more creative in helping individuals find ways tolearn decision-making and manage their actions.Whatever It TakesWhat is the good life? Most individuals with developmental disabilities say it’s about thebasics--a pleasant home, a decent job, health, safety, having caring people aroundthem, and feeling good about themselves. The person-centered planning process andself-determination helps to identify the supports that will assist individuals to achievetheir vision of the “good life.”An answer of “No, we can’t” is replaced by “How can we make this happen?”You, as an employee, are part of a team designed to help the individual reach his or hergoals of self-determination.SECTION 2: ROLES AND FUNCTIONS WITHIN SDSWhen an individual chooses to self-direct their services and supports, the personreceiving services or their guardian are the employer. They are responsible formanaging employees’ day-to-day activities, including making sure services are providedas written in the individual’s plan and to perform other employer related duties. Forindividuals under the age of 18, their parent or guardian will be the employer. Forindividuals 18 years or older, the individual is the employer (EIN holder). If theindividual/employer is unable to meet some or all of the responsibilities of an employer,they can choose a designated representative who agrees to be responsible for theemployer tasks. The individual’s guardian may also choose a designatedrepresentative.When participating in SDS, individuals are supported by a team. Members of theteam include:Support Broker (SB):A Support Broker is someone who works for an agency and provides theindividual/employer or designated representative with information and assistance to5

Last Updated: January 2022Missouri Self-Directed Support Employee Handbookdirect and manage supports as written in the Individualized Support Plan (ISP). TheSupport Broker may also assist the individual/employer or designated representativeto manage their employer related responsibilities.Support Coordinator (SC):The Support Coordinator assists the individual with identifying needs and supports toincrease independence in the home and community. Goals are developed within theIndividualized Support Plan (ISP) to ensure health, safety and independence. TheSupport Coordinator will monitor the services that are defined in the plan to ensure theindividual’s needs are being met.Financial Management Services (FMS):The FMS organization assists the individual/employer or designated representative andemployee in completing required enrollment paperwork for Self-Directed Supports. TheFMS completes many of the employer related activities on behalf of theindividual/employer or their designated representative, such as: background checks foremployees, maintaining required service documentation, collecting and maintainingproof of training records, providing notification when the employee may begin to work,processing employee payroll and tax documents, and issuing year end forms.Additional information regarding roles and responsibilities can be found on the MissouriDepartment Health (DMH), Division of Developmental Disabilities (Division of DD)website: directed-supports6

Last Updated: January 2022Missouri Self-Directed Support Employee HandbookSECTION 3: INDIVIDUAL RIGHTS AND RESPONSIBILITIESMissouri law gives individuals who receive mental health services the following rights(without . humane care and treatment;To the extent that the facilities, equipment and personnel are available, to medicalcare and treatment in accordance with the highest standards accepted in medicalpractice;To safe and sanitary housing;To not participate in non-therapeutic labor;To attend or not attend religious services;To receive prompt evaluation and care, treatment, habilitation or rehabilitationabout which the individual is informed insofar that person is capable ofunderstanding;To be treated with dignity as a human being;To not be the subject of experimental research without prior written and informedconsent or that of a parent, if the person is a minor, or guardian; except that noinvoluntary committed person shall be subject to experimental research, except asprovided by statute;To decide not to participate or to withdraw from any research at any time for anyreason;To have access to consultation with a private physician at the individual’s expense;To be evaluated, treated or habilitated in the least restrictive environment;To not be subjected to any hazardous treatment or surgical procedure unless theindividual’s parent, if the person is a minor, or guardian consents; or unless suchtreatment or surgical procedure is ordered by a court of competent jurisdiction;In the case of hazardous treatment or irreversible surgical procedures, to have,upon request, an impartial review prior to implementation, except in case ofemergency procedures required for the preservation of life;To a nourishing, well-balanced and varied diet;To be free from verbal and physical abuse;To wear one’s own clothes and to keep and use one’s personal possessions*;To keep and be allowed to spend a reasonable sum of one’s own money forcanteen expenses and small purchases*;To communicate by sealed mail or otherwise with persons, including agenciesinside or outside the facility*;To receive visitors of one’s own choosing at reasonable times*;To have reasonable access to a telephone booth to make and receive confidentialcalls*;To have access to one’s own mental and medical records*;To have opportunities for physical exercise and outdoor recreation*;To have reasonable, prompt access to current newspapers, magazines and radioand television programming*.7

Last Updated: January 2022Missouri Self-Directed Support Employee Handbook*Missouri law gives individuals who receive mental health services the abovelisted rights that may be limited for safety or therapeutic reasons: Any proposedlimitation of rights must be reviewed by DMH Regional Office or State OperatedPrograms Human Rights Committee to ensure that a person’s rights are adequatelyprotected.For more information, see “Knowing Your Rights: A Guide forIndividuals with Developmental Disabilities to UnderstandRights and Responsibilities” on the Missouri DepartmentHealth (DMH), Division of Developmental Disabilities(Division of DD) website: anding-rights-andSECTION 4: INDIVIDUAL SUPPORT PLAN (ISP)Everyone served by the Missouri Department of Mental Health (DMH), Division ofDevelopmental Disabilities (Division of DD) has an Individualized Support Plan (ISP).The ISP tells you about the individual you are working with, the things they like, thethings they do not like, special medical concerns, medications they are receiving, andgoals they are working toward achieving. The ISP serves as your guide/training tool tofamiliarize yourself with the individual you are working with and gives you information toassist you in effectively working with him or her.The ISP also outlines your responsibilities with assisting in achieving those goals andsupport needs. Your employer or the individual’s designated representative will providetraining on implementing their ISP and will ensure that you have access to a copy. Youremployer or the individual’s designated representative will also provide you with ongoing training on implementing changes to their ISP to ensure that changes in needsare met.SECTION 5: INDIVIDUAL BACK-UP PLANAn emergency back-up plan is required to handle situations when an employee, who isproviding essential supports, is unavailable. A back-up plan may include friends, familyor other natural supports, trained and qualified employees, or agency providers whomyou can call for assistance.The Individualized Support Plan (ISP) must also address the back-up plan. Allmembers of the individual’s support team need to be educated about the individual’sback-up plan and have information accessible. This form may be used to ensure thatessential information is available to employees.8

Last Updated: January 2022Missouri Self-Directed Support Employee HandbookYour employer/designated representative can train on the back-up plan in anumber different ways: Including it in your ISP trainingAs a separate training based on the Emergency Back-up Plan form or otherdocuments your employer/designated representative has created.The Emergency Back-up Plan form can be found on the Missouri Department of MentalHealth (DMH), Division of Developmental Disabilities (Division of DD) website: directed-supportsSECTION 6: TYPES OF EMPLOYEES AND THEIR ROLES:A. Personal Assistant (PA)An employee who provides personal assistant services can help with any number ofdaily activities, which may include: BathingToiletingTransfer and ambulation9

Last Updated: January 2022Missouri Self-Directed Support Employee Handbook Skin careGroomingDressingShoppingExtension of therapies and exerciseCare of adaptive equipmentMeal preparationEatingIncidental household cleaning and laundryUsing public transportationBankingBudgetingSocial interactionRecreation and leisure activitiesAs a personal assistant you may be at the individual’s side while they do theseactivities, you may teach them how to be more independent in these areas, or you mayhelp them do the things they cannot do for themselves. A personal assistant can alsohelp the individual to be part of their community.A personal assistant may be authorized for “Team Collaboration” which allows all of theindividual’s employees to participate in the Individualized Support Plan (ISP) and tomeet as a team to ensure consistency in its implementation. A team meeting also canbe convened by the individual or their designated representative for the purposes ofdiscussing specific needs of the individual, the individualized progress towardsoutcomes, and other related concerns.B. Enhanced Medical PAAn employee who provides enhanced personal assistant services will performspecialized services as detailed in the individual’s ISP that require a higher level oftraining. The training required is very specific to the higher level of supports that arerequired to ensure the health, welfare and safety of the individual who is receiving theenhanced service.C. Community SpecialistAn employee who provides community specialist has had special training and hasknowledge in providing support in a particular area of expertise. They may have beenhired to develop specialized supports to assist the individual with medical oversight anddelegation, to help train employees and/or to assist the individual in achieving theirgoals when professional expertise is necessary.A community specialist’s expertise may be needed to assist the individual to achieveoutcomes specified in the ISP such as:10

Last Updated: January 2022Missouri Self-Directed Support Employee Handbook Enhance self-directionIndependent living skillsCommunity integrationSocial, leisure and recreational skillsNurse delegationD. Employment RequirementsAll employees must be over the age of 18 and have a high school diploma or GED.There are several exceptions to who may NOT be an employee in SDS. The followingpersons may NOT be an employee: A spouseA parent/step-parent, if the individual is a minor (under age 18)A legal guardian or anyone with any legal authority over the individualA designated representativeAnyone with a felony or offense that is disqualifyingA Community Specialist must have a bachelor’s degree plus one-year experience ORbe a registered nurse OR have an associate’s degree plus three years of experience.Family as an Employee*:An individual’s family member(s) is only eligible to provide Personal Assistanceservices. They must first meet the qualifications listed above. In addition, whenindividuals hire a family member, their ISP must determine if: The individual is not opposed to a family member providing the service;The services to be provided are solely to support the individual and not a typicaltask for the family unit (i.e. family laundry);The individual’s support team agrees that a family member will best meet theindividual’s needs;Family members cannot be hired to provide Support Broker or Community Specialistservices.*A family member is defined as a parent, step parent, sibling, child by blood, adoption,or marriage, spouse, grandparent, or grandchild.SECTION 7: EMPLOYEE TRAINING REQUIREMENTSAll employees are required to receive training prior to working with an individual. Thishandbook is a tool for employees and employers to make sure you have met all initialand on-going training requirements.All employees must complete the training requirements detailed below and in the enrollmentpacket. These trainings are required before an employee can begin providing services.11

Last Updated: January 2022Missouri Self-Directed Support Employee HandbookTraining and First Aid (if applicable)a. Cannot be exempted for Medical PAMedication Administration (if applicable)a. Cannot be exempted for Medical PA employees who are required to providepass medications as defined by the ISP.Behavioral Intervention Crisis Management Training (if applicable)Behavioral Intervention – Positive Behavior Supports Training (if applicable)Employee Handbook, training information includes:a. Procedures and expectations related to the waiver service requirements;b. Procedures for reporting an employee injury;c. Rights and responsibilities of the individual to be served;d. Procedures for billing and payment;e. Service documentation;f. Respecting confidentiality;g. Procedures for arranging Back-up when needed;h. Who to contact within the Regional Office in-case of an emergency or unusualevent and reporting of these events.Individualized Support Plan (ISP)a. Your employer/designated representative will provide you with training onimplementing the ISP and will ensure that you have access to a copy of theISP.b. Your employer will also provide you with on-going training on implementing theISP to ensure that changes in needs are met.ISP training information should include: Information about the specific condition and needs of the individual receivingsupports, including his or her physical, psychological or behavioral challenges,his or her capabilities, and his or her support needs and preferences that relateto that support. Training in communication skills, in understanding and respecting theindividual’s choice and direction, cultural and ethnic diversity, personalproperty and familial and social relationships and in handling conflictand complaints. Training in assisting with activities of daily living, as needed by theindividual and identified by the planning team.IMPORTANT: By submitting your hours, you are verifying that you have reviewed andreceived training (initial and on-going) on the individual’s ISP. By approving your hours,your employer is verifying this as well.12

Last Updated: January 2022Missouri Self-Directed Support Employee Handbook*Abuse and Neglect is an online basedtraining that you must complete every twoyears. The link for the online Abuse andNeglect training is: then click on ReliasSelf-Registration Portals for informationon how to self register and complete thetraining.Additional Training Resources:To access the training resources, go to: sSelfRegistrationPortals. You can access required trainings such asthe Abuse and Neglect Training. Elective trainings are also available on the Relias site.Where do I send my training renewal information?The contracted Financial Management Services (FMS) entity, Acumen, will notifyemployers/designated representatives and employees 90, 60, 30 days in advance of expiringcertifications and trainings. Once employees renew their certification and/or trainings, they willreturn them to Acumen by either email or fax.Email: [email protected]: 1-816-396-6912SECTION 8: FINANCIAL MANAGEMENT SERVICESEveryone who self-directs their supports uses Financial Management Services (FMS). The FMSperforms as the agent to the employer, assisting in managing some of the financialresponsibilities of being an employer.The Missouri Office of Administration has contracted with Acumen Fiscal Agent, LLC, alsoreferred to as Acumen, to perform Financial Management Services (FMS) on behalf of theMissouri Department of Mental Health (DMH), Division of Developmental Disabilities (Divisionof DD) and the Self-Directed Services (SDS) program. Acumen is a national leader in FinancialManagement Services that supports participant direction for over 65 self-directed programs,across 20 states.13

Last Updated: January 2022Missouri Self-Directed Support Employee HandbookTo learn more informationabout Acumen Fiscal Agentgo to the following website:www.acumenfiscalagent.comAcumen Fiscal Agent (Acumen) will perform the following employee related activities on behalf ofyour employer: Collect and process required enrollment paperwork Conduct a background screening on employee candidates Collect documentation to ensure employees meet and maintain training and certificationrequirements Notify the employee and employer when the employee is “Good-to-Go” and eligibleto provide services Process time submissions Process employees’ payroll and the associated employment taxes Broker Workers’ Compensation Maintain service documentation Maintain a back-up electronic system (Direct Care Innovations) forindividuals/designated representative to review, approve or reject timesubmissions Maintain an electronic system for employers to submit required monthlyservice documentationA. Enrollment InformationAcumen’s role is to verify that employment-related paperwork is completed correctly. Acumenis required to follow state and federal guidelines for many of the forms required foremployment. If there are any errors which prevent your paperwork from being processed,Acumen will notify your employer of how to make the corrections. When all required forms,training, documentation, and other required information has been submitted, is complete andcorrect, and entered into the system, you and your employer will be notified of your start date.The start date is called the “Good to Go” date.14

Last Updated: January 2022Missouri Self-Directed Support Employee HandbookAn email will be sent to both the employee and the employer notifying them of the” Good-toGo” date and providing them with additional information. If Acumen does not have an emailon file, a letter will be mailed to the address on file. Once an employee is “Good to Go” andthe notice has been received, the employee may start providing services to the individual.Please add [email protected] to your known sender’s list to ensure these emails arenot seen as junk email.IMPORTANT: No person/applicant/prospective employee may begin working until the FMSnotifies the employer/designated representative that their prospective employee has passedtheir background screening.B. Payroll InformationPAYROLL SCHEDULEAcumen’s “Good-to-Go” notification will include important payroll related information that youwill need when beginning to provide services. You will be given a payroll schedule that detailsthe start and end dates for the two-week time submission periods, when time submissionsare due, and when time submissions will be paid.Below is a copy of a sample payment schedule:So that your employees are always paid on time, please make sure your employee's time is entered and approved by thedue date, even if it falls on a holiday. These dates are strictly enforced. Any time that is approved after the due date will beprocessed in the following payment period.Be sure to have all hours entered and approved by midnight of the "Due NO Later Than" date.If you would like to attend a webinar on how to use the Mobile App or Phone EVV visit: Please share a copy of the pay schedule with your employees, and keep a copy in a safe place for your reference15

Last Updated: January 2022Missouri Self-Directed Support Employee HandbookELECTRONIC VISIT VERIFICATION (EVV)Per the 21st Century Cures Act, services provided in programs such as the Missouri SDS mustbe electronically verified. This is called Electronic Visit Verification (EVV). For a timesubmission to be EVV compliant, it must include 6 points of information and must beelectronically verified. The 6 points are: Type of service (service code) Individual receiving the service Employee providing the service Date of service Time of service Location of

Missouri Self-Directed Support Employee Handbook Last Updated: January 2022 4 SECTION 1: SELF-DIRECTED SUPPORTS Self-Directed Supports (SDS) is an option for service delivery for persons with developmental disabilities and their families who wish to exercise