Employyer eeccoorrd Inform - Moms In Motion · EOR Old Mailing Address: New Physical Address:...

1. Instructions for All Required Tax Forms

Please be aware that PPL will conduct the following

• Criminal Background Record Check• Individuals convicted of certain crimes cannot

• The List of Excluded Individuals/Entities (LEIE) is maintained by theDepartment of Health and Human Services, Office of Inspector General (HHSThe LEIE list includes names ofpatient abuse, or licensing board actions.

• Child Protective Services (CPS) Request for Search of the Central RegistryMedicaid consumer is a minor (under 18) the attendant must complete information form.

2. Information on Pay Schedules & Timesheets

3. Address Change Information

4. Notice of Discontinuation of Employment

5. Frequently Asked Questions

6. Attendant Application Request

This Information Packet is yours to keep. documents on the following topics that will help you be a successful of Record:

If you have questionsor email them at [email protected]

VA DMAS Consumer-Directed Services ProgramPublic Partnerships, LLC 4991 Lake Brook Drive, Suite G90 Glen Allen, VA 23060 Phone: 1-866-259-3009 TTY: 1-800-360-5899 Virginia Relay Service: 7-1-1 Administrative Fax: 1-866-709-3319E-mail: [email protected] Web Site: www.publicpartnerships.com

All Required Tax Forms

Please be aware that PPL will conduct the following background checks on

round Record Check convicted of certain crimes cannot be hired to work in the program

ded Individuals/Entities (LEIE) is maintained by theDepartment of Health and Human Services, Office of Inspector General (HHSThe LEIE list includes names of people with convictions for program

se, or licensing board actions.

Child Protective Services (CPS) Request for Search of the Central Registryis a minor (under 18) the attendant must complete

Information on Pay Schedules & Timesheets

Address Change Information

Notice of Discontinuation of Employment

Frequently Asked Questions

Attendant Application Request Forms

Packet is yours to keep. This packet contains instructionaldocuments on the following topics that will help you be a successful

have questions call PPL customer service at 1-or email them at [email protected].

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Directed Services Program

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www.publicpartnerships.com

checks on Attendants:

be hired to work in the program

ded Individuals/Entities (LEIE) is maintained by the United States Department of Health and Human Services, Office of Inspector General (HHS-OIG).

people with convictions for program-related fraud,

Child Protective Services (CPS) Request for Search of the Central Registry. If the is a minor (under 18) the attendant must complete the release of

contains instructional documents on the following topics that will help you be a successful Employer

-866-259-3009

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Form

�� Instructions on the Employer of Record Confirmation of Information Form

�� Instructions on IRS Form SS

�� Instructions on IRS Form

�� Instructions on IRS Form 8821

�� Instructions on Virginia DMAS Release of Information Form

�� Instructions on Address Changes

�� Address Change Forms

�� Instructions on Notice of Discont

�� Notice of Discontinuation of Employment

�� Instructions on Acceptance of Responsibility for Employment Form

�� Acceptance of Responsibility for

�� Frequently Asked Questions

�� Information on Timesheets

�� Payroll Schedule

�� Attendant Application Request Form

�� Instructions on Attendant Application

Instructions on the Employer of Record Confirmation of Information Form

IRS Form SS-4

Instructions on IRS Form 2678

IRS Form 8821

Virginia DMAS Signature Authority & elease of Information Form

Instructions on Address Changes

Instructions on Notice of Discontinuation of Employment Form

Notice of Discontinuation of Employment Form

Acceptance of Responsibility for Employment Form

Acceptance of Responsibility for Employment Form

Frequently Asked Questions

Information on Timesheets

pplication Request Form

Instructions on Attendant Application

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Page #

Instructions on the Employer of Record Confirmation of Information Form 3

4

5

6

7

8

9-10

11

12

13

14

15-24

25-28

29

30

31-32

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What is the purpose of this form The Services Facilitator providesinformation. Please review to ensure the information is correct.

• If it is correct, the Employer of Recordsign the all forms in this packet.

• If it is incorrect, please call or email cuservice immediately so we can send you a Employer of Record packet.

this form?

provides Public Partnerships, LLC (PPL) with the to ensure the information is correct.

Employer of Record should

forms in this packet.

If it is incorrect, please call or email customer service immediately so we can send you a new

packet.

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This form tells the IRS you are going to be an employer. It is used to obtain an Employer Identification Number (EIN) from the IRS. The form will designate all tax deposit and filing responsibility to PPL. Why isn’t my address listed on lines 4a and 4b? Lines 4a and 4b ask for the mailing address to be attached to this employer account. By establishing PPL’s mailing address on your employer account, PPL will receive the IRS paperwork. Who are the people listed in the ‘Third Party Designee’ section? These are PPL staff members who will obtain an EIN on your behalf. What lines do I complete? You must review, sign and date the bottom of the form. If you have applied for an EIN in the past, complete lines 16a, 16b, and 16c. What if I have an existing EIN number? The DMAS program will only allow the use of an existing EIN through an exception process. PPL will need a letter from the IRS that must state the EIN number is free of “liens and liabilities”.

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With this form, you give the employer tax responsibility to PPL. What is PPL’s role as my agent? The IRS Form 2678 only allows PPL to withhold taxes from your employee’s paychecks and deposit those taxes to the IRS. The form does not allow PPL to perform any other tax responsibilities. PPL is responsible by law for correctly representing you. PPL will incur any penalties of misfiling or incorrectly depositing your employer taxes. Does the IRS Form 2678 authorize you to file my personal income taxes? No. PPL cannot handle any of your personal income tax matters. What sections do I complete? This form is completed for you. You must review, sign and date the bottom of the form.

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This form allows PPL to discuss your employer withholding account with the IRS. Will PPL be able to discuss my personal tax account with the IRS? No. PPL is only able to discuss the employer tax forms listed in Section 3b. PPL will never be able to obtain any of your personal income tax information. What lines do I complete? You must review, sign and date the bottom of the form in Section 7.

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This form allows another person to help you when managing your services. The form will allow you to pick someone to sign timesheets for you or PPL to speak with another person about your services. What does Signature Authority mean? Signatory Authority will allow the person listed on the form to sign timesheets for you. What does Release of Information mean? Release of Information will allow PPL to speak with the person listed on the form about your services.

Do I have to sign the Form? Yes. If you do not have a Signature Authority or you only want PPL to talk with you, complete the top of the form and sign at the bottom. Mark the “I do not give anyone permission on my account”. If you wish to allow another person to sign timesheets, list the person on the form under Signature Authority. If you wish to allow PPL to speak with another person, list the person on the form under Release of Information. You can allow the same person to be the Signature Authority and on the Release of Information. List the person helping you manage services, mark the “I give the above person(s) permissions on my account” and sign the form. Who can PPL talk to about my services?

Only the person you list on the form. The person must verify your address and Social Security Number. Can the Signature Authority sign the Employer tax packet or Attendant Forms? No, only the Employer of Record can sign the tax forms and attendant forms.

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Consumer Address Change PPL cannot change the Consumer’s address. If the consumer has a change of address, the change must be reported to the local Department of Social Services. DMAS will report consumer address changes to PPL on a weekly basis. Consumer Phone Number or E-mail Change PPL can change your phone number and/or email address using the Consumer Change Form. Employer of Record Address Change The Employer of Record, who is not the consumer, has two options to notify PPL of address changes. You can change your information using the Employer of Record Change of Address Form. How can I change my information? To change your information you can -

• Send the change form to PPL using the form on PPL’s website at https://www.publicpartnerships.com//. Scroll to the middle of the screen. Answer User Name vaclient. The password is pcgva67.

• The form can also be found on page 9 and 10 of this packet.

• Calling customer service to have a form sent to you.

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If you have any questions, please

Mail: Public Partnerships, LLC

Attn: DMAS

4991 Lake Brook Drive, Suite G90

Glen Allen, VA 23060

Fax: 1

If you have an address change, you must change your address with the Department of Social Services.

Check All Boxes That Apply:

□ Change in E-Mail □ Change in

Consumer ID:

Consumer First Name & Middle Initial

Consumer Last Name:

Consumer Date of Birth:

Consumer Phone Number :( )

Consumer or Employer of Record Signature

CCoonnssuumm

If you have any questions, please call PPL at 1-866-259-3009

Public Partnerships, LLC

Attn: DMAS Consumer Directed Services Program



1-866-709-3319

, you must change your address with the Department of Social Services.

Change in Phone Number

& Middle Initial:

Email Address:

Signature Date

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Program

, you must change your address with the Department of Social Services.

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If you have any questions, please call PPL at 1

Mail: Public Partnerships,

Attn: DMAS



Fax: 1

Please complete this form when there is a change in your personal information.

consumer, you must change your address with the Department of Social Services.

Check All Boxes That Apply:

□ Change in Name □ Change in Address

Consumer ID:

EOR First Name & Middle Initial:

EOR Last Name:

EOR Date of Birth:

EOR Phone Number: ( )

EOR Old Mailing Address:

New Physical Address:

City/State/Zip Code:

County:

New Mailing Address:

City/State/Zip Code:

County:

Employer of Record Signature

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If you have any questions, please call PPL at 1-866-259-3009

Public Partnerships, LLC




1-866-709-3319

Please complete this form when there is a change in your personal information.


Change in Address □ Change in Phone Number

Email Address:

Date

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Please complete this form when there is a change in your personal information. If you are also the


Change in Phone Number

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This form tells PPL when an attendant is no longer working for you. Why is this form important? PPL needs to know when an attendant is no longer working for the following reasons: • To prevent incorrect payments • For correct information on who is working for you or who has

worked for you • For unemployment hearings. PPL can communicate to the

Virginia Employment Commission the last date of employment and reason.

Does the attendant need to sign the form? No, just complete and sign the form yourself. The attendant does not need to sign this form. What must I include on the form? Complete all sections of the form including the Last Date Attendant Worked and the Reason for Separation. Does the Services Facilitator need to sign? No, The Services Facilitator can sign the form but it is not required. Need more forms?

• Download the form on PPL’s website at https://www.publicpartnerships.com//. Scroll to the middle of the screen. Answer User Name vaclient. The password is pcgva67.

• The form can also be found on page 12 of this packet.

• Calling customer service to have a form sent to you. Where do I send the form? Mail or fax the form to PPL.

Mail: Public Partnerships, LLC Fax: 1-866-709-3319




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This form tells PPL when an attendant is no longer working for you. The information on this form will be used by PPL to prevent incorrect payments, maintain up-to-date information on who is working for you, and communicate to the Virginia Employment Commission the last date of employment and reason.

This form can be completed by the Employer of Record, or by both parties (the Employer and the Attendant). Consumer Name__________________________________ Consumer ID_____________________________

EMPLOYER of RECORD (EOR)

Name:____________________________________ Phone:___________________________________

ATTENDANT/EMPLOYEE

Name: _____________________________________Attendant ID:__________________________________

Phone: _________________________________________

LAST DATE EMPLOYEE WORKED: _____________ REASON FOR SEPARATION: Quit Fired Deceased OTHER (Circle One)

Include the last timesheet for hours worked. Timesheet Attached: (Circle One)(Circle One)(Circle One)(Circle One) YES NO The form provides an opportunity for either or both parties to document the reason(s) for ending employment. Briefly state the reason(s) for ending the employment agreement between the two parties. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Employer Signature: _______________________________Date:___________ Attendant Signature: _______________________________Date ___________ *Power of Attorney, Executor of Estate, or Service Facilitator Signature_______________________________ Date ____________________

If the Attendant cannot or will not sign, the Employer of Record should sign, date, and return this form without the Attendant’s signature. *A Power of Attorney (POA), Executor of the Estate (must provide a copy of the POA to ensure that they have authority to terminate the employee) or Service Facilitators may sign the form when the Employer of Record is unable to do so. This form must be signed. Mail or fax the form to PPL. Mail: Public Partnerships, LLC Fax: 1-866-709-3319 VA DMAS Consumer-Directed Services Program 4991 Lake Brook Drive, Suite G90 Glen Allen, VA 23060

REVISED: January 2013

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The employer can accept responsibility on behalf of the attendant AFTER being notified by PPL of their criminal history results. Can I hire an employee who has been convicted of a crime? You may be able to hire an attendant convicted of a crime. The felony conviction cannot be listed on the Barrier Crimes List. The Barrier Crimes list is found on page 22 of this packet in accordance with the Code of Virginia §37.2-314, §37.2-416, or §32.1-162.9:1 and Virginia regulations 12 VAC 30-120-770 In the event that your attendant has been convicted of a crime that is not a barrier crime, you will be given the opportunity to employ the attendant. You will be required to complete the Acceptance of Responsibility for Employment form and send it back to PPL. You can fax or mail the form to PPL. What if I do not want to hire an attendant convicted of a crime? Complete the Notice of Discontinued Employment Form and send it to PPL. The form can be found on page 12 of this packet. What if I learn the attendant was convicted of a barrier crime? Contact your Service Facilitator. Complete the Notice of Discontinued Employment Form and send it to PPL. The form can be found on page 12 of this packet. Can the attendant be paid for hours worked if convicted of a Barrier Crime? DMAS and PPL are not allowed to pay someone who has been convicted of a Barrier Crime. The attendant can be paid for work up until the results were received or no more than 30 days after the start date.

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Consumer ID: Consumer Name: Employer of Record (EOR) Name: This form must be signed and sent to PPL if you decide to hire an attendant that has been convicted of a non-barrier crime. As an employer, I have the right to choose to hire and employ an attendant who I know has been convicted of a crime. If the employee has been convicted of barrier crimes, I cannot hire him/her per Section 32.1-162.9:1, §63.2-1719, and §37.2-314 of the Code of Virginia and Virginia regulations 12 VAC 30-120-770. Barrier crimes can change at any time. A list of the barrier crimes can be found in Frequently Asked Questions in this Packet. By choosing to hire an attendant who has been convicted of a non-barrier crime: I understand this decision and the consequences are my sole responsibility. In making any and all hiring decisions as an employer, I agree to hold harmless from any claims and responsibility the Department of Medical Assistance Services, the Service Facilitator that I have chosen, and Public Partnerships, LLC. Attendant/Employee:

Print Name

Employer Signature: Date: Send the completed form to PPL. Mail: Public Partnerships, LLC Fax: 1-866-709-3319 VA DMAS Consumer-Directed Services Program 4991 Lake Brook Drive, Suite G90 Glen Allen, VA 23060

REVISED: January 2013

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General Program Questions What does the Employer of Record (EOR) mean? The EOR is the person who will Can the Consumer be the EOR? Yes, either you or someone you designate can be the EOR. What do I need to do as the Employer As the Employer you will,

• Review the Employer/Employee agreement• Sign all Employer of Recor• Sign all Attendant paperwork• Monitor the Attendant• Approve timesheets and submit sig• Keep track of authorized services used• Establish schedules and tasks • Hire, supervise, and discontinue employment of the

PPL will,

• Perform a criminal background check on • Perform child abuse and neglect background checks on prospective

care to individuals under the age of 18• Perform required state and federal background and employment eligibility checks on

Attendants • Issue wages using direct deposit

card of the Attendant’s • Withhold state and federal • File monthly, quarterly, and annual tax deposits• Issue a W-2 Wage Statement • Provide the Quarterly Service Report (QSR

authorizations • Answer questions about enrol• Help you and your Attendant

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General Program Questions

What does the Employer of Record (EOR) mean?

The EOR is the person who will employ the Attendants working to provide authorized services

Consumer be the EOR?

Yes, either you or someone you designate can be the EOR.

do I need to do as the Employer?

the Employer/Employee agreement with each Attendant Sign all Employer of Record tax paperwork

ttendant paperwork Monitor the Attendant’s work

and submit signed timesheets to PPL for each Aauthorized services used

Establish schedules and tasks for each Attendant in line with the plan of carediscontinue employment of the Attendants.

Perform a criminal background check on all Attendants Perform child abuse and neglect background checks on prospective

individuals under the age of 18 Perform required state and federal background and employment eligibility checks on

direct deposit to your Attendant’s checking or savings account,ttendant’s choice, or the PPL Debit Card

federal taxes and other withholdings for each AttendantFile monthly, quarterly, and annual tax deposits and forms with state and federal agencies

2 Wage Statement to each Attendant in January every yearthe Quarterly Service Report (QSR) four times a year to review

about enrollment, timesheets, and payments Attendant with the enrollment process through Customer Service.

eedd QQuueessttiioonnss

to provide authorized services.

ned timesheets to PPL for each Attendant

ttendant in line with the plan of care

Perform child abuse and neglect background checks on prospective Attendants providing

Perform required state and federal background and employment eligibility checks on

checking or savings account, debit

Attendant with state and federal agencies

ttendant in January every year to review your service

ough Customer Service.

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What do I need to do first? Review and sign all required forms. Once completed, PPL. What is a Web Portal? PPL has an online system for review your service authorization useinformation is in your Information Packet on page Where can I find out more information on the PPL Web Portal You can visit the Public Partnershipthe internet browser. Scroll to the middle of the screen. Answer User Name password is pcgva67. Learning tutorials are located website. How does the consumer change All consumer address changes must be reported to the Please contact your eligibility worker to address automatically. Can the consumer change the Yes, PPL can accept the consumer’s phone number and email address changes. page 9 of this packet. Can the Employer of Record change their records with PPL? Yes, The Employer of Record (if different than the consumer) change. To change your information you can

• Send the change form to PPL using the form on PPL’s websithttps://www.publicpartnerships.com//Name vaclient. The password is

• The form can also be found on page 10

• Calling customer service to have a form sent to you.


all required forms. Once completed, fax or mail the EOR Tax Forms

PPL has an online system for employers to track timesheets, approve or rejectreview your service authorization use and patient pay requirements. PPL Web Portal access information is in your Information Packet on page 25.

Where can I find out more information on the PPL Web Portal

You can visit the Public Partnership’s website. Type https://www.publicpartnerships.com//Scroll to the middle of the screen. Answer User Name

are located at the bottom of the screen at “How To Guides” on the PPL

change an address with PPL?

changes must be reported to the local Department of Social Services. Please contact your eligibility worker to report address changes. PPL will receive

the phone number and email address with PPL?

Yes, PPL can accept the consumer’s phone number and email address changes.

Can the Employer of Record change their records with PPL?

Yes, The Employer of Record (if different than the consumer) can notify PPL of To change your information you can -

Send the change form to PPL using the form on PPL’s website at https://www.publicpartnerships.com//. Scroll to the middle of the screen. Answer User

The password is pcgva67.

form can also be found on page 10 of this packet.

customer service to have a form sent to you.


EOR Tax Forms back to

approve or reject timesheets and PPL Web Portal access

https://www.publicpartnerships.com// into Scroll to the middle of the screen. Answer User Name vaclient. The

Guides” on the PPL

Department of Social Services. PPL will receive the new

phone number and email address with PPL?

Yes, PPL can accept the consumer’s phone number and email address changes. Use the form on

notify PPL of an address

. Scroll to the middle of the screen. Answer User

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What if the consumer loses Medicaid/Waiver Eligibility? You should contact your local Department of Social ServiService Facilitator. The consumer is in a Nursing Facili No, the Attendant cannot be paid to provide care while the consumer is receivin-patient setting. Will I be required to pay for services out of my own pocket? All payroll related expenses are funded using wages, employer payroll taxes, DMAS will not pay for services not meeting requirements, such as but not limited to

• Medicaid or Waiver ineligibility• an Attendant has failed a criminal histor• an Attendant has failed a child a• an Attendant is named in the federal List of excluded• the Attendant worked over authorized service hours.• timesheets were not submitted to PPL before 1 year of the date worked

The consumer will be responsible for paying the patient pay as determined by the Department of Social Services. What is the Employer/Employee Agreement You must review the Employer/Employee Agreement found in the Attendant Forms packet. This document needs to be signed and dated by the Attendant and you before PPL can issue a paycheckwage rate, and conditions of employment. What if I do not understand how to complete the PPL paperwork? Call PPL Customer Service (866) 259completion of paperwork. PPL also providers interpreter service by calling our Customer Service line.


What if the consumer loses Medicaid/Waiver Eligibility?

You should contact your local Department of Social Services (DSS) eligibility worker

The consumer is in a Nursing Facility, can the Attendant be paid?

ttendant cannot be paid to provide care while the consumer is receiv

Will I be required to pay for services out of my own pocket?

All payroll related expenses are funded using Medicaid funds. These expenses include wages, employer payroll taxes, and unemployment insurance.

DMAS will not pay for services not meeting requirements, such as but not limited to

aiver ineligibility ttendant has failed a criminal history check due to a barrier crimettendant has failed a child abuse and neglect records check ttendant is named in the federal List of excluded Individuals/ Entities databasettendant worked over authorized service hours.

imesheets were not submitted to PPL before 1 year of the date worked

The consumer will be responsible for paying the patient pay as determined by the Department of

Employer/Employee Agreement

the Employer/Employee Agreement with each Attendant. The agreement is found in the Attendant Forms packet. This document needs to be signed and dated by the Attendant and you before PPL can issue a paycheck. The agreement will establish a hire date, wage rate, and conditions of employment.

What if I do not understand how to complete the PPL paperwork?

PPL Customer Service (866) 259-3009 (toll free) – Customer Service staff will assist in paperwork. PPL also providers interpreter service by calling our Customer


ces (DSS) eligibility worker or your

ttendant cannot be paid to provide care while the consumer is receiving services in an

funds. These expenses include Attendant

DMAS will not pay for services not meeting requirements, such as but not limited to:

y check due to a barrier crime

Individuals/ Entities database

imesheets were not submitted to PPL before 1 year of the date worked.

The consumer will be responsible for paying the patient pay as determined by the Department of

with each Attendant. The agreement is found in the Attendant Forms packet. This document needs to be signed and dated by the

The agreement will establish a hire date,

Customer Service staff will assist in paperwork. PPL also providers interpreter service by calling our Customer

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Why do I need to sign the USCIS Form I The United States Citizenship and Immigration Services (USCIS) is a department within Homeland Security. Federal law requires all employers (you) to complete the IAttendants. You must look at theinstructions on how to completemust be signed within 3 days of employment. Attendants should not start work without this completed form. Do my Attendants have to complete paperwork? The Attendant must complete an application form. The form Attendant can complete the application online athttps://fms.publicpartnerships.com/PPLPortal/Login.aspx?vadmasApplication” under the Resource section on the right side. PPL will send the Attendant Enrollment Forms Packet after the application has been received and processed by PPL. What if I no longer want an You can tell your Attendant that you no longer wish to have services provided by PPL the Notice of Discontinuation of Employment form found on page

Will the IRS or Virginia Department of Taxation send me Now that you are an employer you may receive letters or formthe IRS, Virginia Department of Taxation, and Virginia Employment Commission. PPL asks for these letters to be sent to PPL but they may letters are for information only and Customer Service, you may be asked to fax or mail the form to us. What taxes are withheld for each of my Attendants? Most people must pay taxes. Withholdings include Social Security, Medicare (FICA), and income taxes (federal and state) for each paycheck. Withholdings are based on the tax exemption status the Attendantthe Attendant’s pay stub. PPL will


Why do I need to sign the USCIS Form I-9 for my Attendant?

The United States Citizenship and Immigration Services (USCIS) is a department within y. Federal law requires all employers (you) to complete the I

Attendants. You must look at the Attendant’s identification before signing the form. The on how to complete the form are in the Attendant Information Packet. This

must be signed within 3 days of employment. Attendants should not start work without this

Do my Attendants have to complete paperwork?

must complete an application form. The form is found in this packet or the ant can complete the application online at:

https://fms.publicpartnerships.com/PPLPortal/Login.aspx?vadmas. Click on “Attendant Application” under the Resource section on the right side.

PPL will send the Attendant Enrollment Forms Packet after the application has been received

an Attendant to work for me?

ttendant that you no longer wish to have services provided by Notice of Discontinuation of Employment form found on page 12

Tax Questions

Department of Taxation send me letters?

ow that you are an employer you may receive letters or forms. These letters may come from the IRS, Virginia Department of Taxation, and Virginia Employment Commission. PPL asks for these letters to be sent to PPL but they may be sent to the address of the employer. Most of letters are for information only and you do not need to act. If you have questions

, you may be asked to fax or mail the form to us.

What taxes are withheld for each of my Attendants?

ople must pay taxes. Withholdings include Social Security, Medicare (FICA), and income taxes (federal and state) for each paycheck. Withholdings are based on the tax

ttendant selected on the tax paperwork. A list of withholdings wipay stub. PPL will mail the W-2 Wage Statement in January.


The United States Citizenship and Immigration Services (USCIS) is a department within y. Federal law requires all employers (you) to complete the I-9 for your new

identification before signing the form. The the form are in the Attendant Information Packet. This form

must be signed within 3 days of employment. Attendants should not start work without this

is found in this packet or the

Click on “Attendant

PPL will send the Attendant Enrollment Forms Packet after the application has been received

ttendant that you no longer wish to have services provided by him/her. Send of this packet.

. These letters may come from the IRS, Virginia Department of Taxation, and Virginia Employment Commission. PPL asks for

dress of the employer. Most of the do not need to act. If you have questions, call PPL

ople must pay taxes. Withholdings include Social Security, Medicare (FICA), and income taxes (federal and state) for each paycheck. Withholdings are based on the tax

selected on the tax paperwork. A list of withholdings will be on 2 Wage Statement in January.

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Does the Employer of Record pay taxes? DMAS will pay the employer’sMedicare (FICA) taxes and federal and state unemployment insurance As your agent, PPL will complete all paperwork.

When can the Attendant start getting paid? PPL can start paying your Attendants

1. Service Authorization is active

2. Employer is eligible for Medicaid and Waiver services.

3. Employer of Record Enrollment and an Employer Identification Number (EIN) has been issued

4. Attendant Enrollment

Who is responsible for submitting timesheets to PPL? As the employer, you will approve and and submit the Attendant’s final timesh What is a payroll schedule? Depending on where the consumer lives, you will use Schedule A or Schedule B. The schedis in this packet on page 29 or 30 Customer Service. Schedule A – Central and Tidewater regionsSchedule B – Northern, Piedmont and Southwest regions


the Employer of Record pay taxes?

’s portion of taxes. Employers must pay Social Security and federal and state unemployment insurance taxes

As your agent, PPL will complete all paperwork.

Payroll Questions

start getting paid?

Attendants once the following has been completed

Service Authorization is active.

Employer is eligible for Medicaid and Waiver services.

Enrollment Forms Packet has been received, all and an Employer Identification Number (EIN) has been issued.

Forms Packet has been received and all forms are

Who is responsible for submitting timesheets to PPL?

approve and submit timesheets to PPL. You will also review, signttendant’s final timesheet upon Discontinuation of Employment.

Depending on where the consumer lives, you will use Schedule A or Schedule B. The schedor 30 – please use the pay schedule for your area. If unsure cal

Central and Tidewater regions Northern, Piedmont and Southwest regions


Social Security and taxes for each Attendant.

once the following has been completed:

all forms are complete,

forms are complete.

You will also review, sign, eet upon Discontinuation of Employment.

Depending on where the consumer lives, you will use Schedule A or Schedule B. The schedule please use the pay schedule for your area. If unsure call PPL

of 32

What is E-Timesheet? The employer and the Attendantinformation is in this packet on page What is a Patient Participation Deduction The Patient Participation deduction is the services. Not all consumers have a patient pay. Attendant for this deduction. deduction, on the paystub, to receive reimbursement How will PPL deduct my Patient Pay while I am in the ConsumerProgram? Patient pay, determined by the pay check of the first Attendant paid each month.containing the first day of each month. How can I submit a Complai Complaints can be made by phone fax, email, mail or in

o PPL Customer Service (866) 259

o Fax: 1-804-665-2152o Email: [email protected] Mail/In-Person:

Public Partnerships, LLC4991 Lake Brook Drive, Ste G90Glen Allen, VA 23060

PPL will attempt to contact you will review and take steps to resolve your complaint writing, within 5 business days Department of Medical Assistance Services appeal process The Department of Medical Assistance Services (DMAS) Individuals to appeal decisions made by DMAS and its contractors.


Attendant can submit timesheets through our Web Portal. Eis in this packet on page 26.

hat is a Patient Participation Deduction (Patient Pay)?

The Patient Participation deduction is the amount the consumer must pay each month for Not all consumers have a patient pay. The EOR is responsible for reifor this deduction. The Attendant will need to show the EOR a copy of the patient pay

to receive reimbursement.

How will PPL deduct my Patient Pay while I am in the Consumer-Directed Services

by the local Department of Social Services, will be deducted from the ttendant paid each month. Patient pay is deducted from the pay period

containing the first day of each month.

n I submit a Complaint to PPL?

phone fax, email, mail or in-person.

PPL Customer Service (866) 259-3009 (toll free)

2152 [email protected]

Partnerships, LLC 4991 Lake Brook Drive, Ste G90 Glen Allen, VA 23060

PPL will attempt to contact you by phone within 1 business day of receiving the steps to resolve your complaint within 3 business days

within 5 business days, to written complaints.

Department of Medical Assistance Services appeal process.

The Department of Medical Assistance Services (DMAS) offers a process for Medicaid Individuals to appeal decisions made by DMAS and its contractors.


through our Web Portal. E-Timesheet

amount the consumer must pay each month for is responsible for reimbursing the

a copy of the patient pay

Directed Services

ill be deducted from the atient pay is deducted from the pay period

receiving the complaint. PPL within 3 business days. PPL will respond in

a process for Medicaid

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Who can submit an LEIE Appeal? An LEIE appeal may be sent, to DMAS, by the Medicaid Individual What can I Appeal? You may appeal an Attendant’s excluded by the United States Department of Health and Human Services, Office of Inspector General (HHS-OIG) from working Medicaid payments cannot be made Excluded Individuals/Entities (LEIE) How will I know if my Attendant has been excluded from participation in federal health care programs? PPL will mail you a letter if the Afederal List of Excluded Individuals/Entities (LEIE) database. How can I submit an LEIE Appeal to DMAS? LEIE Appeals can be sent in writing to Fax: 1-804-371-8491 Mail: Appeals Division

Department of Medical Assistance Services600 E. Broad Street Richmond, Virginia 23219(804) 371-8488

Appeals must be received by DMAS within 30 days from the date on tdenying the Attendant’s employment. Where can I find more information? You can find more information http://www.dmas.virginia.gov/Content_pgs/appeal You can find more information about the LEIE database on the HHSwww.oig.hhs.gov under “Exclusions Program”


Appeal?

, to DMAS, by the Medicaid Individual.

endant’s denial of employment, by PPL, if the Attendant has beenexcluded by the United States Department of Health and Human Services, Office of Inspector

working in all federal health care programs.

Medicaid payments cannot be made to an excluded person who is named in the federal ListExcluded Individuals/Entities (LEIE) database kept by HHS-OIG.

ttendant has been excluded from participation in federal health

will mail you a letter if the Attendant is denied employment due to being named in the federal List of Excluded Individuals/Entities (LEIE) database.

Appeal to DMAS?

in writing to DMAS by fax or mail.

Medical Assistance Services

Richmond, Virginia 23219

Appeals must be received by DMAS within 30 days from the date on the letter frottendant’s employment.

Where can I find more information?

You can find more information about appeals on the DMAS website URL http://www.dmas.virginia.gov/Content_pgs/appeal-home.aspx

You can find more information about the LEIE database on the HHS-OIG website URLunder “Exclusions Program”


ttendant has been excluded by the United States Department of Health and Human Services, Office of Inspector

n the federal List of

ttendant has been excluded from participation in federal health

being named in the

he letter from PPL

on the DMAS website URL -

OIG website URL-

of 32

What background checks are completed on the

PPL will complete the following background checks on

• Criminal Background Record Checkhired to work in the program.

• List of Excluded Individuals/Entities (LEIE). The United States Department of Health and Human Services, Office of Inspector General (HHSlist has names of peoplelicensing board actions.

• Child Protective Services (CPS) Request for Search of the Services Central RegistryAttendant must complete the release of information form.

What is a Criminal History Background Check? This background check is a list of What is a Barrier Crime? Virginia laws define barrier crimerisk groups such as children, elderly and What crimes are considered Barrier Crimes? The barrier crimes list is defined by and Virginia regulations 12 VAC 30 1. Murder or manslaughter as set out in Article 1 (§2. Malicious wounding by mob as set out in §3. Abduction as set out in subsection A of §4. Abduction for immoral purpose5. Assaults and bodily wounding as set out in Article 4 (§

18.2 6. Robbery as set out in § 18.27. Carjacking as set out in § 18.28. Extortion by threat, as set out in § 9. Threats of death or bodily injury as set out in §


Background Checks

What background checks are completed on the Attendants?

plete the following background checks on Attendants

Criminal Background Record Check. Attendants convicted of barrierhired to work in the program. List of Excluded Individuals/Entities (LEIE). The United States Department of Health and Human Services, Office of Inspector General (HHS-OIG) maintains the LEIE. The

of people with findings of program-related fraud, patient abuse, or nsing board actions.

Child Protective Services (CPS) Request for Search of the Virginia Department of Social Central Registry. If the consumer is an individual under the age of 18,

ttendant must complete the release of information form.

t is a Criminal History Background Check?

list of criminal convictions by Attendants.

rimes that prevent a person with certain convictrisk groups such as children, elderly and persons with intellectual disabilities.

What crimes are considered Barrier Crimes?

defined by the Code of Virginia §37.2-314, §37.2-egulations 12 VAC 30-120-770. Barrier crimes are subject to change

Murder or manslaughter as set out in Article 1 (§18.2-30 et seq.) of Chapter 4 of Title 18.2by mob as set out in §18.2-41

Abduction as set out in subsection A of §18.2-47 Abduction for immoral purposes as set out in § 18.2-48 Assaults and bodily wounding as set out in Article 4 (§18.2-51 et seq.) of Chapter

18.2-58 18.2-58.1

as set out in § 18.2-59 Threats of death or bodily injury as set out in § 18.2-60


barrier crimes cannot be

List of Excluded Individuals/Entities (LEIE). The United States Department of Health OIG) maintains the LEIE. The

related fraud, patient abuse, or

Virginia Department of Social an individual under the age of 18, the

convictions to work with at with intellectual disabilities.

-416, or §32.1-162.9:1 subject to change.

et seq.) of Chapter 4 of Title 18.2

et seq.) of Chapter 4 of Title

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10. Felony stalking as set out in § 11. Sexual assault as set out in Article 7 (§ 12. Arson as set out in Article 1 (§ 13. Burglary, as set out in Article 2 (§ 14. Any felony violation relating to distribution of drugs, as set out in Article 1 (§

seq.) of Chapter 7 of Title 18.215. Drive by shooting as set out in § 16. Use of a machine gun in a crime of violence as set out in § 17. Aggressive use of a machine gun as set out in § 18. Use of a sawed-off shotgun in a crime of violence as set out in subsection A of § 19. Pandering as set out in § 18.220. Crimes against nature involving children as set out in § 21. Incest as set out in § 18.2-22. Taking indecent liberties with children as set out in § 23. Abuse and neglect of children as set out in § 24. Failure to secure medical attention for an injured child as set out in § 25. Obscenity offenses as set out in § 26. Possession of child pornography as set out in § 27. Electronic facilitation of pornography as set out in 28. Incest, as set out in § 18.2-29. Abuse and neglect of incapacitated adults as set out in § 30. Employing or permitting a minor to assist in an act constituting an offense under Article 5 (§

18.2-372 et seq.) of Chapter 8 of Title 18.2 as set out in § 31. Delivery of drugs to prisoners as set out in § 32. Escape from jail as set out in § 33. Felonies by prisoners as set out in § 34. In the case of child welfare agencies and foster and adoptive homes approved by child

placing agencies "Barrier crime" shall also include convictions of burglary as set out in Article 2 (§ 18.2-89 et seq.) of Chapter 5 of Title 18.2 and any felony violation relating to possession or distribution of drugs as set out in Article 1 (§ Title 18.2, or an equivalent offense in another state;

a. (ii) convicted of any felony violation relating to possession of drugs, as set out in Article 1 (§ 18.2-247application date for employment; or (iii) convicted of any felony violation relating to possession of drugs, as set out in Article 1 (§ 18.2, and continue on probation or parole or have failed to pay required court costs.


Felony stalking as set out in § 18.2-60.3 Sexual assault as set out in Article 7 (§ 18.2-61 et seq.) of Chapter 4 of Title 18.2Arson as set out in Article 1 (§ 18.2-77 et seq.) of Chapter 5 of Title 18.2Burglary, as set out in Article 2 (§ 18.2-89 et seq.) of Chapter 5 of Title 18.2Any felony violation relating to distribution of drugs, as set out in Article 1 (§

er 7 of Title 18.2 Drive by shooting as set out in § 18.2-286.1 Use of a machine gun in a crime of violence as set out in § 18.2-289 Aggressive use of a machine gun as set out in § 18.2-290

off shotgun in a crime of violence as set out in subsection A of § 18.2-355

Crimes against nature involving children as set out in § 18.2-361 -366

Taking indecent liberties with children as set out in § 18.2-370 or § 18.2Abuse and neglect of children as set out in § 18.2-371.1 Failure to secure medical attention for an injured child as set out in § 18.2Obscenity offenses as set out in § 18.2-374.1 Possession of child pornography as set out in § 18.2-374.1:1 Electronic facilitation of pornography as set out in § 18.2-374.3

-366 Abuse and neglect of incapacitated adults as set out in § 18.2-369 Employing or permitting a minor to assist in an act constituting an offense under Article 5 (§

et seq.) of Chapter 8 of Title 18.2 as set out in § 18.2-379 Delivery of drugs to prisoners as set out in § 18.2-474.1 Escape from jail as set out in § 18.2-477 Felonies by prisoners as set out in § 53.1-203; or an equivalent offense in another stateIn the case of child welfare agencies and foster and adoptive homes approved by childplacing agencies "Barrier crime" shall also include convictions of burglary as set out in

et seq.) of Chapter 5 of Title 18.2 and any felony violation relating to possession or distribution of drugs as set out in Article 1 (§ 18.2-247 et seq.) of Chapter 7 of Title 18.2, or an equivalent offense in another state;

(ii) convicted of any felony violation relating to possession of drugs, as set out in 247 et seq.) of Chapter 7 of Title 18.2, in the five years prior to the

application date for employment; or (iii) convicted of any felony violation relating to possession of drugs, as set out in Article 1 (§ 18.2-247 et seq.) of Chapter 7 of Title 18.2, and continue on probation or parole or have failed to pay required court costs.


apter 4 of Title 18.2 et seq.) of Chapter 5 of Title 18.2

et seq.) of Chapter 5 of Title 18.2 Any felony violation relating to distribution of drugs, as set out in Article 1 (§ 18.2-247 et

off shotgun in a crime of violence as set out in subsection A of § 18.2-300

18.2-370.1

18.2-314

Employing or permitting a minor to assist in an act constituting an offense under Article 5 (§

; or an equivalent offense in another state In the case of child welfare agencies and foster and adoptive homes approved by child-placing agencies "Barrier crime" shall also include convictions of burglary as set out in

et seq.) of Chapter 5 of Title 18.2 and any felony violation relating to et seq.) of Chapter 7 of

(ii) convicted of any felony violation relating to possession of drugs, as set out in et seq.) of Chapter 7 of Title 18.2, in the five years prior to the

application date for employment; or (iii) convicted of any felony violation relating to et seq.) of Chapter 7 of Title

18.2, and continue on probation or parole or have failed to pay required court costs.

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Can I hire someone who has been convicted of a Barrier Crime? No. If the criminal history record check finds the cannot receive Medicaid payment to work for you. How will PPL identify a Barrier Crime? PPL will request records from the VA S What is the Department of Social Services/Child Protective Services Central Registry? This registry contains information on people who have local Department of Social Services abuse/neglect. Can I hire someone who has No. If the Child Protective Services Central Registry record check finds the Attendant has a finding of child abuse/neglect, the Attendant cannot receive Medicaid This check will only be performed if the consumer is a minor. What is the LEIE? The List of Excluded Individuals/Entities (LEIE) database is maintained by the Office of Inspector General. This list has Medicare or Medicaid programThese persons cannot receive Medicaid funds for payment. go to www.oig.hhs.gov/fraud/exclusions.asp How often will PPL review the LEIE listing? PPL will conduct an LEIE background check on all new a month to comply with federal law.


Can I hire someone who has been convicted of a Barrier Crime?

No. If the criminal history record check finds the Attendant has been convictedcannot receive Medicaid payment to work for you.

How will PPL identify a Barrier Crime?

ll request records from the VA State Police.

Department of Social Services/Child Protective Services Central Registry?

This registry contains information on people who have findings of child abuse/neglect local Department of Social Services in which the Attendant has been identified as res

Can I hire someone who has finding of child abuse/neglect?

No. If the Child Protective Services Central Registry record check finds the Attendant has a finding of child abuse/neglect, the Attendant cannot receive Medicaid payment to work for you.This check will only be performed if the consumer is a minor.

The List of Excluded Individuals/Entities (LEIE) database is maintained by the Office of Inspector General. This list has names of people who have been convicted of crimes related to Medicare or Medicaid programs, patient abuse, and actions taken by a State licensing authority. These persons cannot receive Medicaid funds for payment. If you would like more information

www.oig.hhs.gov/fraud/exclusions.asp.

How often will PPL review the LEIE listing?

conduct an LEIE background check on all new Attendants and on every Awith federal law.


has been convicted, the Attendant

Department of Social Services/Child Protective Services Central Registry?

of child abuse/neglect made by a been identified as responsible for

No. If the Child Protective Services Central Registry record check finds the Attendant has a payment to work for you.

The List of Excluded Individuals/Entities (LEIE) database is maintained by the Office of have been convicted of crimes related to

, patient abuse, and actions taken by a State licensing authority. If you would like more information

and on every Attendant once

of 32

How can I submit and approve my attendant’s timesheet? You can submit the timesheet using the PPL Web Portal or submit a paper timesheet. What do I need to approve t

1. PPL Payroll Schedule, this is found on pay schedule for the area where you live

2. Electronic Timesheet Instructions are3. Paper Timesheet Instructions are found on

What if my attendant’s timesheet i If the Attendant’s timesheet is rejected or cannot be processed, PPL provides updates on this information through online access using the Web Portal. If the EOR or Attendant doaccess to a computer, PPL provides this information through use of the interactive voice response (IVR) system or will notify using an automated call (Blaze) to the telephone number provided by the Attendant. Using the PPL Web Portal Use your home computer or a public computer. Public computcommunity centers.

1. Type https://fms.publicpartnerships.com/pplportal/Login.aspx?vadmassearch.

2. Click “Online User Registrationfollowing:

• State: • Program: • Role:

3. Enter your Consumer ID Number

• If you enrolled in the ConsumerConsumer ID Number is your Medicaid ID number

• If you enrolled in the ConsumerConsumer ID number is the number PPL assigned to you starti

4. Create a user name. The user name must be six (6) characters long and have 1 (one)

letter and 1 (one) number.

How can I submit and approve my attendant’s timesheet?

You can submit the timesheet using the PPL Web Portal or submit a paper timesheet.

approve time?

PPL Payroll Schedule, this is found on page 29 and 30 of this packetpay schedule for the area where you live – if unsure call PPL)

Instructions are found on page 26 of this packetPaper Timesheet Instructions are found on page 26 of this packet.

my attendant’s timesheet is rejected or cannot be processed?

If the Attendant’s timesheet is rejected or cannot be processed, PPL provides updates on this information through online access using the Web Portal. If the EOR or Attendant doaccess to a computer, PPL provides this information through use of the interactive voice response (IVR) system or will notify using an automated call (Blaze) to the telephone number

home computer or a public computer. Public computers can be found at the library or

https://fms.publicpartnerships.com/pplportal/Login.aspx?vadmas

Click “Online User Registration.” You will be asked a few question

Virginia VA DMAS FI Program Consumer

ID Number, your mailing zip code, and your last name.nrolled in the Consumer-Directed Services Program before July 2011, the

Consumer ID Number is your Medicaid ID number If you enrolled in the Consumer-Directed Services Program after July 2011, the Consumer ID number is the number PPL assigned to you starti

Create a user name. The user name must be six (6) characters long and have 1 (one) letter and 1 (one) number.

PPuubblliicc PPaarrttnn

TTiimmeesshheeeett

You can submit the timesheet using the PPL Web Portal or submit a paper timesheet.

of this packet (select the correct

of this packet.

If the Attendant’s timesheet is rejected or cannot be processed, PPL provides updates on this information through online access using the Web Portal. If the EOR or Attendant do not have access to a computer, PPL provides this information through use of the interactive voice response (IVR) system or will notify using an automated call (Blaze) to the telephone number

ers can be found at the library or

https://fms.publicpartnerships.com/pplportal/Login.aspx?vadmas within the internet

” You will be asked a few questions. Enter the

, your mailing zip code, and your last name. Directed Services Program before July 2011, the

Directed Services Program after July 2011, the Consumer ID number is the number PPL assigned to you starting with a C.

Create a user name. The user name must be six (6) characters long and have 1 (one)

nneerrsshhiippss,, LLLLCC

IInnffoorrmmaattiioonn

of 32

Mail: PublAttn: 4991 Lake Brook Drive, Suite G90Glen Allen, VA 23060

Fax: 1

Review the E-Timesheet instructions onPortal. You can also learn more about ehttps://www.publicpartnerships.com// E-Timesheet Instructions Once you have logged into the PPL Web Portal, you can

1. Click “Timesheet List”2. Within the Timesheet Status dropdown 3. Select “View” next to the timesheet you would like to review to approve or reject.4. Once you have reviewed the timesheet for the correct hours submitted by the attendant

you are ready to either Approve or Reject the timesheet5. On the Search screen, click “Approve/Reject”6. Check the box next to “I hereby certify…”

a. Click “Approve” the timesheet will be submitted to PPL.OR b. Click “Reject”

rejected timesheet will be sent back t Electronic Timesheets must be sent prior to 5PM Tuesday after the end of the pay period. If your timesheet is sent after the deadline, it will be processed the following week. Using Paper Timesheets Paper timesheets can be faxed or mailed to PPL.

Paper Timesheet Instructions Make sure to look at the fax machine you areplaced Face Up and some require that right, it will delay your payment Timesheets must be sent prior to the 5PM Friday payroll deadline for timely payroll processing. If your timesheet is sent after the deadline, it will be processed the following week.


TTiimmeesshheeeett

Public Partnerships, LLC Attn: DMAS Consumer-Directed Services 4991 Lake Brook Drive, Suite G90 Glen Allen, VA 23060 1-888-564-1532

Timesheet instructions on page 26 for approving timesheets Portal. You can also learn more about e-timesheets by reviewing the online tutorials at https://www.publicpartnerships.com//

Once you have logged into the PPL Web Portal, you can approve your timesheets.

” Within the Timesheet Status dropdown menu, select “Submitted” Select “View” next to the timesheet you would like to review to approve or reject.Once you have reviewed the timesheet for the correct hours submitted by the attendant you are ready to either Approve or Reject the timesheet

Search screen, click “Approve/Reject” Check the box next to “I hereby certify…”

Click “Approve” the timesheet will be submitted to PPL.

Click “Reject” You will need to select a rejection reason and add notes. The rejected timesheet will be sent back to the attendant to make corrections.

Electronic Timesheets must be sent prior to 5PM Tuesday after the end of the pay period. If your timesheet is sent after the deadline, it will be processed the following week.

Paper timesheets can be faxed or mailed to PPL.

Paper Timesheet Instructions:

fax machine you are using. Some fax machines require and some require that the document is placed Face Down. If you do not do this

it will delay your payment because PPL may receive a blank page.

be sent prior to the 5PM Friday payroll deadline for timely payroll processing. If your timesheet is sent after the deadline, it will be processed the following week.




using the PPL Web timesheets by reviewing the online tutorials at

your timesheets.

Select “View” next to the timesheet you would like to review to approve or reject. Once you have reviewed the timesheet for the correct hours submitted by the attendant

ou will need to select a rejection reason and add notes. The o the attendant to make corrections.

Electronic Timesheets must be sent prior to 5PM Tuesday after the end of the pay period. If your timesheet is sent after the deadline, it will be processed the following week.

Some fax machines require the document is . If you do not do this

be sent prior to the 5PM Friday payroll deadline for timely payroll processing. If your timesheet is sent after the deadline, it will be processed the following week.

of 32

Use AM and PM correctly. AM Starts at midnight and goes until 1 minute before nostarts at noon and goes until 1 minute before midnight. Use thno delay in your pay. Need additional timesheets? You can download a personal timesheet on the PPL Web Portal. instructions on page 25. Once you have logged into the PPL Web Portal, click on “Print Forms”. You can also call Customer Service. Special Situations When your attendant works overnight, midnight and another line for work When the attendant works multiple times in one dayline. For example – Start work at 9AM and leave work at 10:30AM. This will be one line item. Return to work at 12:00PM and leave work again at 2:00PM. This will be your second line item for the day. Helpful Information when reviewing

Always Always use black ink. Always stay inside the lines and boxes.Always write clear. Always complete 1 timesheet per consumer.

Always complete a timesheet for each service type.Always sign the timesheet, the employer and attendant must sign and date the timesheet. Always complete all required boxes.Always use 2 lines when an attendant starts and stops work 2 times in the same day. Always use AM and PM correctly. Always follow the fax machine instructions.

Always fax your signed timesheet on time. Follow your Payroll A or Payroll B schedule.


TTiimmeesshheeeett

Use AM and PM correctly. AM Starts at midnight and goes until 1 minute before nostarts at noon and goes until 1 minute before midnight. Use the chart below

Need additional timesheets?

You can download a personal timesheet on the PPL Web Portal. Follow the PPL Web Portal . Once you have logged into the PPL Web Portal, click on “Print Forms”.

ervice.

overnight, he/she must complete one line for work midnight and another line for work completed after midnight.

multiple times in one day, the start time should be enteredtart work at 9AM and leave work at 10:30AM. This will be one line item.

eturn to work at 12:00PM and leave work again at 2:00PM. This will be your second line item

reviewing the timesheet

Do NotDo not use pencil or color ink.

Always stay inside the lines and boxes. Do not use military time. Do not round time.

Always complete 1 timesheet per consumer. Do not use the same timesheet for more than 1 consumer.

Always complete a timesheet for each service type. Do not use the same timesheet for more than 1 service.Always sign the timesheet, the employer and attendant Do not use other timesheets.

required boxes. Do not write on the edges of the boxes.Always use 2 lines when an attendant starts and stops Do not cross out information if you make a mistake.

Start a new timesheet. Do not write notes on the timesheet.

Always follow the fax machine instructions. Do not forget to fill in the Attendant and Consumer Name, ID, and Service Type.

Always fax your signed timesheet on time. Follow your Do not use whiteout.


TTiimmeesshheeeett



Use AM and PM correctly. AM Starts at midnight and goes until 1 minute before noon. PM below to make sure there is

Follow the PPL Web Portal . Once you have logged into the PPL Web Portal, click on “Print Forms”.

must complete one line for work completed before

should be entered on a new tart work at 9AM and leave work at 10:30AM. This will be one line item.

eturn to work at 12:00PM and leave work again at 2:00PM. This will be your second line item

Do Not Do not use pencil or color ink.

Do not use the same timesheet for more than 1

Do not use the same timesheet for more than 1 service.

Do not write on the edges of the boxes. Do not cross out information if you make a mistake.

write notes on the timesheet. Do not forget to fill in the Attendant and Consumer



of 32

Please ensure all of the below required fields are

Timesheet Item NameAttendant’s Name Consumer’s Name PPL Attendant ID

Consumer’s ID Number

Service Type

Begin and End Date

Time In/Time Out

AM/PM

Total Hours

Date of Attendant Signature Attendant Signature Consumer or EOR Signature

Date of Consumer or EOR Signature


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ensure all of the below required fields are complete and accurate

Timesheet Item Name Required InformationName of the person providing servicesName of the person who receives the servicesThis is your Attendant ID number. This number either starts with the first four letters of your last name or with the letter E. This is the PPL Consumer ID number. If services started before July 2011, it is the If services started after July 2011, it is the C number assigned. Fill in the circle next to the service you are performing. If you provide more than one (1) type of service, use a separate timesheet. This is the first and last day of the pay period. Use your payroll schedule to complete these dates.Time In is the time you start services.Time Out is the time you stop services.Fill in the circle next to the Time In and Time indicates if you worked in the morning or the evening.Enter in the total number of hours worked. Do not round time. Write the exact time.Date the person providing services signed the timesheet.This is the signature of the person providing services.This is the signature of the person receiving services or the employer of record.

Date of Consumer or EOR Signature Date the person receiving services or record signed the timesheet.



and accurate

Required Information Name of the person providing services Name of the person who receives the services This is your Attendant ID number. This number either

letters of your last name or with

This is the PPL Consumer ID number. If services started before July 2011, it is the Medicaid ID number. If services started after July 2011, it is the C number

Fill in the circle next to the service you are performing. If you provide more than one (1) type of service, use a

This is the first and last day of the pay period. Use your payroll schedule to complete these dates. Time In is the time you start services. Time Out is the time you stop services. Fill in the circle next to the Time In and Time Out. This indicates if you worked in the morning or the evening. Enter in the total number of hours worked. Do not round time. Write the exact time. Date the person providing services signed the timesheet. This is the signature of the person providing services. This is the signature of the person receiving services or

Date the person receiving services or the employer of

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Pay Period

START DATE

Pay Period

END DATE

Timesheet Received

By 5:00 PM

Check or

Direct Deposit

IssuedTHURSDAY WEDNESDAY FRIDAY FRIDAY

1/3/2013 1/16/2013 1/18/2013 1/25/2013

1/17/2013 1/30/2013 2/1/2013 2/8/2013

1/31/2013 2/13/2013 2/15/2013 2/22/2013

2/14/2013 2/27/2013 3/1/2013 3/8/2013

2/28/2013 3/13/2013 3/15/2013 3/22/2013

3/14/2013 3/27/2013 3/29/2013 4/5/2013

3/28/2013 4/10/2013 4/12/2013 4/19/2013

4/11/2013 4/24/2013 4/26/2013 5/3/2013

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5/9/2013 5/22/2013 5/24/2013 5/31/2013

5/23/2013 6/5/2013 6/7/2013 6/14/2013

6/6/2013 6/19/2013 6/21/2013 6/28/2013

6/20/2013 7/3/2013 7/5/2013 7/12/2013

7/4/2013 7/17/2013 7/19/2013 7/26/2013

7/18/2013 7/31/2013 8/2/2013 8/9/2013

8/1/2013 8/14/2013 8/16/2013 8/23/2013

8/15/2013 8/28/2013 8/30/2013 9/6/2013

8/29/2013 9/11/2013 9/13/2013 9/20/2013

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9/26/2013 10/9/2013 10/11/2013 10/18/2013

10/10/2013 10/23/2013 10/25/2013 11/1/2013

10/24/2013 11/6/2013 11/8/2013 11/15/2013

11/7/2013 11/20/2013 11/22/2013 11/29/2013

11/21/2013 12/4/2013 12/6/2013 12/13/2013

12/5/2013 12/18/2013 12/20/2013 12/27/2013

12/19/2013 1/1/2014 1/3/2014 1/10/2014

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2/13/2014 2/26/2014 2/28/2014 3/7/2014

2/27/2014 3/12/2014 3/14/2014 3/21/2014

PAYROLL SCHEDULE - A

VA DMAS Consumer Directed Services Program

For Central VA & Tidewater

Circled Dates are payroll periods that include the 1st day of the month. If you are responsible for paying your attendant's

PATIENT PAY, please note that it is DUE when your attendant receives the pay stub for the circled periods.

FAX SIGNED TIMESHEETS TO PPL AT (888) 564-1532 or mail to: Public Partnerships, LLC, 4991 Lake Brook Drive Ste 90, Glen Allen, VA 23060

or submit online at : https://fms.publicpartnerships.com/PPLPortal/Login.aspx

VA DMAS

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The EOR and Attendant must complete an Attendant Application Form

if an EXISTING Attendant is applying to work for a new or

requirement for physical address) and a mailing address

enter all information and submit the completed form online

Customer Service at 1-866-259-3009. You can check the status of your request online.

Type of Request (Select One)

�� New Attendant

�� Existing Attendant (Provider ID Number:

Date of Request:

First Name*

Mid Init

Street Address (physical address no P.O. Box)

Mailing Address:

Email Address:

PROOF OF CITIZENSHIP: The Attendant Employment Packet you will receive contains the Homeland

Security (USCIS I-9 Form). You and your employer should read the instructions and complete the form

completely and accurately. It is your employer’s responsibilit

documents as described in the form instructions and certify that you are able to work in the United

States. This form must be included with the Employment Forms Packet that you submit to Public

Partnerships.

Expected Date of Employment for Attendant:

(MM/DD/YYYY):

CONSUMER INFORMATION Please complete the following information

Consumer ID: (This is a number that you will get from your

employer – it starts with a C typically. In some cases it may

be the consumers Medicaid ID.

Consumer First Name:

EOR First Name:

EOR Phone Number:

Attendant Application Request Form

The EOR and Attendant must complete an Attendant Application Form when a NEW Attendant is applying to work for a consumer or

if an EXISTING Attendant is applying to work for a new or additional CONSUMER. All attendants must include a street address (IRS

and a mailing address where correspondence, like employment packets, will be mailed

enter all information and submit the completed form online or fax to PPL at 1-866-709-3319. If you have questions call PPL

You can check the status of your request online.

(Provider ID Number: )

Process Request as Follows:

�� Mail to the Employer of Record

�� Email to the Employer of Record

ATTENDANT INFORMATION

Last Name*

Maiden Name

Date of Birth*

Box) City / State / Zip*

Telephone #*

Alternate Telephone:

City / State / Zip*

Optional – Used for Criminal

Background Check

Gender:

The Attendant Employment Packet you will receive contains the Homeland

9 Form). You and your employer should read the instructions and complete the form

It is your employer’s responsibility to review your proof of citizenship


This form must be included with the Employment Forms Packet that you submit to Public

Date of Employment for Attendant: Date Documents for I-9 Form Was Reviewed by Employer:

(MM/DD/YYYY):


Consumer ID: (This is a number that you will get from your

it starts with a C typically. In some cases it may

Consumer Last Name:

EOR Last Name:

EOR Email Address:

Attendant Application Request Form

when a NEW Attendant is applying to work for a consumer or

must include a street address (IRS

where correspondence, like employment packets, will be mailed. Please

If you have questions call PPL

Mail to the Employer of Record

Email to the Employer of Record

Date of Birth* SSN*

Optional – Used for Criminal

Background Check

Race:

The Attendant Employment Packet you will receive contains the Homeland

9 Form). You and your employer should read the instructions and complete the form

y to review your proof of citizenship


This form must be included with the Employment Forms Packet that you submit to Public

9 Form Was Reviewed by Employer:


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What is for the purpose of the form This Application for Employment completed by the EOR and the Attendant an attendant can work for the (EOR) and start getting payment forservices to the consumer.

Why is this important? PPL uses this form to get requiredabout you and the consumer you will be working for in order to complete the employment process.

How do I fill out the form You can fill out this form online at

https://fms.publicpartnerships.co Or Complete the paper copy of the must complete each section then 1-866-709-3319 or mail it to PPL. VA DMAS Consumer-Directed Services ProgramPublic Partnerships, LLC 4991 Lake Brook Drive, Suite G90Glen Allen, VA 23060

The Attendant Application Form should be completed by the Employer of Record and the Attendant. All fields on the form and online that are required. If these fields are not completed PPL will return the form for correction. When you receive the Employment Forms I-9) form is one of the forms that must be fully and accurately completed by you and your employer. Please follow the directions provided with the form to complete this form.

for the purpose of the form?

Application for Employment must be by the EOR and the Attendant before

Employer of Record payment for providing

Why is this important?

get required information consumer you will be working

in order to complete the employment process.

the form?

online at

https://fms.publicpartnerships.com/PPLPortal/Login.aspx?vadmas

paper copy of the form you received from your Employer of Record. then sign, and date it. You may fax the completed form

or mail it to PPL.



The Attendant Application Form should be completed by the Employer of Record and the Attendant. All fields on the form and online that are followed by an asterisk (*) are required. If these fields are not completed PPL will return the form for correction.

When you receive the Employment Forms Packet, the Homeland Security (USCIS Form 9) form is one of the forms that must be fully and accurately completed by you and your

Please follow the directions provided with the form to complete this form.

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of Record. You the completed form to:

The Attendant Application Form should be completed by the Employer of Record and the followed by an asterisk (*) are

required. If these fields are not completed PPL will return the form for correction.

the Homeland Security (USCIS Form 9) form is one of the forms that must be fully and accurately completed by you and your

Please follow the directions provided with the form to complete this form.

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Item Description 1. Type of Request 2. Date of Request 3. Process Request as Follows

4. First Name 5. Middle Initial 6. Last Name 7. Maiden Name 8. Date of Birth 9. Social Security Number 10. Street Address (Physical)

11. City, State and Zip Code 12. Telephone Number 13. Alternate Telephone Number

14. Mailing Address 15. City, State and Zip Code 16. Email address 17. Gender 18. Race 19. Expected Date of

Employment for the Attendant

20. Date that Documents for I-9 Form Were Reviewed by Employer

21. Consumer ID

22. First Name 23. Last Name

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How to Complete Are you a new or an existing attendant The date you are completing the form Choose if we should email or mail the Attendant Enrollment Forms Packet to your employer. Give us your employer’s email addresswant us to send the packet by secure email. First Name as it appears on your Social Security CardMiddle Name as it appears on your Social Security CardLast Name as it appears on your Social Security CardMaiden Name especially if that is on your Social Security CardMonth, Day, and Year of Birth Enter SSN on your Social Security Card – that matches your nameThe address where you live. This cannot be a Post Office Boxrequired. The city, state and zip code where you live The telephone number where you can be reached if

Another telephone number where you can be reached if questions Where you want us to send mail if different from The city, state and zip code where you want to receive your mailEmail address that we can use to send information to youOptional - identify your gender – male or femaleOptional – used to complete the Criminal Background CheckThe date you plan to begin work. This cannot be before the date of the consumer’s authorization to receive services Note: Attendants cannot be paid for service dates that have not been authorized by Medicaid; or services provided to ineligible consumers. Attendants will not be paid until all consumer and attendant enrollment forms have been completed and processed by PPL. The date that employer reviewed the documents that were identified for proof of citizenship or ability to work in the United States

Enter the Consumer ID for the consumer you will be working for in the program. If the consumer entered the program before July 2011, the Consumer ID is the consumer’s Medicaid ID. If the consumer enrolled in the program after July 2011 the Consumer ID will start with a “C” and is the number provided to by PPL. The First Name of the person who will be your EmployerThe Last Name of the person who will be your Employer

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Attendant Enrollment Forms your employer’s email address if you

First Name as it appears on your Social Security Card Middle Name as it appears on your Social Security Card Last Name as it appears on your Social Security Card Maiden Name especially if that is on your Social Security Card

that matches your name cannot be a Post Office Box. This is

The telephone number where you can be reached if we have questions telephone number where you can be reached if we have

if different from your Physical Address The city, state and zip code where you want to receive your mail

can use to send information to you male or female

used to complete the Criminal Background Check his cannot be before the date

uthorization to receive services.

service dates that have not provided to ineligible

will not be paid until all consumer and attendant enrollment forms have been completed and processed

documents that were identified for proof of citizenship or ability to work in the United States.

Enter the Consumer ID for the consumer you will be working for in the program. If the consumer entered the program before July 2011, the

er’s Medicaid ID. If the consumer enrolled in the program after July 2011 the Consumer ID will start with a “C” and is

he First Name of the person who will be your Employer. n who will be your Employer.

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