The purpose of this form is to outline the responsibilities you have as a participant-directed service employee. The service you are providing is directed by the participant or their representative which means they are your Employer. For the purposes of this form, in-home support caregivers and/or respite caregivers will be referred to as participant-directed service employees (PDE).

As a PDE, I understand that: 

1. I must have a PPD Tuberculin skin tests completed annually unless I have a documented history of a positive PPD. In that case, I will complete a questionnaire for signs and symptoms of TB annually.

2. PDE services may include:

a. Support of daily living activities, e.g. assistance with bathing, dressing, feeding, personal grooming, personal hygiene, transferring and mobility;

b. Meal or snack preparation, planning and serving, cleaning up afterwards, following specially prescribed diets as necessary and encouraging participants to adhere to any specially prescribed diets;

c. General housekeeping including cleaning (such as sweeping, vacuuming, mopping, dusting, taking out the trash, changing bed linens, defrosting and cleaning the refrigerator, cleaning the stove or oven, cleaning bathrooms) and activities as needed to maintain the participant in a safe and sanitary environment. Housekeeping only includes areas specific to the participant such as the participant’s bedroom, bathroom, etc;

d. Shopping assistance, essential errands, and escorting participant to medical services;

e. Assistance with communication, which includes, but is not limited to placing a phone within participant’s reach and physically assisting participant with the use of the phone, and orientation to daily events;

f. Monitoring medication, e.g. consists of informing the participant it is time to take medication as prescribed by the physician. It does not mean that the PDE is responsible for giving the medicine; however, it does not preclude the PDE from handing the medicine container or medicines already set up in daily containers to the participant.

g. General supervision.

3. I am responsible for maintaining individual participant records. These records are subject to the confidentiality rules for all Medicaid Providers and health care providers and shall be made available to DDSN and its contracted providers upon request. Records shall include the following:

a. current and historical Service Authorization and Termination Forms

b. the Daily Log which will include any records of occurrences in which the PDE did not provide services for the specified number of hours

c. a copy of the participant's back-up plan for service provision when the PDE is unable to provide services. These may be formal or informal supports.

4. If the participant, responsible party, or I identify PDE duties that would be beneficial to the participant’s care but are not specified on the Authorization Form from the DDSN Waiver Case Manager, the DDSN Waiver Case Manager must be contacted to discuss the possibility of adding those duties. These duties MAY NOT include skilled medical care. It will be the DDSN Waiver Case Manager’s responsibility to decide whether the participant’s Plan should be amended/new authorization completed including these duties. The DDSN Waiver Case Manager will have three (3) working days of the receipt of my or the participant’s request to modify/amend the Authorization or complete the appropriate assessment.

5. PDEs are not provided with any liability insurance coverage or benefits, are not bonded, and are not licensed by any state or local agency.

6. Injury to the PDE or to the participant is not the responsibility of any local or state agency. The employer’s homeowner’s insurance policy may provide some protection, but likely would require additional coverage. The employer can check with their insurance agent and explain what service is being provided so s/he can advise the employer relative to their policy. Homeowner’s policies usually only provide additional liability protection.

7. I am required to report any suspected abuse, neglect or exploitation of the participant to Adult Protective Services by contacting the Department of Social Services in the county in which the participant lives, and the participant’s waiver case manager.

8. PDEs have the right to terminate employment with or without cause. It is important that both parties are treated professionally and fairly. Should the PDE decide to terminate employment, 2 weeks’ notice will be given unless personal safety is threatened.

9. Termination or laying off an employee because of an employee’s age, race, color, religion, sex, national origin or disability is not acceptable and against the law.

10. It is my responsibility to notify the DDSN Waiver Case Manager of the following:

a. a change in the participant’s condition

b. the death of the participant

c. a participant’s relocation out of service area

d. the participant no longer wishes to participate in this service

e. knowledge of participant’s Medicaid ineligibility

f. my wish to terminate as the provider of PDE services

g. the responsible party’s desire to no longer serve in that role

h. my inability to provide PDE services as authorized *THIS MUST BE DONE IMMEDIATELY BY TELEPHONE

 

In the event that I am unable to reach the participant, the responsible party, or the DDSN Waiver Case Manager, it is my responsibility to notify the participant’s designated emergency contact until the participant, responsible party, and the DDSN Waiver Case Manager can be reached.

The designated emergency contact is:

12. When two consecutive attempted visits occur, I must notify the DDSN Waiver Case Manager. Prior to notifying the DDSN Waiver Case Manager, I must attempt to locate the participant or family member and or responsible party.

13. I must adhere to basic infection control procedures at all times while providing PDE services.

14. I am responsible for signing and completing all paperwork required by the Fiscal Agent.

15. All hours should be totaled and weekly comments written prior to obtaining the participant’s signature on the PDE Daily Log. I am also responsible for maintaining copies of the completed and signed Daily Log for Medicaid and tax audit purposes. I am responsible for sending copies of the completed and signed Daily Logs to the DDSN Waiver Case Manager for review on a monthly basis. I am responsible for submitting the Daily Logs to the Fiscal Agent as specified; they will be responsible for issuing my checks and taking out my taxes.

16. The PDE Daily Log(s) will be used for reimbursement purposes. The PDE Daily Log(s) cannot be filed and reimbursement will not be paid until the DDSN Waiver Case Manager authorizes the service and I have provided the service.

17. Health information must be kept confidential as indicated by HIPAA rules and regulations.

18. I understand that no services may be provided while a participant is in the hospital, nursing home, ICF/IID, jail or PRTF.

19. I understand that without specific approval from the South Carolina Department of Health and Human Services, I will be unable to serve the participant if I am or become the participant’s legal guardian or spouse. I also understand that parents of minor children are not permitted to provide PDE services to their minor child.

20. Services provided to a participant with no Medicaid eligibility will not be reimbursed by Medicaid.

21. I understand the participant or responsible party is my employer of record. I understand I am not an employee of the South Carolina Department of Disabilities and Special Needs (SCDDSN), the Fiscal Agent or any other state agency.

22. I certify I am fully ambulatory.

23. I certify I am able to read, write and communicate effectively with the participant and/or their representative.

24. I understand I cannot be enrolled as a Medicaid provider or an individual DDSN provider.

25. I hereby grant permission for the following to be requested on my behalf and that information may be shared with all potential participants:

• SLED Background Check
• DSS Child Abuse and Neglect Central Registry Check

26. I understand it is against federal law to delegate my role as a PDE to another caregiver.

27. I will provide references to my employer upon request.

My signature below indicates I understand and acknowledge all of the above requirements.