You are a Consumer in New York's Consumer Directed Personal Assistance Program ("CDPAP"). Renaissance Home Health Care ("Renaissance") is your Fiscal Intermediary. You are allowed to appoint a Designated Representative. You may be required by your Managed Care Organization, Managed Long Term Care Plan, or Local District of Social Services to appoint a Designated Representative if you are unable to direct your own workers.

A Designated Representative is an adult the Consumer has delegated authority to instruct, supervise and direct a Consumer's Personal Assistant(s) and to perform the Consumer's responsibilities specified in the Memorandum of Understanding with Renaissance and under applicable law, and who is willing and able to perform these responsibilities.

The Designated Representative may not be a Consumer's Personal Assistant or an employee, representative, or affiliated person of Renaissance.

A. INTRODUCTION

New York State's Consumer Directed Personal Assistance Program ("CDPAP") is intended to permit chronically ill or physically disabled individuals receiving home care services under Medicaid greater flexibility and freedom of choice in obtaining such services. Renaissance Home Health Care is a Fiscal Intermediary and [{consumerName186}] is a Consumer.

A Consumer and/or a Consumer's Designated Representative is the employer of a Consumer's Personal Assistant(s A Fiscal Intermediary is not the employer, in a sole or joint capacity, of a Consumer's Personal Assistant(s) and only provides limited services to a Consumer as a payroll agent, billing a Consumer's Managed Care Organization, Managed Long Term Care Plan, or Local District of Social Services, as applicable and processing payments to Personal Assistant(s).

Renaissance Home Health Care ("Renaissance") and [{consumerName186}] (" You" ) Hereby agree as follows:

B. CONSUMER RESPONSIBILITIES

You have made an informed decision to receive care services under CDPAP. You are the sole employer of your Personal Assistant(s). You will fulfill the following responsibilities:

1. Recruit, hire, employ, supervise and schedule enough qualified individuals as Personal Assistants to provide the services set forth in your plan of care.
2. Not discriminate in your hiring, provide equal employment opportunities, and comply with labor law.
3. Review your plan of care with each Personal Assistant to ensure your Personal Assistant(s) only perform the tasks authorized by your plan of care during hours authorized by your plan of care.
4. Provide as much training as necessary for your Personal Assistant(s) so they are able to competently and safely provide services.
5. Develop and maintain a contingency plan for substitute coverage when your Personal Assistant(s) are temporarily unavailable.
6. Notify Renaissance and your Managed Care Organization, Managed Long Term Care Plan, or Local District of Social Services, as applicable, within five (5) business days of any change in your status or condition, including but not limited to hospitalization or address change, or any change in the employment status of your Personal Assistant(s).
7. Review your Personal Assistant's time sheets, attest that they are accurate, and reflect only authorized services that were provided.
8. Comply with Renaissance's Policies and Procedures for Consumers.
9. Distribute paychecks to your Personal Assistant(s), or help set up a direct deposit arrangement between Renaissance and your Personal Assistant(s).
10. Enter into this memorandum of understanding with Renaissance as the Fiscal Intermediary.

C. FISCAL INTERMEDIARY RESPONSIBILITIES

Renaissance is not the employer or joint employer of your Personal Assistant(s). Renaissance will fulfill the following responsibilities:

1. Bill your Managed Care Organization or Managed Long Term Care Plan and process your Personal Assistant(s) process payments for authorized hours worked by your Personal Assistant(s).
2. Process your Personal Assistant(s)'s wage and benefits, including all required taxes, withholdings, and insurance requirements.
3. Make sure your Personal Assistant(s) have completed pre-employment and annual health assessments.
4. Maintain personnel records, including a separate health assessments file, for your Personal Assistant(s) as well as relevant records and authorizations for you as a Consumer.
5. Monitor your ongoing ability to fulfill your responsibilities under CDPAP.
6. Report any problems or suspected problems to your Managed Care Organization and/or Managed Long Term Care Plan.
7. Enter into this memorandum of understanding with you as the Consumer.

Renaissance will not fulfill any Consumer responsibilities.

Renaissance Home Health Care ("Renaissance") has developed policies and procedures to enable it to administer payroll and benefits for your Personal Assistants. They are set forth below.

Pursuant to the Memorandum of Understanding between you and RENAISSANCE, you must follow these policies and procedures.

RENAISSANCE reserves the right, in its sole discretion, to interpret, administer, change, modify, or delete any of these policies or procedures at any time. No changes can be made to these policies and procedures unless approved in writing by the Executive Director of RENAISSANCE.

After reviewing the policies and procedures, please sign the acknowledgement below.

Note: If you have appointed a Designated Representative to fulfill your responsibilities as Consumer, “you” as used herein, also refers to your Designated Representative and your Designated Representative must sign the acknowledgment.

1. AGENCY OVERVIEW

You, as a Consumer, are the sole employer of your Personal Assistant(s). Renaissance is your Fiscal Intermediary and is not the sole or joint employer of your Personal Assistant(s). Renaissance, is your agent whose sole responsibility is to  process payroll and administer benefits for your Personal Assistant(s) on your behalf.  

2. APPLICABLE DEFINITIONS

Personal Assistant ("PA"): an adult who provides consumer directed personal assistance to a consumer under the consumer's instruction, supervision and direction or under the instruction, supervision and direction of the consumer’s designated representative. A consumer's spouse, parent or designated representative may not be the consumer directed personal assistant for that consumer; however, a consumer directed personal assistant may include any other adult relative of the consumer who does not reside with the consumer or any other adult relative who resides with the consumer because the amount of care the consumer requires makes such relative presence necessary.

Designated representative: an adult to whom a self-directing consumer has delegated authority to instruct, supervise and direct the consumer directed personal assistant and to perform the consumer's responsibilities specified in subdivision (g) of Section 505.28 of Title18 of the New York Code, Rules and Regulations ("NYCRR") and, who is willing and able to perform these responsibilities. With respect to a non-self-directing consumer, a “designated representative” means the consumer’s patient, legal guradian or a responsible adult surrogate who is willing and able to perform such responsibilities on the consumer behalf. The designated representative may not be the consumer directed personal assistant or a fiscal intermediary employee, representative or affiliated person.

Fiscal Intermediary ("FI"): an entity that has a contract with an MCO to provide wage and benefit processing for consumer directed personal assistants and other fiscal intermediary responsibilities specified in subdivision (i) of Section 505.28 of Title 18 of the NYCRR.

Self-directing consumer: a consumer who is capable of malting choices regarding the consumer's activities. Of daily living and the type, quality and management of his or her consumer directed personal assistance, understand the impact of these choices; and assumes responsibility for results of these choices.

Managed Care Company ("MCO"): a managed care organization, managed long term care plan, or local district of social services.

3. PAYROLL

1. Work week and payday

a. Policy

1. Renaissance's work week is seven days, from Sunday through Saturday. 
2. Your Personal Assistant will be paid on a weekly basis. The payday is Thursday.
3. Pay stubs will be distributed to your Personal Assistants by UPS Mail. If enrolled into direct deposit, pay stub will not be generated.

 

b. Procedure

1. Wages, for Personal Assistant enrolled in direct deposit, will be deposited in their designated account on payday. Wages, for Personal Assistant who is not enrolled in direct deposit, will be paid by check.
2. If your Personal Assistant(s) do(es) not receive their direct deposit payment or pay check in a timely fashion, you must notify RENAISSANCE immediately.
3. Pay stubs will be distributed to your Personal Assistant via UPS mail. Personal Assistants should carefully review their pay stubs and direct deposits or pay checks for errors each week.
4. You may also review your Personal Assistant's pay stubs each week. If you or your Personal Assistant(s) find an error, you must report it to RENAISSANCE immediately. If there has been an erroneous overpayment or underpayment, RENAISSANCE will correct it as soon as possible.

2. Payroll deductions

a. Policy

1. RENAISSANCE is required by law to make certain deductions from your Personal Assistant's pay each pay period, including: 
   • Federal and state income taxes
   • Social Security (FICA) taxes
   • State disability insurance taxes
   • Deductions required by wage garnishment or child support orders
   • Other authorized deductions.
2. No unauthorized deductions will be made.
3. All deductions for overpayments will be made in accordance with New York State Law.

b. Procedure

All deductions from your Personal Assistant's pay will be identified on your Personal Assistant's pay stubs.

3. Recording, submitting, and attesting to hours worked

a. Policy

To ensure that RENAISSANCE has accurate time records and that your Personal Assistants are paid in a timely manner, all authorized hours worked by your Personal Assistant must be accurately recorded.

All hours worked must be accurately recorded.You must review and attest to the accuracy of the work hours submitted for payment to your Personal Assistant. 

RENAISSANCE will make no payments to your Personal Assistants without your attesting the work hours actually worked.

To be paid on Thursday, hours must be submitted to RENAISSANCE by Monday.

If the hours submitted are incomplete, incorrect, or inconsistent with these policies and procedures, they will be rejected by RENAISSANCE and your Personal Assistant will not be paid for them. For your Personal Assistants to be paid for those hours, they must be completed, corrected and/or made to comply with these policies and procedures, then re-submitted to RENAISSANCE.

All authorized hours worked, WITHOUT EXCEPTION, INCLUDING ANY CORRECTIONS must be submitted to RENAISSANCE within 90 days of the date the work was performed. Any hours submitted more than 90 days from the date the work was performed will not be paid to your Personal Assistant(s) by RENAISSANCE. You and/or your Designated Representative will be personally responsible for paying your Personal Assistant for any authorized hours worked that are not submitted to RENAISSANCE within 90 days of the date the work was performed.

b. Procedure

All authorized hours worked must be recorded using HHAeXchange mobile application (clock in/out system), or timesheet when needed.

RENAISSANCE may send your Personal Assistant's timesheets to your MCO any other relevant authority, as part of our responsibility to monitor that you and/or your Designated Representative are able to fulfill your responsibilities under CDPAP.

4. Payable hours

a. Policy

1. RENAISSANCE will only pay for the number of hours authorized by you. RENAISSANCE will NOT pay your Personal Assistants for hours worked exceeding the number of hours authorized by your MCO, even if you, as sole employer, are legally required to pay your Personal Assistants for those hours. You are personally responsible for paying your Personal Assistant for any hours worked exceeding the authorized hours.
2. RENAISSANCE will only pay for services authorized by your MCO. RENAISSANCE will NOT pay your Personal Assistants for hours worked providing services that were not authorized by your MCO, even if you, as sole employer, are legally required to pay your PA for those hours. You are personally responsible for paying your Personal Assistant for any hours worked providing services not authorized by your MCO.
3. RENAISSANCE will NOT pay your Personal Assistants for hours worked that violate any applicable laws, regulations, or administrative guidance, even if you, as sole employer, are legally required to pay your PA for those hours.
4. RENAISSANCE will bill your MCO and pay your PA for each authorized hour recorded and submitted in accordance with Section 3, above. All authorized hours worked by your Personal Assistants will count towards your total authorized hours for that authorization period. For example, if your Personal Assistant works from noon on Saturday to noon on Sunday, RENAISSANCE would pay your Personal Assistant for all 24 hours, not 16 or 13 hours. All 24 Hours worked by your Personal Assistant would count against your total authorized hours for that authorization period
5. RENAISSANCE will pay your Personal Assistants for submitted hours authorized by your MCO in accordance with New York Labor Law.

b. Procedure

All hours that qualify as work hours under the law count toward your authorized hours. If you allow your Personal Assistants to work more than your authorized hours for the week, you personally, not us, are liable to pay them for all the extra time they work.

The definition of work hours under the law includes, but is not limited to:

• Training time - the time your Personal Assistant takes for training, at your request, to learn how to care for you properly, is payable time.
• Waiting time - the time your Personal Assistant spends waiting for you, whether at a doctor's office, or senior or day care center, or whatever the case may be, at your request, is payable time.
• On-call time - the time your Personal Assistant must be available and ready on short notice to attend to you, is payable time.
• Errand time - the time your Personal Assistant spends doing errands for you, such as food shopping before she comes to work is payable time. So is their transportation time from the food market to meet you after she shops for you on a day she works for you, is payable time.
• Travel time - the time your Personal Assistant drives you anywhere or accompanies you in a car or train or by other means of transportation during work hours, is payabloe time.

5. OTHER COMPENSATION AND BENEFITS

a. Policy

1. If you elect to provide your Personal Assistants with added compensation or benefits in addition to cash wages, RENAISSANCE will administer such compensation or benefits in accordance with applicable law.
2. RENAISSANCE will neither administer nor pay for the provision, maintenance, or replacement of Personal Protective Equipment (PPE), such as gloves or masks, that you are required to provide your Personal Assistants, at no cost, with all necessary PPE, in accordance with applicable law.

b. Procedure

1. RENAISSANCE will institute supplemental policies to effectively administer compensation or benefits in addition to cash wages and will provide you with these supplement policies.

FRAUD PREVENTION POLICY

As a Fiscal Intermediary in New York State's a Consumer Directed Personal Assistance Program ("CDPAP"), Renaissance Home Health Care ("Renaissance") is required by law to comply with all federal and New York state laws and regulations pertaining to New York state Medicaid program providers, including provisions to prevent fraud, waste and abuse. Renaissance has procedures in place to prevent and detect fraud, waste and abuse, and actively supports the efforts of New York State and Federal authorities to do the same. Furthermore, Renaissance is legally obligated to report all suspected fraud, abuse and false claims to relevant federal, state and/or local authorities for investigation. If Renaissance suspects a Consumer has committed fraud, abuse or submitted false claims, Renaissance will seek to immediately terminate its relationship with the Consumer.

Consumers are responsible for understanding what constitutes fraud and working to prevent it. This means: Train each of their Personal Assistants about fraud, abuse and false claims; Attest to the accuracy and compliance of each time sheet of each Personal Assistant, which includes Ensuring that the time sheet only states the actual time spent providing services Ensuring that the services provided were authorized under the Consumer's plan of care, and; Ensuring that such services were only provided to the Consumer; Submit each Personal Assistant's time sheets to Renaissance according to Renaissance's Policies and Procedures for Consumers Allow Renaissance to monitor Consumer's practices pursuant to law to ensure that there is no fraud, waste or abuse; and Immediately report to Renaissance any suspected fraud, waste or abuse. Consumers may do so by calling Wendy Garcia at 718-649-3670 Ext 4803. To ensure all Consumers are aware of what constitutes a false claim and potential penalties under applicable Federal and New York state law, a detailed overview of relevant statues pertaining to false claims, kickbacks and civil monetary penalties is attached as Appendix A.

I am a Consumer in New York's Consumer Directed Personal Assistance Program ("CDPAP"). Renaissance Home Health Care ("Renaissance") is my Fiscal Intermediary. If I have appointed a Designated Representative to fulfill my responsibilities as a Consumer, "I", as used in this agreement refers to both me as the Consumer and my Designated Representative. Renaissance and I hereby agree:

1. My Plan of Care. I am responsible for and assume all risks for, associated with, or related to administering my Plan of Care and any care I receive through CDPAP.
2. My Personal Assistants. I am responsible for and assume all risks for my own health, safety, and welfare when I employ and receive services from my Personal Assistants.
3. My Work Locations. I am responsible for and assume all risks for any unsafe condition or violation of any safety laws at any locations where I employ and receive services from my Personal Assistants.
4. My Household Members and Third Parties. I am responsible for and assume all my risks for the safety and welfare of my household members and any third parties in any location where I employ and receive services from my Personal Assistant, including but not limited to my home and my vehicle or my Personal Assistant's or other person's vehicle.
5. Insurance. If I permit my Personal Assistants to drive or be a passenger in any car or personal vehicle, I will make sure the car or personal vehicle has insurance in accordance with New York State law.
6. Severability. If any portion of this agreement is declared unenforceable by a court or an authorized governmental agency, the unenforceability of such portion will not make unenforceable the remaining portions of this agreement.
7. Amendment and Waiver. No amendment or modification of this agreement will be valid or binding unless made in writing and signed by both me and an authorized representative of Renaissance.

You are a Consumer in New York State's Consumer Directed Personal Assistance Program ("CDPAP"). Renaissance cannot arrange back-up care services or emergency services for you. You are responsible for managing your care, including hiring and scheduling your Personal Assistants, and arranging for back-up care services when your regularly-scheduled Personal Assistant is unavailable for any reason.

For back-up workers to be paid by Renaissance, they must be enrolled as Personal Assistants. Please remember that your spouse, Designated Representative, or any other person legally responsible for you, cannot be enrolled as a Personal Assistant. You may choose to have informal back-up workers, but they will NOT be paid by Renaissance.

I hereby certify:

1. I understand that New York Social Services Law § 365-f(3) prohibits my Personal Assistant from being my spouse, my Designated Representative, or any other person legally responsible for my care and support.
2. The above-named Personal Assistant is NOT my spouse, my Designated Representative, or any other person legally responsible for my care and support.
3. I understand that if my spouse, my Designated Representative, or any other person legally responsible for my care and support is my Personal Assistant, it may be considered Medicaid fraud. If Medicaid fraud is found, I agree to repay to Renaissance all wages and other compensation fraudulently paid to my Personal Assistant(s), plus any applicable penalty and interest.
4. I will immediately notify Renaissance if the above-named Personal Assistant becomes my spouse, my Designated Representative, or legally responsible for my care and support.
5. If the above-named Personal Assistant is currently my relative through blood, marriage or adoption, I will immediately notify Renaissance if the above- named Personal Assistant is no longer my relative through blood, marriage or adoption.

If the above-named Personal Assistant resides in the same home as me and has NO other residence, I will enter into an agreement with the above-named Personal Assistant to exclude from compensable worktime periods of complete freedom from duty, as required by the United States Department of Labor.

I will immediately notify Renaissance if the residence of the above-named Personal Assistant changes from what I have certified above.

I have been advised that Renaissance Home Health Care is not liable or responsible for any injury, to persons or property, which might occur as a result of being transported by my Personal Assistant in either my automobile or in the automobile of my Personal Assistant. I have been further advised that I should verify that my Personal Assistant is a duly licensed driver in the State of New York and has at least the minimum medical and liability coverage on his/her vehicle and its occupants, as required by the laws of the State of NewYork.

I am a Consumer in New York State's Consumer Directed Personal Assistance Program ("CDPAP I am the sole employer of my Personal Assistant(s Renaissance Home Health Care ("Renaissance") is my Fiscal Intermediary, responsible for processing payroll for my Personal Assistants Renaissance is not an employer of my Personal Assistants in a joint or sole capacity.

Before my Personal Assistants can provide me services and be pay rolled by Renaissance under CDPAP, my Personal Assistants must provide certain information, complete certain forms, and be provided with certain notices as required by applicable federal, New York state and local law. It is my responsibility as the sole employer of my Personal Assistants to collect the required information, ensure completion of required forms, and provide required notices.

The forms and notices (collectively, the "Payroll Forms") include: (1) Wage and Benefit Processing Information; (2) Internal Revenue Service Form W-4; (3) New York State Department of Taxation and Finance Form IT 2104; (4) U.S. Citizenship and Immigration Services Form 1-9; (5) Universal Precautions and Hepatitis B Vaccination Acknowledgement; (6) Notice and Acknowledgement of Pay Rate and Payday under Section 195.1 of the New York State Labor Law; and (7) New York City Earned Sick Time Act Notice of Employee Rights.

To ensure compliance with law and expedite the commencement of services by my Personal Assistants under CDPAP, I hereby authorize Renaissance to act as my representative and agent for the following limited purposes: (1) to provide the Payroll Forms to my Personal Assistants; (2) to ensure the Payroll Forms are appropriately completed and signed; and (3) to complete the sections of the Payroll Forms required of me on my behalf; and (4) to collect and file the payroll Forms, as appropriate.

I acknowledge that pursuant to 18 NYCRR § 505.28(i1 iii), Renaissance is required to maintain a copy of the Payroll Forms of my Personal Assistants in its personnel records for each Personal Assistant. I understand that Renaissance may also provide me with a copy of the Payroll Forms.

Nothing herein shall be construed as an assumption of liability by Renaissance of my obligations as the sole employer of my Personal Assistants under applicable federal, New York state and local law. I understand that Renaissance makes no representations that the Payroll Forms encompass all of my obligations as an employer.

This authorization will remain in effect until I provide written notice to Renaissance to cancel it.

As a Consumer in New York State's Consumer Directed Personal Assistance Program ("CDPAP"), you are the sole employer of your Personnel Assistant(s).

Renaissance Home Health Care ("Renaissance"), as your Fiscal Intermediary, is only responsible for paying your Personal Assistants for hours authorized by your Managed Care Organization, Managed Long Term Care Plan, or Local District of Social Services, as applicable, in accordance with Renaissance's Policies and Procedures for Consumers.

To enable Renaissance to perform its responsibilities, you must take the following steps to comply with the law.

1. Obtaining an EIN.

As the sole employer of your Personal Assistant(s), you are required by federal and New York State law to obtain a Federal Employer Identification Number ("EIN" To obtain an EIN, you must complete the Internal Revenue Service Form SS-4, attached as Appendix A. By signing this Employer Withholding Procedure, you authorize Renaissance to apply for and receive your EIN, and to answer questions about the completion of Form SS-4, on your behalf. Renaissance will retain a copy of your signed SS-4.

2. Registering as an employer.

You are required to register as an employer with the New York State Department of Taxation and Finance and the New York State Department of Labor. To register, you must complete Form NYS 100, attached with instructions as Appendix B.

3. Designating Renaissance as your agent for tax withholding purposes.

As the sole employer of your Personal Assistant(s), you are responsible for withholding federal and New York state tax, and paying local employment taxes for your Personal Assistant(s).

To allow Renaissance to assume these payroll responsibilities on your behalf, you must designate Renaissance as your agent for that purpose using the Internal Revenue Service Form 2678, attached as Appendix C.

You, as the Consumer, are the sole employer of your Personal Assistant(s You must set the wage rate and determine the total compensation package for each Personal Assistant. Parkshore CDPAP ("Renaissance"), as your Fiscal Intermediary, does not set the wage rate of any Personal Assistant you employ. Renaissance only processes the wage rate and other compensation options you choose. Cash wages and all other benefits and compensation are administered according to Parkshore CDPAP's Policies and Procedures for Consumers. Only cash wages, and no other benefits or compensation, are paid for any overtime hours worked by any Personal Assistant.