§ 441.545 Service models. A State may choose one or more of the following as the service delivery model to provide self-directed home and community-based attendant services and supports: ( a ) *Agency-provider model.* ( 1 ) The agency-provider model is a delivery method in which the services and supports are provided by entities, under a contract or provider agreement with the State Medicaid agency or delegated entity to provide services. Under this model, the entity either provides the services directly through their employees or arranges for the provision of services under the direction of the individual receiving services.
( 2 ) Under the agency-provider model for Community First Choice, individuals maintain the ability to have a significant role in the selection and dismissal of the providers of their choice, for the delivery of their specific care, and for the services and supports identified in their person-centered service plan.
( b ) *Self-directed model with service budget.* A self-directed model with a service budget is one in which the individual has both a person-centered service plan and a service budget based on the assessment of functional need. ( 1 ) *Financial management entity.* States must make available financial management activities to all individuals with a service budget. The financial management entity performs functions including, but not limited to, the following activities: ( i ) Collect and process timesheets of the individual's attendant care providers.
( ii ) Process payroll, withholding, filing, and payment of applicable Federal, State, and local employment related taxes and insurance.
( iii ) Separately track budget funds and expenditures for each individual.
( iv ) Track and report disbursements and balances of each individual's funds.
( v ) Process and pay invoices for services in the person-centered service plan.
( vi ) Provide individual periodic reports of expenditures and the status of the approved service budget to the individual and to the State.
( vii ) States may perform the functions of a financial management entity internally or use a vendor organization that has the capabilities to perform the required tasks in accordance with all applicable requirements of the Internal Revenue Service.
( 2 ) *Direct cash.* States may disburse cash prospectively to individuals self-directing their Community First Choice services and supports, and must meet the following requirements: ( i ) Ensure compliance with all applicable requirements of the Internal Revenue Service, and State employment and taxation authorities, including but not limited to, retaining required forms and payment of FICA, FUTA and State unemployment taxes.
( ii ) Permit individuals using the cash option to choose to use the financial management entity for some or all of the functions described in paragraph (b)(1)(ii) of this section.
( iii ) Make available a financial management entity to an individual who has demonstrated, after additional counseling, information, training, or assistance that the individual cannot effectively manage the cash option described in this section.
( iv ) The State may require an individual to use a financial management entity, but must provide the individual with the conditions under which this option would be enforced.
( 3 ) *Vouchers.* States have the option to issue vouchers to individuals who self-direct their Community First Choice services and supports as long as the requirements in paragraphs (b)(2)(i) through (iv) of this paragraph are met.
( c ) *Other service delivery models.* States have the option of proposing other service delivery models. Such models are defined by the State and approved by CMS.