To access the Support Advisor training, please visit the CDS Option, Support Advisor Training and Application webpage.
Financial Management Services Agencies (FMSA) Enrollment Training
Financial Management Services Agencies (FMSAs) provide financial management services (FMS) to individuals who hire their own service providers under the Consumer Directed Services (CDS) option for certain long-term services and supports. Businesses or other entities that want to be an FMSA must complete a 3-day training course provided by the Texas Health and Human Services Commission (HHSC).
FMSAs serve as the vendor fiscal/employer agent for individuals who hire their own employees for their Medicaid services. FMSAs provide payroll services and deposit and report withholding taxes on behalf of individuals who employ their service providers. FMSAs assume tax liability for proper withholding of federal income taxes and federal unemployment taxes in accordance with Section 3504 of the Internal Revenue Code. In addition, an FMSA must comply with state laws and regulations of the Texas Workforce Commission regarding payment of state unemployment insurance.
FMSAs DO NOT deliver direct in-home or community-based services, such as attendant services.
FMSAs have the following roles and responsibilities:
- registering and operating as a Vendor Fiscal/Employer Agent (V F/EA) in accordance with §3504 of the Internal Revenue Code;
- providing a required face-to-face initial orientation to individuals when they first choose the CDS option;
- providing ongoing training, assistance, and support for employer-related responsibilities;
- verifying qualifications of applicants before services are delivered;
- monitoring continued eligibility of service providers;
- approving and monitoring budgets for services delivered through the CDS option;
- ensuring that all service agreements are fully executed for each of the employer's service providers before issuing the initial payment for services to the service provider;
- managing payroll, including calculations of employee withholdings and employer contributions and depositing these funds with appropriate agencies (FMSAs are not allowed to use a payroll agent);
- complying with applicable government regulations concerning employee withholdings, garnishments, mandated withholdings, and benefits;
- preparing and filing required tax forms and reports;
- paying allowable expenses incurred by the employer;
- providing status reports concerning the individual's budget, expenditures, and compliance with CDS option requirements; and
- responding to the employer or the employer's designated representative (DR) as soon as possible, but at least within two working days after receipt of information requiring a response from the FMSA, unless indicated otherwise in Texas Administrative Code (TAC) Chapter 41, Consumer Directed Services, rules.
The FMSA must accept the designated fee established as payment in full for FMS delivered. The rate for FMS ranges from $210.08 per month for some waiver programs to $114.40 per month for Primary Home Care, Family Care, Community Attendant Services, and Personal Care Services. To learn more about rates for CDS services, visit HHSC's Provider Finance Department webpage.
Additional FMSA Contracting Requirements
An applicant must be able and willing to fulfill the requirements listed in TAC 40, Part 1, Chapter 49, Contracting with Community Services.
FMSAs must pay for services first and then bill the state for reimbursement. Entities should have at least two months' operating funds when they apply for a contract to become an FMSA.
HHSC conducts contract monitoring of FMSAs. The contract monitoring tools may be viewed here.
Note: Certification of an entity as an FMSA does not guarantee any referrals. All FMSAs are included on a choice list provided to individuals who choose the CDS option.
Why is training certification necessary for FMSAs?
FMS is a highly complex and technical service. It requires a thorough understanding of, and rigid compliance with, federal laws and rules of the Internal Revenue Service (IRS) relating to being a fiscal employer agent on behalf of individuals using Medicaid-funded programs. FMSAs must have a working knowledge of all home- and community-based services provided by HHSC, as well as knowledge of principles of self-determination and person-first language and practices.
Training Attendance Requirements
To be considered eligible for an FMSA contract:
- At least 2 key operations staff, including the program manager and payroll staff, must attend each presentation, each day of the training to apply to contract with HHSC as an FMSA.
- All trainees must sign in each day in order to be considered eligible for a contract.
- All trainees must demonstrate understanding of the material by passing a knowledge test at the end of the training.
Note: Attendance does not obligate an applicant to contract with HHSC.
Prior to attending the HHSC FMSA training, participants must read the CDS rules located in TAC, Title 40, Chapter 41. Be sure to have these rules available for your reference during the training.
Basic Course Description
- Overview of the CDS Option
- Overview of Texas Medicaid Waivers
- Person-Centered Planning
- CDS Resources
- Ongoing FMSA Responsibilities (Texas Administrative Code, Title 40, Part 1, Chapter 41)
- CDS Budgeting
- Electronic Visit Verification (EVV)
- Support Consultation Services and Support Advisor Responsibilities
- Overview of Medicaid Programs with the CDS Option — Program Specific Rules
- CDS Fraud Reporting Process
- Contracting Requirements for New FMSAs (Texas Administrative Code, Title 40, Part 1, Chapter 49)
- FMSA Contract Monitoring
- Vendor Fiscal/Employer Agent Responsibilities
- Texas Workforce Commission Requirements and Resources (State Unemployment Tax Reporting)
- Knowledge Test
The agenda for the training may vary depending on the schedule of presenters.
Each FMSA staff person must be registered under their own name and sign in each day of the scheduled training with the unique registration link issued to them to receive credit for attendance. Staff attending the training under another employee's link will not be on record as having attended and will not receive credit for the training or exam. Business entities are asked to limit the registration and attendance of their employees to no more than three persons.
Please contact the CDS email box regarding accommodations for the enrollment training or for taking the online test.
Other Government Agency Requirements
- Texas Workforce Commission's FMSA requirements are provided as part of HHSC's FMSA Enrollment training.
- HHSC provides an overview of IRS requirements.
- FMSAs are responsible for knowing their obligations as a vendor fiscal/employer agent under the IRS Code and as an authorized employer representative with the Texas Workforce Commission.