The sixteen FMS standards

How to read this page. This is a summary, not the text. Many of the original lists say "including, but not limited to", so where we list what a provider must cover, the list is what DDS named, not everything that could apply. San Diego Regional Center uses these standards to approve providers and to monitor them afterwards. Where the exact words matter, read Attachment A itself.

1. Eligibility

Who is allowed to be a provider at all.

Meet DDS's vendorization requirements and be eligible to provide Medicaid-funded services. (1.1, 1.2)
Show that the provider, its staff and its contractors are not on the federal list of people excluded from health programs or the Medi-Cal suspended list, and disclose anyone in control of the business convicted, found liable or settled for fraud or abuse in a government program, or for abuse or neglect of a child, elder or dependent adult, in the last ten years. Failing to disclose disqualifies the provider outright. (1.3)
At least 12 months' experience providing financial management services in a Medicaid self-direction program. (1.4)
Accept the DDS monthly rate schedule and, for employer models, the employer burden DDS approves. (1.5, 1.6)

For you: the burden rate a provider charges is the one DDS approved for it — the same numbers we publish on Choosing an FMS.

2. Financial solvency

Whether the provider has the money to keep paying people if something goes wrong.

To start: a line of credit or cash reserve of at least $500,000. (2.1)
On an ongoing basis: enough to cover at least four weeks of payroll and bill payments. (2.2)
Every year: proof of solvency and insurance — including cover for fraud, theft, errors and omissions, and business interruption — at the limits SDRC sets, and an independent audit or financial review. (2.3, 2.5)
Proper accounting, with funds tracked separately for each participant and every source document kept. (2.4)
Invoice the regional center within 30 days, both for its own fee and for what it has paid on your behalf. (2.6, 2.7)

For you: the four-week cushion is the part that matters. It is meant to keep caregivers and vendors paid through a delay in reimbursement or a problem at the provider's end.

3. Qualifications

Whether the provider has the people, systems and know-how to do the job.

Know the Lanterman Act, the regional center system, the SDP rules and the principles of self-determination. (3.1)
Have written policies, qualified staff, working systems — accounting, payroll, Electronic Visit Verification, secure data, customer service — a program design, and its own quality checks. (3.2)
For employer models, payroll staff with at least a year's experience who are certified payroll professionals, CPAs, or accounting graduates with a year in the field. (3.5)
Train every new employee within 30 days of hire — including person-centered practice, respectful communication with people with developmental disabilities and their families, and spotting and reporting special incidents — and keep training them on the SDP directives, plans and budgets, and common mistakes. (3.6)

4. General compliance

The laws a provider must follow, and some it must actively act on.

Follow, among others, the Lanterman Act, HIPAA, state confidentiality law, abuse and neglect reporting laws, anti-discrimination law, the 21st Century Cures Act (which brought in Electronic Visit Verification), federal and California wage-and-hour law, and Cal/OSHA. (4.1)
Have an information security policy, a process for telling your regional center and SDRC about a data breach, and a disaster recovery plan that keeps payroll and vendor payments running through a natural disaster or other emergency. (4.1)
Report special incidents to your regional center within 24 hours and in writing within 48 — every incident it learns of, whether or not its own staff saw it. For this purpose a participant counts as being in the provider's care at all times. (4.2, 4.3)
Report suspected abuse directly to Adult or Child Protective Services, the Long-Term Care Ombudsman or the police where the law requires — a report to the regional center does not replace that duty. (4.3, 4.4)
Send accurate monthly budget statements to you and your regional center, and give DDS access to them, broken down by service code, through an online portal. (4.6, 4.7)
Avoid conflicts of interest: no other paid services to SDP participants, no recommendations in your planning meeting about services it would profit from, and no financial interest in anyone your budget pays. (4.8)
Give DDS data on request within 30 days, and at least yearly a list of the providers it pays, what it paid them by regional center, and how it confirmed their qualifications. (4.9)

For you: the conflict-of-interest rule is worth knowing. Your plan belongs to you, your facilitator if you use one, and your regional center. An FMS with a stake in what goes into it would be narrowing your choices, and the standards now say in writing that it must not.

5. Grievances and complaints

Give every participant a copy of its grievance process. It must say that you and your employees can file a grievance about the provider or its staff, and that it will be investigated and resolved within a set timeline of no more than 60 calendar days, with a corrective action plan if upheld. (5.1)
Keep investigations confidential, and give you a written outcome with a full description of any corrective action. (5.2)
Tell you about the wider complaint routes for rights violations in the developmental services system, and point you to the right place if your complaint is about someone else. (5.3, 5.4)
Track every grievance and send a summary every six months to DDS, your regional center and SDRC. (5.5)

For you: ask for the grievance process when you enroll. Every provider has to have one now, and it has to have a deadline. If a complaint about the provider goes nowhere, the six-monthly report means it is on record with DDS. See also the grievance and Ombudsperson entries.

6. Customer service

Set a process and timelines for answering calls, email, mail and other messages, give it to you, your regional center, SDRC, and your workers and vendors, and post it on its website. (6.1)
Track whether it meets those timelines for urgent and non-urgent messages, and review its customer service every six months. (6.2)
Give participants and their employees a toll-free phone line, an email address and a secure platform for communicating. (6.3)
Accept Video Relay Service calls and use other accommodations for people who are Deaf, Hard of Hearing or DeafBlind, and provide translation and interpreters for families whose preferred language is not English. (6.4, 6.5)

For you: every provider now has to publish its own response standard. That gives you a number to hold it to — and a number to compare when you are choosing.

7. Enrolling you, and the service agreement

Get and follow your IPP, certified individual budget and certified spending plan. (7.1)
Give you an enrollment packet for the model you chose, including how the monthly statement works and how changes to your budget or plan are handled. (7.2)
Sign a plain-language service agreement with you covering, among other things: exactly what it will do and how (in person, virtual or both); what you are responsible for; its privacy notice; its DDS-approved fee, burden rate and other approved costs; its hiring practices and payroll cycle; how to report incidents and file grievances; how to reach the Ombudsperson; and how it would help you move to another provider, including what happens to your employees' accrued benefits. (7.3)
The agreement must commit to 60 days' notice before it discontinues or changes your service, unless your planning team identifies a health and safety risk, and 30 days' notice if the provider's own vendorization is ending. (7.3)
Give a signed copy to you and to your regional center before services start or change. (7.4)

For you: if you are with a provider already, the next agreement you are asked to sign should cover all of this. If yours does not, ask why.

8. Your budget and spending plan

Check that your spending plan covers the real costs — employer taxes, required sick time and approved burden — within what is authorized. (8.1)
Tell you and your regional center within five business days if your plan needs changing, including when you ask for something not in it. (8.2)
Before paying anyone or invoicing for anything, confirm that the provider is qualified, the rate is reasonable and meets minimum wage, the service is in your IPP and plan with money left to pay it, and it is allowable under DDS directives, Medicaid rules and the waiver. (8.3)
Every six months, check a sample of invoices and time entries — 10% of participants or at least 20 — and report the findings to each participant checked and their regional center within 30 days. (8.3)
Track spending and tell you and your regional center within five business days about overspending, underspending or anything that looks unauthorized. (8.4)

For you: this is the check that protects your money. A provider confirming eligibility before someone starts is not standing in your way — it is the step that stops a month of work turning out to be unpayable.

9. Setting you up as an employer

For families who employ their own workers, under Co-Employer or Sole Employer.

Give you an orientation before you enroll on what you are responsible for and what the provider is. (9.1)
Give you an employer enrollment packet, and train and support you on it — including Electronic Visit Verification, Cal/OSHA, minimum wage, overtime, breaks, leave, harassment prevention, anti-discrimination, pay equity and the Fair Chance Act. (9.2, 9.3)
Train you on its software, with disability-related accommodations where needed. (9.4)
Handle the registrations that make you an employer: IRS and state employer accounts, the Employment Development Department, the Department of Industrial Relations, and the agent appointments that let the provider file for you. (9.5, 9.6)

For you: household employment is unusually complicated, and this standard is DDS writing down that teaching you the employer side is part of the job. If something about being an employer is unclear, your FMS is required to help you with it.

10. Setting up your service providers

For vendors, local businesses and independent providers you pay rather than employ.

Check that someone paid as an independent contractor really is one, not an employee. (10.1)
Document that your regional center has done its yearly check that services are delivered in settings that meet federal community-living rules. (10.2)
Screen providers against the exclusion lists, and help you verify their licenses, qualifications and rates. (10.3, 10.4, 10.7)
Tell you and your regional center within five business days of spotting a possible conflict of interest — for example, someone who helps make decisions for you and is also paid by you. (10.5)
Teach providers how to report special incidents, give you both a setup packet, and report new contractor relationships to the state. (10.6, 10.8, 10.9)

11. Setting up your employees

Screen a new worker against the exclusion lists and help you get the required background check. (11.1, 11.5)
Flag possible conflicts of interest within five business days. (11.2)
Help you verify the worker's qualifications and that the pay rate is reasonable. (11.3, 11.4)
Establish whether the worker is related to you and where they live, because that decides which tax and workers' compensation rules apply. (11.7)
Handle the hiring paperwork, onboarding, new-hire reporting within 20 days and timesheets. (11.8–11.10, 11.14, 11.15)
Tell you when a worker is cleared to start — background check complete, DDS clearance received, and the service authorized in your plan. (11.11)
Teach workers their duty to report anything that could affect your health or safety, and the rules on workers' comp, accurate time entries, overtime and breaks. (11.12, 11.13)

For you: 11.7 is DDS acknowledging what we say throughout this site — that employing a relative, or someone who lives with you, can change the rules that apply. Ask your FMS before you set a schedule or a wage. See Who can be paid?

12. Moving to another provider, or ending service

If you move: a standard transfer process completed within 60 days of your request, with your records — budget, plan, spending to date, and provider and employee files — sent to the new provider within 30 days, pay dates coordinated, and your workers and vendors paid without interruption throughout. (12.1)
If the provider ends your service: at least 60 days' notice, unless your planning team identifies a health and safety risk or the provider's vendorization is being terminated. (12.2)
If the provider is losing its vendorization: it must tell you, your regional center and SDRC in writing within five business days of being notified. You decide whether to move. (12.2)
Either way: final expenditure reports and a year-to-date statement within 30 days of your last day of service, and all final tax filings. (12.2)

For you: this is the first time the mechanics of switching have been written down for every provider. You can change providers at any time; these are the rules the provider you are leaving has to follow.

13. Workers' compensation

Confirm that every non-exempt employee is classified correctly and covered by the right workers' compensation policy before they start work. (13.1)
Have a process for filing claims, comply with audits, and answer workers' comp questions from families, workers, the Department of Industrial Relations and the State Compensation Insurance Fund on time. (13.2–13.4)

For you: see workers' compensation. Under Sole Employer the policy is yours, so ask how your provider handles this check.

14. Payments

Fix overpayments and underpayments immediately, including when your budget hits zero, and report them to you, your regional center and SDRC. (14.1)
Have a process for replacing lost or stolen checks. (14.2)
Review every payment quarterly for accuracy and timeliness, and report problems to whoever is affected. (14.3)
Not pay a provider for goods it bought on your behalf, or for services it did not deliver itself; pay out-of-state services only with documented approval. (14.5, 14.6)
Pay complete and accurate invoices within 30 calendar days. (14.8)
Check time entries — breaks, overtime, authorized services, approved rates — before paying, and tell you or your worker when a time entry cannot be paid and why. (14.9, 14.10)
Require Electronic Visit Verification where the law does, and support you and your workers in using it. (14.11)

For you: 30 days is the latest an invoice can be paid, and it says nothing about how quickly a particular provider actually pays. Ask every provider you consider for their real schedule, in writing. Caregiver wages are a different stream: they are paid on the provider's payroll cycle, which has to meet California wage law.

15. Billing

Bill your regional center accurately within 30 days, in line with your spending plan and with the paperwork to back it up. (15.1–15.3)
Keep every claim and its records for at least five years, longer if an audit or appeal is open. (15.4)
Ask the regional center for reimbursement only after the provider has actually been paid — not for anticipated payments or time entries not yet through payroll. (15.5)

16. Taxes

For Co-Employer and Sole Employer, where the provider files on your behalf.

File, pay and reconcile federal and California payroll taxes on time — withholding, Social Security and Medicare, state income tax, disability insurance and unemployment insurance — and local taxes where they apply. (16.1, 16.2)
Audit its own filings quarterly and yearly. (16.3)
Answer requests from the Employment Development Department, Social Security and tax agencies on your behalf before they are due. (16.5)
Handle garnishments, refunds for workers below the Social Security threshold, W-2s (including Difficulty of Care exclusions under IRS Notice 2014-7), 1099s for contractors and unclaimed checks. (16.6–16.13)

For you: if a letter arrives from the IRS or the EDD about your household employment, your FMS is responsible for answering it. Send it to them quickly.