Getting paid

Who actually pays you

The participant has a budget. Their FMS holds it, keeps the records and makes the payments. So the invoice goes to the FMS, by whatever route that provider asks for — an address for invoices, a portal, a form. Ask what it is and use it. Sending an invoice somewhere other than where a provider collects them is the commonest self-inflicted delay there is.

The participant approves every invoice before it is paid. This is not a formality and it is not optional. It is also the reason the detail on your invoice matters: the person approving it has to be able to recognize what they are approving.

Which kind of provider you are

Before the invoice rules, the category — because the rules branch on it, and DDS defines both terms rather than leaving them to usage.

A local business or community resource is “an entity, not vendored by a regional center, providing a service to a participant in the SDP that is also provided to individuals without developmental disabilities.”

An SDP Provider is “either a business entity, including a regional center vendor, or an independent contractor who receives payment by invoicing for services which are provided to a participant in the SDP.”

So the test for the first one is whether you sell the same thing to everybody. A gym, a dance studio, a driving school, a swim class at the recreation center — these are local businesses, and the detailed invoice rules below do not apply to you. Your FMS works out the documentation with the participant, and what that looks like is your ordinary paperwork: a membership contract, or the agreement and payment terms you would give any customer.

One thing worth knowing if that is you. DDS says payments “shall be aligned with the typical processes used by local businesses or community resources”, and gives the example that if a subscription is payable at the start of the month, the FMS should move its payment schedule to match. You are not expected to restructure your billing around the program. If an FMS payment cycle is about to cut across how your business actually works, say so.

What your invoice has to show

This part is a requirement rather than a preference, and it applies if you are an SDP Provider as defined above.

Billing by the hour or by the day. Seven things:

• Your hourly or daily rate
• The SDP service code
• The date each service or task was provided
• A description of the specific service or task
• The amount of time spent on each one
• The total cost
• A statement that all services on the invoice have been provided to the participant

This is the default. DDS says an SDP Provider’s services “must be billed at an hourly or daily rate” unless you take the route below.

Billing at any other rate — per session, per month, per course. A later directive replaced the rules above for this case. The invoice needs the rate, the service code, a description, the time spent for the period of the invoice, the dates, and the same statement. Two further conditions come with it:

• The rate may not be longer than monthly. DDS puts it as “the cost of the services may not be more than a monthly rate”, so a quarterly, termly or annual rate is not available to you — it has to be expressed monthly or shorter.
• You and the participant must have a written service agreement, updated annually and sent to the FMS to check. It has to name the participant, your contact details, the start and end dates, the services and their SDP codes, how often, the rate and unit, what each of you is responsible for, how either of you ends it, both signatures, and a statement that the payment is accepted as payment in full.

Regional center vendors providing services under their existing program design invoice as they always have, at their traditional rate. But if you are vendored and you bill at a different rate or unit than your traditional one, that exemption falls away and you bill under the detailed requirements above.

DDS, “Self-Determination Program: Billing Requirements for Services”, 26 December 2023 — the definitions, the hourly and daily invoice contents, and the rule on local businesses. DDS, “Self-Determination Program: Updated Billing Requirements for Services Billing at ‘Other Rate’”, 22 April 2024 — which replaced the earlier requirements for anything not billed hourly or daily, and added the service agreement, in force for services provided after 30 June 2024. Both are issued under Welfare and Institutions Code section 4685.8(p)(2), which lets DDS direct the program until regulations are adopted.

You do not need to know your own service code off by heart — it is in the participant's spending plan, and their FMS or independent facilitator can tell you. But an invoice without one, from a provider who needs one, will come back.

What cannot be paid for

Worth reading even if none of them sounds like you, because every one is a request somebody has made in good faith.

• Anything not in the participant's spending plan, or not authorized yet. The plan is the authority to spend. If it is not there, the plan has to change first.
• Goods you bought on the participant's behalf. The December 2023 directive is explicit: payments to an SDP Provider “shall not include reimbursement for goods purchased by an SDP Provider on behalf of the participant”. If a purchase is part of your service, say so before you spend your own money, because it has to be made a different way.
• Services someone else provided. Same sentence of the same directive: no “payment for services not provided directly by the SDP Provider”. You invoice for your own work, and a subcontractor the participant has not been set up with cannot be paid through your invoice.
• Tips and gratuities. Not from public funds. This one is not in the DDS billing directives — it is how FMS providers generally treat it, so ask yours if it matters to your service.
• Anything from a provider outside California that DDS has not authorized. This one catches people, because nothing about it is visible until the invoice cannot be paid. If you are located and doing business outside California — including delivering by video — the regional center has to get approval from DDS before the money can be spent, and it cannot be granted after the fact. What that involves.

What actually holds a payment up

In roughly the order they occur:

• Your paperwork is not finished. An FMS has to finish verifying you before it can pay you, so this is the one that can turn a delay into a loss. What a provider will do about work done in that gap is its own call, and worth asking before you are in it.
• A name mismatch. Payments go to the name on your W-9 and nothing else. If your bank account is in a trading name and your W-9 is in your own, fix it before the first invoice rather than after.
• A license has expired, or you have appeared on an exclusion list. Either way the FMS can no longer verify that you may be paid, and payment stops until that is resolved.
• The invoice is missing something from the list above — most often the service code, the dates, or the statement that the service was provided.
• The participant has not approved it yet. Nothing moves until they do. If an invoice has gone quiet, this is worth asking about first and is usually nothing more than someone being away.
• The budget line is exhausted. A spending plan allocates a specific amount to a specific service. When that is spent, further invoices against it cannot be paid until the plan is revised.

While you are providing the service

• Tell the FMS when something changes — your address, your bank, your license, your business name. All four stop payments when they are wrong.
• Keep your records for three years. This one is a requirement, not a convention: the December 2023 directive has every SDP Provider agree to keep, for at least three years from the date of service, everything needed to show the full extent of the services provided, and to hand it over on request to DDS or another state or federal agency.
• What you are attesting to on every invoice. The same directive sets out what an SDP Provider agrees: that the services were, to the best of your knowledge, consistent with the participant's IPP, spending plan and your service agreement; that SDP claims are paid from federal and state funds, so falsifying or concealing a material fact can be prosecuted; and that you offer your service without discrimination.
• Report serious incidents immediately — an injury, suspected abuse or neglect, a crime against the participant, a medication error, an unplanned hospital admission, a participant who goes missing. Your FMS will have told you how to reach them for this, and it will not be an ordinary email address. In an emergency, call 911 first and report afterwards.
• Declare conflicts of interest — most commonly, being paid to provide a service while also helping the participant decide what services to buy.

If the participant changes FMS

Your arrangement is with the participant, but your payments come from whichever FMS holds their budget. If they move, the new provider has to take you on before it can pay you, and that is not automatic.

Ask early, start the paperwork early, and be clear with the participant about the date from which you can be paid by the new provider. More on what carries over and what does not.

Elsewhere on this site

• What you will be asked for — the documents and the checks.
• Spending plan builder — if a participant has asked you to help them cost a service, this is where the numbers go.
• Glossary — the terms used on this page, written out.