When using Consumer-Directed Medicaid services, two key partners work together behind the scenes to ensure that services are approved, attendants are paid, and families get the support they need: Managed Care Organizations (MCO’s) and Fiscal Agents (FE/A’s).

The Approving Authority is responsible for reviewing needs and authorizing hours of care. Depending on the type of waiver, this may be DMAS, an MCO, or DBHDS.

Who Are They?

• Managed Care Organizations (MCOs): Anthem, Sentara, UnitedHealthcare, Humana, Aetna
• DMAS: Direct Medicaid Services

   

DBHDS: Department of Behavioral Health & Developmental Services (for DD Waivers)

What They Do:

• Review documentation and approve the number of hours requested
• Must complete approvals within 14 business days
• Provide a written decision if hours are not fully approved

Go to your MCO for questions about approval of hours.

Your Fiscal Agent acts as the bank and payroll processor for Consumer-Directed services. They make sure attendants get paid correctly and that paperwork is handled smoothly.

Who Are They?

• Public Partnerships (PPL): works with Anthem, UnitedHealthcare, Aetna
  
• Consumer Direct Care Network (CDCN): works with Straight Medicaid, Aetna, Sentara, Humana

   

What They Do:

• Receive the service approval from the Approving Authority (MCO/DMAS/DBHDS)
  
• Handle payroll and act as the “bank” for the Medicaid Member’s authorized services
  
• Guide the Employer of Record (EOR) and attendants through the enrollment process
  
• Answer all payroll-related questions from the Employer of Record

Go to your Fiscal Agent for questions about payroll, enrollment, or timesheets.

1. The Approving Authority (MCO/DMAS/DBHDS) reviews your documentation and approves or denies the number of service hours requested by the service facilitator.
   
2. The Fiscal Agent receives this approval from the approving authority, handles payroll, and ensures your attendants are enrolled and paid.

Together, they help ensure that services are delivered, tracked, and funded properly.