OWD is a justification form supported by evidence and documentation. The EOR must select one or more criteria below, and provide proof to support the choice.

OWD Criteria & Acceptable Evidence

1. Unable to Hire Staff

• Copies of advertisements posted (with locations/images) seeking external attendant care.
• Copies of interview notes or summaries of attempts to hire.
• Documentation showing high turnover of previously hired staff.

Note: All advertisements/postings must come directly from the Employer of Record.

2. Special Behavioral Needs

• A current/active behavioral support plan (attach provider name and plan, or Support Coordinator verification).
• Proof that a referral for behavioral support has been made (verified by Support Coordinator).

3. Special Medical Needs (Non-Skilled Care)

• Letter from a physician describing the individual’s special medical needs.
• Physician’s OWD statement explaining why the condition can only be managed by a family member or live-in attendant.

4. Language Barriers

• Documentation of attempts to hire someone fluent in the family’s language (ads, postings, or outreach efforts).
• Physician’s statement describing the language difficulty/barrier and training provided on any device/communication method.
• Physician must clearly state why the live-in family member is the only appropriate provider due to communication needs.

Note: This does not apply simply because the individual is non-verbal and uses a device.

5. Other (Must Meet Regulatory Compliance)

• Physician’s written explanation of an extenuating circumstance.
• Statement clearly showing why the live-in family member is the only person able to provide care.

Reminder: OWD is always submitted by the Employer of Record (EOR) and must include supporting documentation.