Before filling out packets and forms, it is important to know your role. Click here or scroll to the bottom of the page to review the different roles to help you determine which forms you need to fill out.
Virginia Premier Health Plan Forms
The Employer Enrollment Packet contains all the required forms to setup an individual as the Employer.
The Attendant Enrollment Packet contains all the required forms to begin the employment process.
This form is for Service Facilitators.
Form/Packet Instructional Materials
Change of Employer of Record
New Employer must submit to Consumer Direct Care Network (1) Employer Enrollment Packet and (2) an Employer of Record Change Attendant Attestation Form for each employed Attendant.
Payroll, Exemptions, and Other Forms
What’s My Role?
Before filling out packets and forms, it is important to know your role. Below are definitions to help you determine which forms you need to fill out.
Employer of Record (EOR) – The Employer of Record (EOR) is the person who performs the function of the employer in the consumer-directed model. The EOR may be the individual receiving the services or another person designated by the individual. If you are the Employer of Record, you will fill out the Employer packets and/or forms.
Attendant – The person hired to provide consumer directed care or supports. This person is sometimes called a Caregiver. If you are the Attendant, you will fill out the Attendant packets and/or forms.
Service Facilitator – A person who helps Participants and their family. If you are the Service Facilitator, you will fill out the Fiscal Agent Request Form (FARF).
Participant – The person receiving Medicaid waiver services/supports. This person is also called an Individual. If you are the Participant and are your own Employer of Record, you will fill out the Employer packets and/or forms.