From Kendra Scalia's Electronic Visit Verification (EVV) Is Here: What you need to know and how to get involved:

"Since 1997, I have hired my own PCAs through the consumer-directed service model.  I train my staff how to help me.  I manage their work schedules.  I supervise the work they complete.  I sign off on all timesheets.  I submit timesheets to a third-party responsible for payroll processing called a fiscal intermediary (FI). And, when necessary, I have the difficult task of firing individuals.  As a consumer in this model, I am the legal employer.  Navigating these work relationships in a very intimate environment is difficult yet a right my community fought for and one I will never willfullly give away."