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US · guidance

CMS Pub. 100-16, ch. mc86c18b, § 190.5

Special Rules for Individual Employee Status

activein force · 2026-08-25 – presentas-observed

In general, an individual who is not actively working is considered to have employee

status if the relationship is such that:

• The individual is receiving payments from an employer which are subject to taxes

under the Federal Insurance Contributions Act (FICA), or would be subject to

such taxes except that the employer is one that is not required to pay such taxes

under the IRC;

• The individual is termed an employee under state or Federal law or in accordance

with a court decision;

30

• The employer pays the same taxes for the individual as he/she pays for actively

working employees;

• The individual continues to accrue vacation time or receives vacation pay;

• The individual participates in an employer's benefit plan in which only employees

may participate;

• The individual has rights to return to duty if his/her condition improves; and

• The individual continues to accrue sick leave.

History

(Rev. 30, 09-05-03)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
f5ef86b34cf4585ad7fa4ea4fde139394107b3b2482659d3111f181b605540c3
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