ACL 11-55: IHSS Medical Certification Form (7/27/11)

Starting August 1st, all new IHSS applicants must have a new form SOC 873 completed.  Recipients must have the form completed around the time of their reassessment. (The ACL also describes alternative documentation to the 873 that will be acceptable.) New WIC section 12309.1 required a medical certification form that includes a declaration from a licensed health care professional that the applicant/recipient is unable to independently perform some activity of daily living and that without the assistance of IHSS services, the applicant/recipient would be at risk of placement in out-of-home care. The form must also include a description of any condition or functional limitation that has resulted in, or contributed to, the applicant/recipient’s need for assistance. (Same purpose, new look.)  Individuals will have 45 days from the date the county requests the form to obtain the verification, with good cause extensions for recipients (but not applicants).  The form must have questions 5 and 6 completed.  The county will perform an assessment only if both 5 and 6 answers are YES.  If either is a “no” IHSS will be denied, and for recipients, services terminated. Once the new form is completed, it does not need to be done at subsequent reassessments, as counties can use the 873 or their own form at that time.

Counties can give the form to the applicant/recipient, but if the person requests assistance, the county must send it for them.  (Even if the county sends the form, it is the individual’s responsibility to ensure it is returned, but can sign the release section on the form, which permits the counties to contact the provider.)  If 5 and 6 are marked “yes” the form will not be the sole determinative factor in services, as usual.   [Download]