Yearly Archives: 2018

Paid sick leave for IHSS providers

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CDSS has issued instructions implementing SB 3 regarding paid sick leave for IHSS providers.  Beginning July 1, 2018, IHSS providers who work 100 hours will be eligible for 8 hours of paid sick leave per year. The sick leave time will increase to 16 hours per year on July 1, 2020 and 24 hours per year on July 1, 2022.

Providers will be able to use paid accrued sick leave after working an additional 200 hours or 60 calendar days from the date when the provider earned the sick leave, whichever is first.

Providers will lose any used sick leave at the end of each fiscal year.  Accrued sick leave will not be paid at the end of employment.  However, if the provider is rehired as an IHSS provider within a year, previously accrued sick leave will be reinstated.

IHSS providers can use accrued sick leave for diagnosis, care or treatment of an existing condition or preventative care for themselves or their family, or if the provider is a victim of domestic violence, sexual assault or stalking.

IHSS providers can request paid sick leave by completing the SOC 2302 IHSS Program Provider Sick Leave Request Form.  Both the recipient and the provider sign the form.  The provider submits the form to the CMIPS vendor, Enterprise Services.  The minimum increment for paid sick leave is 1 hour, and additional sick leave may be used in 30 minute increments.  Providers should give 48 hours notice to the recipient for planned usage of paid sick leave and immediate notice or at least two hours prior to the start of the work day for emergencies.

CDSS will add the amount of available sick leave to each provider’s pay warrant.  Providers will receive a supplemental check which will include the wages received for the sick time used.  (ACL 18-01, January 9, 2018.)

Providing Voluntary Inpatient Detox Services through Medi-Cal Fee for Service

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Voluntary inpatient detoxification (VID) services are a Medi-Cal benefit carved out of managed care and covered through Medi-Cal fee for service.  To be eligible, inpatient detoxification must be the primary reason for voluntary admission.  DHCS’s All Plan Letter sets out medical criteria for inpatient admission for VID.

When a managed care plan sees a member who does not meet the medical necessity criteria, the plan should refer the member to the county’s behavioral health department for referral to other medically necessary substance use disorder treatment services.  Plans must also provide care coordination to ensure appropriate referrals to available services.

To receive VID services, plans must refer members to VID service providers in general acute care hospitals.  The VID service provider must submit a TAR to a local Medi-Cal field office with documentation verifying admission criteria and medical necessity.

DHCS APL 18-001 (January 11, 2018).

Clarification of Medi-Cal ICT Process after SB 1339

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SB 1339 codified the Medi-Cal Intercounty Transfer (ICT) process, effective June 1, 2017.  Medi-Cal beneficiaries must notify either the county they are leaving (sending county) or the county to which they are moving (receiving county) of a change in residence.  Once this happens, it is the responsibility of the notified county to initiate an ICT for all public benefits within seven business days of notice of new residence.

The bill prohibits counties from requiring the beneficiary to reapply for Medi-Cal benefits in the receiving county.  Benefits must continue without interruption during the ICT process.  The ICT must be completed no later than the first day of the next available benefit month following the 30 days after the beneficiary’s initial notification of change in residence.

If a beneficiary moves and is still enrolled in a managed care plan from the sending county, the beneficiary should continue to have access to emergency services and authorized out-of-network coverage until the ICT is processed and the beneficiary is disenrolled from the plan.  If the beneficiary needs non-emergency care the same month in the new county, the Medi-Cal Managed Care Ombudsman should disenroll the beneficiary from the plan on an expedited basis.  Changes requested by phone to the Ombudsman will be effective within two business days of processing the request.

If an individual household member moves out of the county, Medi-Cal eligibility must continue uninterrupted.  For short-term changes, counties can update the address; this does not initiate an ICT.  If an individual beneficiary moves to a new county but continues to be claimed as a member of a tax household in their former county, the county will update the individual’s address only.  This is not considered an ICT, but the individual will be able to enroll in a health plan in the new county while remaining in the existing case.

DHCS ACWDL 18-02 (January 11, 2018).

Denials and Terminations of Caretaker Adult MAGI Medi-Cal Cases when Child Lacks Coverage

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Under current State and Federal regulations, a parent or caretaker relative with a dependent child under 19 living in the home does not qualify for MAGI Medi-Cal if the child does not have minimum essential coverage (MEC).

Applicants and beneficiaries can self-attest that a dependent child has MEC at the time of application, renewal, or change in circumstance unless the county has information that states otherwise.  If a County worker learns that a dependent child does not have MEC, the worker should do an ex parte review to confirm MEC status.

As with any other discontinuance or denial, the County must send a NOA with proper language.  DHCS has provided sample language for such notices.

DHCS ACWDL 18-01 (January 8, 2018).

Medi-Cal Pregnancy Services Available Regardless of Gender Identity

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DHCS issued an All County Letter to update counties about eligibility for pregnancy services.  Based on Section 1557 of the Affordable Care Act, SAWS will change its language for Medi-Cal NOAs about coverage of pregnancy services.  The programming will allow pregnancy to be selected for any person on a Medi-Cal case regardless of gender.  As of July 18, 2016, all persons, regardless of gender identity, may request eligibility on the basis of pregnancy when applying for public insurance programs.  CalHEERS is working on an update to reflect this change.

DHCS ACWDL 17-38 (December 4, 2017).