The California Department of Social Services has issued clarification regarding several In Home Supportive Services (IHSS) Protective Supervision (PS) issues.

When two or more IHSS recipients are living together and receiving PS, the need is considered a common need and is prorated between the recipients.  CDSS issued instructions for how to prorate PS in the CMIPS II computer system.

Alternative resources are supportive services that are available to meet the recipient’s needs.  The county shall arrange for delivery of alternative services when they are available at no cost to either the IHSS program or the recipient.  Examples of alternative resources include adult or child day care centers, schools, community resource centers, Senior Centers and respite centers.  Multipurpose Senior Services Program and Regional Centers cannot be considered alternative resources.  Voluntary services cannot be considered an alternative resource, but can be used to fulfill the recipient’s 24 hour per day plan.

Environmental modification cannot be required to eliminate the need for PS.  However, existing environmental modifications can be considered if they eliminate the safety hazard that puts the recipient at risk.  Modifications or restraints such as locking the recipient in a room cannot be considered an appropriate modification.

The risk of falling can be considered for PS if the reason for the fall risk is related to the recipient’s mental impairment or illness.  For example, PS can be authorized for a recipient who has a fall risk if the recipient is unable to walk unassisted but, due to a mental impairment, forgets and frequently attempts to walk unassisted.

Eligibility for PS because of combative behavior is based upon evaluation of the willfulness of that behavior.  The recipient is considered nonself-directing if they are unable to assess the danger and risk of self harm.  An example is head banging as a manifestation of mental impairment or illness.  A recipient who displays intentional self-destructive behavior with the knowledge that the behavior may cause self harm would not be eligible for PS.  Recipients who exhibit anti-social or aggressive behavior directed to harm other people are ineligible for PS.  (ACL 17-95, September 12, 2017.)

The California Department of Social Services has issued instructions regarding electronic timesheets for In Home Supportive Services (IHSS) providers.  IHSS timesheets can now be submitted electronically using the Electronic Timesheet Service (ETS).  The ETS allows providers and recipients to enter time worked and submit timesheets, and view the previous three months of timesheet history.

ETS is optional.  To use it, both the provider and the recipient need to enroll.  After both the provider and the recipient are enrolled, the provider submits the timesheet and the recipient approves it.  Providers will not be able to submit their timesheets for recipient approval if the timesheet has errors.  Examples of errors that will block submitting the time sheet are hours claimed exceed remaining recipient authorized hours , hours claimed exceed remaining provider assigned hours,  no remaining recipient authorized hours , no remaining provider assigned hours, hours claimed exceed weekly maximum, and hours claimed exceed monthly overtime maximum and hours exceed overtime exemption limitation.

Providers and recipients can opt-out of ETS at any time.  (ACL 17-76, July 14, 2017.)

The California Department of Social Services has issued instructions regarding IHSS time for Medical Accompaniment.  Accompaniment to health care appointments and alternative resource sites is an allowable IHSS service.  CDSS states its policy is Medical Accompaniment can only be authorized when the recipient needs assistance with another IHSS authorized task during transportation or at the medical appointment or alternative resource site.  CDSS policy is Medical Accompaniment is not authorized only to fill the recipient’s need for transportation. Wait time is available for appointments when the provider provides authorized Medical Accompaniment and the provider is not performing work duties but is unable to use the time for their own purposes.

CDSS policy is that Medical Accompaniment is generally unavailable for minor recipients because it is a parental responsibility to accompany children to medical appointments.  Medical Accompaniment for a minor can be authorized only if the minor has an assessed extraordinary need, the appointment is for specialty care, and the minor has a need for another IHSS authorized task during transportation or at the medical appointment.  Although Medical Accompaniment is not available for routine medical appointments, if the minor recipient needs other authorized services based on assessed extraordinary need, the provider may be paid for assistance with another IHSS authorized task during transportation or at the medical appointment.  Wait time is also generally unavailable for minor recipients, with limited exceptions such as a medical professional taking physical charge of the minor recipient for a set period of time and there is enough time for the parent provider to conduct their own personal business.

Medical Accompaniment is available for appointments only when the county verifies that the recipient is not receiving Medi-Cal non-emergency medical transportation for that appointment.  When a recipient receives non-emergency medical transportation for an appointment, but the recipient needs assistance with another IHSS authorized task during transportation or at the medical appointment, Medical Accompaniment can be authorized, but only for the amount of time for travel to and from the recipient’s home to the appointment.  This is because the time for the other IHSS authorized tasks should already have been accounted for in the total authorization for those service categories.  (ACL 17-42, June 23, 2017.)

The California Department of Social Services (CDSS) has issued instructions about IHSS eligibility for children in Adoption Assistance Program (AAP) or Foster Care.  Children who receive AAP benefits who apply for IHSS must receive a comprehensive needs assessment.  Children who receive AAP can be eligible for IHSS.  AAP cannot be considered an alternative resource when determining the number of hours of IHSS eligibility.

Children placed in with an approved resource family or in a setting that must be approved as a resource family prior to December 31, 2019 are considered to be residing in their own home and are eligible for IHSS.  Children placed with a relative or with Non-Relative Extended Family Member are also eligible for IHSS.  Children who live in licensed community care facilities such as group homes, short-term residential therapeutic programs and transitional housing placement providers are not eligible for IHSS as long as they are in those placements because they are not residing in their own home.  (ACIN I-40-17, June 23, 2017.)

Previously, the California Department of Social Services (CDSS) instructed that IHSS providers who did not sign the SOC 846 provider agreement by April 29, 2017 would be terminated from the program.  CDSS has rescinded this policy.  CDSS states that most providers completed and returned the SOC 846 and all providers have received the information contained in the SOC 846. As a result, no disciplinary action will be taken against IHSS providers who do not sign and return the provider agreement.  (ACL 17-43, May 19, 2017.)