CDSS has issued instructions and forms to counties about certification from a licensed health care professional as a condition of eligibility for In Home Supportive Services (IHSS) benefits.  Counties are required to provide applicants with the SOC 873 certification form and SOC 874 instructions.  Applicants must submit the completed form within 45 days of receiving it from the county.  Applicants can submit alternative documentation if it contains the same information as the SOC 873 form.  The application will be denied if certification is not submitted within 45 days of the county providing the forms.

The health care certification is not the only factor in determining the need for IHSS services, but should be considered as one indicator of the need for services.  However, the IHSS application must be denied if the first two questions on the SOC 873 form are not answered yes by the licensed health care professional.  If the county believes the applicant should be eligible for IHSS despite not receiving yes answers to those questions, the form must be returned to the health care professional to be reconsidered.

Services cannot be authorized until the county has received certification from a licensed health care professional unless services are being requested on behalf of an applicant who is returning to the community from a hospital or nursing home and needs services to remain safely in the community or the applicant is at imminent risk of out-of-home placement.  ACL 16-78 (September 28, 2016).

The California Department of Social Services has issued information about new regulations implementing IHSS provider enrollment rules and procedures.  These rules and procedures include 90 days to complete the provider enrollment process with a  possible 45 day extension for good cause, attending an in-person orientation, fingerprinting for criminal background check, notice of eligibility or ineligibility to be enrolled as a provider and waiver of disqualifying convictions.  In addition, the county will determine whether a provider has legal authority to work in the United States.

The new regulations also specify that an enrolled provider cannot be required to complete the provider enrollment process when the provider moves from one county to another.  The county that the provider moved from is obligated to give the new county the criminal background check clearance documents and the new county must accept that documentation.  ACL 16-53 (July 7, 2016).

The California Department of Social Services has issued instructions about the extraordinary circumstances exception to IHSS provider workweek and travel time limitations.  The extraordinary circumstances exception is available to providers who work for two or more recipients and the recipients meet at least one of the following: 1) have complex medical and/or behavioral needs that must be met by a provider who lives in the same home as the recipient; 2) live in a rural or remote area where providers are limited and as a result the recipient cannot hire another provider or 3) is unable to hire a provider who speaks their language in order to direct their care.

The complex medical or behavioral needs exception applies only when the recipient’s physical or mental health would be harmed to the point of risking out of home placement if services are provided by anyone other than the primary IHSS provider.  Counties will review this exception every 12 months.

The rural or remote location exception applies to areas that are outside of urban areas, defined as population over 50,000 people and outside of urban clusters, which is defined as population centers of between 2,500 and 50,000 people.  The county is required to search for alternative providers, and must review this exception every six months.

The language barrier exception only applies when the inability to hire a provider who speaks the recipients language results in a consistent barrier to the recipient directing their own care that cannot be overcome.  CDSS states that tasks that do not require direction by the recipient such as domestic or related services or some personal care services which only require some direction from the recipient, can be performed by a provider who does not speak the recipient’s language.  The county is required to search for alternative providers, and must review this exception every six months.

CDSS also clarified the live-in family care provider exception.  This exception can apply people who were live-in care providers before January 31, 2016 if the exception is needed after that date because of a change in the recipient’s condition.  ACL 16-22 (April 1, 2016).

The California Department of Social Services has issued instructions about violations for IHSS providers who exceed workweek and travel time limitations.  Those limitations are described in ACL 16-01.

A violation of the workweek and travel time limitations occurs when: 1) a provider works more than 40 hours in a workweek without county approval and the recipient’s receives less than 40 hours; 2) a provider works more hours in a workweek than the recipient’s maximum weekly hours causing the provider to work more overtime hours in a month than normal without county approval; 3) a provider works more than 66 hours in a week when working for multiple recipients and 4) a provider claims more than 7 hours of travel in a workweek.

The first violation causes a written warning.  The second violation is a warning and a one-time opportunity to complete voluntary instructional materials.  If the materials are completed within 14 days, the second violation is rescinded.  The next violation would then be considered the second violation and will not be rescinded.  The materials are attached to ACL 16-44.

The third violation causes a 90 day suspension of the IHSS provider’s eligibility to work.  The fourth violation causes a one year suspension of the IHSS provider’s eligibility to work.

If a provider has no violations for a year, one violation is rescinded.

For first and second violations, providers can request a county administrative review of the violation, followed by an administrative hearing.  For third and fourth violation, providers can request a county administrative review, then a CDSS administrative review, then an administrative hearing.  ACL 16-36 (April 21, 2016).

The California Department of Social Services previously stated in ACL 16-01 that In Home Supportive Services providers were required to submit the Provider Enrollment Agreement (SOC 846) by April 15, 2016 or be terminated on May 1, 2016.

CDSS changed its policy so that providers who did not submit the SOC 846 by April 15, 2016 will not be automatically terminated.  The SOC 846 remains a required form that must be submitted and counties must assist in providers in completing the form.  ACL 16-27 (April 14, 2016).