Position Statements in CDSS hearings

CDSS has issued instructions implementing AB 2346 about position statements.  Previously, public and private agencies other than the Department of Health Care Services were required to make paper copies of their position statements available to claimants at least two business days prior to the hearing.  AB 2346 extends this requirement to the Department of Health Care Services.  This means that position statements in Medi-Cal cases must now be made available two business days before the hearing.

In addition, position statements can now be provided to the claimant in one of three ways: 1) secure electronic transmission at least two business days before the hearing, with the claimant’s permission, and if the agency can comply with state and federal electronic privacy laws, 2) first class mail with mailing early enough for the claimant to receive the position statement two business days before the hearing, or 3) paper copy available at the appropriate office of the county welfare department two business days before the hearing, with public or private agencies that are not part of the county welfare department mailing a paper copy of the position statement to the county early enough for the county welfare department to make it available at least two business days before the hearing.

If electronic transmission does not apply, the county can choose whether to mail the position statement or make it available at the county welfare department office, but the county should discuss with the claimant how the claimant would prefer to receive the position statement.

If the position statement is not made available to the claimant two business days before the hearing or the agency modifies the position statement after providing it to the claimant, the claimant will have good cause to postpone the hearing.  The claimant must waive the 90 day deadline for a decision to get this postponement.  Because the postponement was caused by the county’s failure to provide the position statement as required, this postponement will be considered the claimant first postponement for purposes of evaluating subsequent postponement requests.

(ACL 17-21, February 16, 2017.)

Federal taxation of IHSS wages

The California Department of Social Services (CDSS) has announced that it will allow IHSS providers to self-certify that they live in the same home as the IHSS recipient for purposes of federal income taxes.

Internal Revenue Service Notice 2014-7 states that wages for an IHSS provider who lives in the same home as the recipient are not considered gross income for purposes of federal income taxes.  CDSS will allow self-certification that the IHSS provider lives with the recipient by submitting the SOC 2298 form.  Providers will only need to submit the form once.  If the living situation changes, the provider will need to submit the SOC 2299 form.

Wages will continue to be included as federally taxable income until the SOC 2298 form is submitted and processed.  CDSS Provider Bulletin, Live-In Provider Self Certification Information.

IHSS licensed health care professional certification

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).

Certain IHSS/HCB caregiver wages are MAGI exempt

DHCS clarified its MAGI Income and Deductions chart to account for recent IRS clarification about live-in caregiver wages.  Caregiver wages paid under certain IHSS and Home and Community Based Waivers are not counted for MAGI determinations when paid to a provider who lives with the Medi-Cal beneficiary receiving personal care services.

This exemption applies to:

  • In-Home Operations Waiver
  • Nursing Facility/Acute Hospital Waiver
  • Personal Care Services Program
  • In-Home Supportive Services Plus Option
  • Community First Choice Option
  • In-Home Supportive Services – Residual Program

DHCS MEDIL I 16-17 (September 21, 2016).

IHSS provider enrollment

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).

Extraordinary circumstances exception to IHSS provider workweek and travel time limitations

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).