IHSS

CDSS issues new instructions about Protective Supervision

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In this letter, CDSS states several policies about several aspects of eligibility for In Home Supportive Services Protective Supervision, which is 24 hour supervision to safeguard against injury, hazard or accident. (MPP § 30-757.17.) These policies include:

  • A person must be both mentally ill and non-selfdirecting to be eligible for Protective Supervision. CDSS states it will amend MPP Section 30-757.17 to reflect this policy.
  • A person must be physically able to harm themselves to be eligible for Protective Supervision. This can include observation of persons who are bedridden but who are able to harm themselves. CDSS gives the example of a bedridden person who can pull out a G-tube.
  • While Protective Supervision is not available to guard against deliberate self-destructive behavior, a recipient who engages in deliberate self-destructive behavior and other behavior that is a basis for Protective Supervision such as wandering can be eligible for Protective Supervision to prevent the wandering.
  • Environmental modifications such as removing knobs from stoves or adding safety latches can eliminate the need for Protective Supervision.
  • Fluctuating or episodic behavior can be a basis for Protective Supervision if the behavior is unpredictable. However, if the behavior is predictable, IHSS should only be authorized for the time when the behavior occurs.
  • Leaving a recipient for fixed short periods of time is not, by itself, a reason to deny Protective Supervision
  • Actual injury is not required for Protective Supervision eligibility. A history of a propensity for the recipient to place themselves in danger is sufficient for Protective Supervision eligibility.

The letter also restates criteria for assessing children for eligibility for Protective Supervision. ACL 15-25.

Instructions to determine IHSS eligibility for “non-disabled” people with MAGI Medi-Cal

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Under the ACA, 19 to 64 year olds who are neither disabled nor blind can be eligible for Medi-Cal if if their modified adjusted gross income (MAGI) is below a certain amount.  There are several MAGI aid codes, many of which indicate eligibility for full-scope Medi-Cal with federal financial participation (FFP).  For such individuals who have not yet been determined to be disabled by CDSS or the Social Security Administration, they may still receive IHSS if they (1) meet the criteria for disability under MPP Section 30-780.2(b), and (2) have an assessed need for IHSS.  ACL 14-67.

Federal judge halts implementation of new IHSS overtime rules

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On January 14, 2015, Judge Richard Leon of the U.S. District Court, District of Columbia issued a ruling vacating the U.S. Department of Labor’s revised companionship services definition scheduled to take effect the following day. In response, CDSS has postponed changes related to overtime, travel time and wait time pay for all IHSS providers. The forms and notices previously issued to implement the changes will not be used. Notices were to issue to all IHSS providers and recipients informing them 2014 hours allocations will remain in effect and the planned 61-hour limit will not take effect. The Department of Labor has appealed Judge Leon’s ruling.  ACL 15-10.

IHSS provider enrollment orientation rules change next month

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Beginning April 1, 2015, prospective IHSS providers must attend an in-person provider enrollment orientation that includes training and materials detailing the applicable federal and state minimum wage, overtime, travel time and wait time laws. Counties must provide the orientation in English and any language spoken by five percent or more non-English speakers in the county. The county’s recognized employee organization must be permitted to make a presentation at the orientation. These changes are pursuant to SB 878. In addition, prospective providers may no longer use printouts from the Social Security Administration as original documentation of identity. However, Social Security cards, state driver’s licenses or identification cards and tribal identification cards are still accepted. ACL 14-102.

New IHSS time sheet and reimbursement processes implemented

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IHSS providers who provide services to different recipients at different locations on the same workday are now eligible to be paid for up to 7 hours of travel time per work week in accordance with Welf. & Inst. Code §12300.4(f).  Such providers, effective January 1, 2015, must now submit the IHSS timesheet with travel (SOC 2262) and the travel claim form (SOC 2275) to be paid for their travel time.  ACL 14-103.

Clarification for using personal care services to meet Medi-Cal share of cost

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DHCS recently clarified the process for using out-of-pocket expenses from personal care services to meet current or future share of cost amounts.  Previously, IHSS needed to assess and approve the need for personal care services, and the out-of-pocket costs of approved hours were used as an income deduction.  Since these services are now provided as a Medi-Cal benefit, out-of-pocket costs can now be used to meet share of cost and not income deductions.

These out-of-pocket personal care services must be prescribed by a healthcare professional.  The services need not be assessed by IHSS or provided by an IHSS provider, and they may exceed the maximum assessed IHSS hours as long as the need for hours has been documented.

The letter provides answers to frequently asked questions about using these out-of-pocket expenses toward the Medi-Cal share of cost.  DHCS ACWDL 15-02 (1/12/15).