More instructions re: reimbursement for expenses during 3-month retroactive Medi-cal coverage period. This one pertains to reimbursement of IHSS recipients who have paid excess out-of-pocket Share of Cost (SOC) expenses. The “complex issue” of IHSS-buy out cases will be deferred to a future ACL, but in the meantime, recipients who believe they have paid a SOC in excess of their obligation must submit their claims through the Department of Health Care Services (CDHCS) Beneficiary Services Center (BSC), unless it is a Buy-Out claim for reimbursement for the current month or one month prior. That category of buy-out claims is to be made bay the County using the Special Pre-Authorized Transaction (SPEC) created for this purpose. [Download]
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
IHSS
Errata to ACL 06-34: Correction ACL 06-34, Hourly Task Guidelines Regulations For IHSS/PCSP/IPW Programs (5/4/07)
If you felt attached to Attachment B to ACL 06-34…. get over it! This Errata provides the correct Attachment, which pertains to Annotated Assessment Criteria. The goal was to improve clarity, consistency and correct the listing of specific tasks which require determination of functional ranking. [Download]
ACIN I-05-07: New In-Home Supportive Services (IHSS) Plus Waiver Program Regulations (2/23/07)
The “new” regs, effective 10/1/06, are attached to this ACIN. Basically, the IHSS Plus Waiver regulations replicate the “IHSS-R” Program regulations…except where they don’t. This ACIN lists the differences. Some variations in eligibility, program content, application process, needs assessment and overpayment process. Do IHSS? check out the details…. [Download]
ACL 07-11: Implementation Of Conlan II: Reimbursement Of Covered Services For IHSS Recipients (2/20/07)
The long-awaited-for notice and process for the submission and handling of claims for reimbursement for bills paid out of pocket by folks later found eligible for Medi-Cal, and who are IHSS recipients. CDSS is handling the IHSS claims. (DHS is doing the “straight” Medi-Cal — see All Plan Letter 07002.) The notice is set to be mailed to 11.5 million folks. Wow. [Download]
ACL 06-35 – Quality Assurance/Improvement Monitoring Regulations For The In-Home Supportive Services/Personal Care Services/Independence Plus Waiver Programs (September 1, 2006).
This ACL transmits the regs to implement the SB1104 provisions intended to “improve the quality of IHSS/PCSP need assessments, enhance program integrity, and detect and prevent program fraud and abuse.” Counties must establish a dedicated IHSS Quality Assurance/Improvement function, and to develop policies, procedures, implementation timelines, and instructions under which county QA/QI programs will perform mandated activities regarding IHSS programs. Counties must have a standardized process with regularly scheduled reviews; case samples from all district offices, a needs assessment process; and desk and home-visit reviews. Needless to say, counties also must include procedures for preventing and detecting fraud, including follow-up if fraud is suspected and to collection of overpayments. [Download]
ACIN I-53-06 – Safety Evaluation of IHSS and Adult Protective Services Recipients (July 26, 2006)
This implements the Governor’s call to contact all IHSS and APS clients, in response to the heat wave. Instructions on APS confidentiality, bases for authorizing additional IHSS service hours when needed, and the method for claiming extra time when folks are already at the max. [Download]