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]
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
IHSS
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]
ACL 06-13 – Changes to Case Management, Information and Payrolling System to Ensure Medi-cal Share of Cost Compliance as they Relate to the In-Home Supportive Services plus Waiver Program, the Personal Care Services Program, and the In-Home Supportive Services-Residual Program (May 30, 2006).
The incredibly LONG title of this ACL matches the incredibly LONG ACL. 54 pages of details about the Share of Cost (SOC) issues stemming from the IHSS plus waiver. There are some key tidbits buried in the extensive acronym- and form-laden text, so, sorry, but you should at least skim it. For example, the Medi-Cal SOC “buy out” (where a person pays only the IHSS SOC and not the higher Medi-Cal one) is calculated only once a month, and once that’s done it won’t be changed for the current or prior months. Also, the IHSS SOC will no longer automatically be deducted from the wages. Rather, the IHSS computer system will check first for Medi-Cal Point of Service deductions, and then determine the remaining spenddown amount to deduct from the provider wages. This change in turn, has generated the need for two new notices: one to the recipient to explain how much is owed the provider, and one to the provider saying how much is owed for the work. Good luck! [Download]
ACIN I-21-06 – Protective Supervision Form (April 4, 2006)
Back of the new “Quality Assurance Initiative,” the state was required to develop a standard form to get the appropriate certification for a person’s need for Protective Supervision. Here it is! Counties are to use the form at the initial assessment when the county worker identifies the potential need for Protective Supervision. If the doc fails to return the form, the county “shall make its determination of need based on the available evidence.” [Download]