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

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).

ACL 14-76: Implementation Of Provisions Of Senate Bills 855 And 873 Relating To The IHSS And Waiver Personal Care Services Programs (10/8/14)

Instructions on the AB 855 and SB 873 limit on the number of authorized hours providers in the IHSS and and Waiver Personal Care Services (WPCS) programs are permitted to work in a workweek.  The letter provides information and instructions for implementing new policies that require that IHSS/WPCS providers receive compensation for travel time and wait time under certain circumstances. Included are new and revised forms and notices to be used by counties in implementing the new policies. [Download]

ACL 14-68: IHSS Advance Pay And Provider Enrollment Requirements (11/3/14)

Instructions on the prohibition of using Advance Pay money to pay Individual Providers who have not completed the IHSS provider enrollment process and have not enrolled as IHSS providers, and a review of the time sheet rules.  The Advance Pay option allows eligible IHSS recipients (described in the letter) to get a direct monthly IHSS payment , in order to pay providers at the time services are rendered.  When in Advance Pay the provider’s time sheets must be sent it at the end of each authorized service month.  If the recipient fails to submit the provider’s time sheets, within 90 days from the date of payment, the county shall have the right to change the recipient’s payment delivery method from payment in advance to payment in arrears.  [Download]

ACIN I-31-14: Release Of The Statewide Report Of County Quality Assurance/Quality Improvement Activities In The IHSS For Fiscal Year 2012/13 (6/11/14)

SB 1104 required CDSS and county welfare departments to establish a dedicated QA function to conduct routine scheduled reviews of IHSS cases. This report is the first out after conducting the review. 17,621 case reviews, resulting in about 10 percent of QA case reviews resulted in a change in authorized service hours. Not listed in the executive summary is the discovery that 4% of the cases referred for fraud follow up were being underpaid. Overall, although there was a high level of achievement, not all counties did all required reviews, and data was inconsistent, and the review demonstrated that there needs to be improvements in QA data forms, instructions and training.  The review (with the revised forms) does seem to detect “critical incidents” where an IHSS recipient may be at risk. [Download]