Please Share this Important Information With Your IHSS Clients

Starting August 1, 2011, all current IHSS recipients–and new applicants for the program–must have a licensed health care professional provide medical certification that the recipient has a medical need for IHSS. 

Under the law, your client should receive a new medical certification form (SOC 873) during or shortly after his or her annual assessment. (This is in addition to the form usually requested by the social worker during the assessment.)

The SOC 873  form must be filled out by a licensed health care professional and returned to the county within 45 days of the date of your assessment.  Unless this form is completed and returned, your client will lose authorization for IHSS services.

A licensed health care professional can be a “physician, physician assistant, regional center clinician or clinician supervisor, occupational therapist, physical therapist, psychiatrist, psychologist, optometrist, ophthalmologist, or public health nurse” who is licensed by the appropriate regulatory agency and is “acting within the scope of his or her license or certificate.”

In order for your client to continue to receive IHSS services, his or her licensed health care professional must certify that all of the following is true:

• He or she is unable to perform some activities of daily living independently,  AND
• Without IHSS, he or she is at risk of being placed in out-of-home care, AND
• He or she has a physical or mental condition or functional limitation that requires IHSS services.

Your client should call his or her doctor or health care professional’s office or schedule an appointment to discuss the need to have the medical certification form filled out.  Your client should explain that IHSS helps with services that she or he needs to stay at home safely, and that without the medical certification, he or she will lose eligibility for IHSS. It might be helpful to bring a list describing some of the services she or he needs–for instance, laundry, cooking meals, dressing, bathing, etc.  Your client should ask to be given a copy of the completed form before the health care professional mails it to the county.

Remember, it is your client’s responsibility to make certain the county receives the information within the 45-day period.

*Exceptions to 45-day deadline: If your client makes a good faith effort to provide the medical certification, but is unable to do so due to factors beyond his or her control, he or she can request a “good cause” extension of time from the county.

*Right to appeal: If the county does not receive the medical certification, it will send your client a Notice of Action saying that his or her IHSS is being terminated.  Your client can appeal this decision and ask for a hearing with an administrative law judge to explain why the county’s decision was wrong. Your client can find information on how to apply for a hearing on the back of the Notice of Action. It is important that your client requests the hearing within 10 days of receiving the Notice of Action and states in writing that he or she wants “Aid Paid Pending.” This will ensure that IHSS services are not cut off before the hearing takes place.

New applicants for IHSS normally cannot get IHSS services until the county receives their medical certification forms.  However, there are two exceptions:

• If the applicant is being discharged from a hospital or nursing home and needs IHSS in order to return home safely;  or
• If the applicant is at risk of being forced into an institution without a temporary authorization of IHSS services.

For further information on the new Medical Certification requirement, call UDW at 1-800-621-5016.

Some of the information in this document was obtained from a Fact Sheet on IHSS New Medical Certification Requirement (Publication #F059.01), produced by Disability Rights California.

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Additional Information:

• CDSS, All County Information Notice ACIN #I-74-11  (December 6, 2011).  Re Revised IHSS Health Care Certification Form <http://www.cdss.ca.gov/lettersnotices/entres/getinfo/acin/2011/I-74_11.pdf>
• CDSS All County Letter ACL 11-76  (November 10, 2011) <http://www.cdss.ca.gov/lettersnotices/entres/getinfo/acl/2011/11-76.pdf>  In-Home Supportive Services (IHSS) Health Care Certification Form SOC 873 Exceptions
• Disability Rights California Fact Sheet, Publication #F059.01, “New Medical Certification Requirements”
• CDSS All County Letter (ACL) 11-55   explaining this new requirement and attaching the medical certification form, SOC 873. This document is available on the DSS website at http://www.dss.cahwnet.gov/lettersnotices/PG2438.htm. However, please note that DSS will likely be issuing additional ACLs, some correcting issues with ACL 11-55. These ACLs will be available on the same website.
• The SOC 873 form is also available on the California Department of Social Services forms website, at http://www.dss.cahwnet.gov/cdssweb/PG168.htm#soc.
• Welf. & Inst. Code section 12309.1(d), Government Code 7395.2. The cover letters, forms SOC 874 and 875, are available at http://www.dss.cahwnet.gov/cdssweb/PG168.htm#soc.