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Understanding IHSS Regulations

*Please make sure to read guidelines for use

Since consumers (recipients) of IHSS have their hours authorized during the IHSS Needs Assessment process, it is important that both homecare consumers and providers understand that procedure. The topics below will help consumers and providers understand the Needs Assessment, Provider Requirements (fingerprinting & background checks) as well as the Fair Hearing processes. At the end of each topic there is a reference to the resources where that subject is covered in more detail.

Quick Facts: Questions & Answers About IHSS

• What is the Medical Certification Requirement for IHSS Consumers?
• Do all providers need a background check to work for IHSS?
• What are IHSS consumer rights regarding unannounced home visits?
• Understanding “Unmet Need” and how it impacts consumer hours
• What is a “Functional Index Ranking” and how does it impact my client’s assessed hours or eligibility?
• Preparing for the annual assessment
• What IHSS will pay for
• How to “Log” your time
• How to get the right documents from the doctor
• What is Protective Supervision & how does it qualify a consumer for more hours?
• Using an “Advocate” or representative
• Understanding the “Notice of Action”
• When to ask for a re-assessment
• You can appeal the assessment when consumer’s hours are reduced or an assessment is not right
• How to keep the same hours until your appeal is heard
• If I lose my job, can I qualify for unemployment insurance?
• What happens if I must leave work (my IHSS consumer) to care for a seriously ill parent, child, or spouse
• How to Get Professional Help With all of the Above

Medical Certification for IHSS Consumers

Beginning August 1, 2011, IHSS recipients and new applicants must have a licensed health care professional provide medical certification that the recipient has a medical need for IHSS. This is a one-time certification and will not need to be repeated annually as do many other IHSS medical forms.

New applicants will need to submit the medical certification before they can receive IHSS, and current recipients will need to submit the medical certification around the time of their reassessment. The medical certification form is called SOC 873, and it will be provided to you by the county. 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.

For more detailed information on the Medical Certification requirement please see:

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Background Checks

As part of the 2009-10 state budget changes, all providers must submit fingerprints at their own expense and pass a criminal background check with the California Department of Justice (DOJ); fees vary from $35 to $55.

For more information about fingerprinting:

Background checks may yield specific information that may prevent you from being paid as an IHSS a provider. Disqualifying offenses are separated into two categories:

Tier 1

If you have been convicted of, or incarcerated for the following convictions within the past 10 years then you will not be eligible to be enrolled as an IHSS provider.

• Specified abuse of a child- Penal Code section 273a(a)
• Abuse of an elder or dependant adult – Penal Code Section 368
• Fraud against a government health care or supportive services program

Tier 2

If you have been convicted of, or incarcerated for the following convictions within the past 10 years, you may not be eligible to be enrolled as an IHSS provider.

• A violent or serious felony- Penal Code section 667.5(c) and section 1192.7 (c)
• A felony offense for which a person is required to register as a sex offender – Penal Code section 290(c)
• A felony offense for fraud against a public social services program- Welfare and Institutions Code section 1098 (c) (2) and (g) (2)

For more detailed information about Tier 2 crimes, please see attached document from the Department of Social Services.

Tier 2 crimes may be waived on the following conditions:

• If you have a certificate of rehabilitation or the conviction has been expunged
• If your IHSS recipient requests and individual waiver to hire you
• If you request and are approved of a general exception from CDSS

IMPORTANT: If you believe you have been denied eligibility by error, you have the right to file an Appeal Request (SOC 856) with the Provider Enrollment Appeals Unit (PEAU) and mailing the form to the following address:

California Department of Social Services
Adult Programs Branch
Provider Enrollment Appeals Unit, MS 9-9-04
PO Box 944243
Sacramento, CA 94244-2430

More detailed information about enrollment requirements:

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What are IHSS consumer rights regarding unannounced home visits?

Some counties have been abusive in their application of this mandate. It is important to know your rights:

• County Welfare Dept officials can conduct unannounced home visits during reasonable hours of normal family activity.
  County officials must identify themselves with photo identification, and wear badges.
  They must treat you with courtesy and respect; interviews with you or possible witnesses must be conducted without threats, duress, force, false showing of authority or other misrepresentation.
• Search of your home or removal of physical items of evidence of fraud is not allowed without either a valid search warrant or your permission after you have been fully advised of your rights.

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Understanding “Unmet Need”
and how it impacts consumer hours

Why this is important:
If the consumer has documented unmet need, across the board cuts to IHSS (like the recent 3.6 percent cut) will be applied first to this unmet need. Therefore, the actual reduction in IHSS hours may be significantly less.

There have been problems with counties not documenting or inaccurately documenting unmet need.“Unmet need” refers to a situation where the consumer already gets the maximum hours allowed by IHSS but needs additional care not provided by IHSS. Protective Supervision hours are not counted toward Unmet Need; the additional need for care must be in other categories. Example: A consumer is already authorized for 283 hours from IHSS and they don’t qualify for Regional Center or other services. But they actually require more time for bathing and ambulation (services that IHSS authorizes). The unmet need is being provided by a relative that volunteers the service (is not paid for it). This unmet need should be documented by the case worker.

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What is the “Functional Index Ranking” and how does it affect my client’s assessment and eligibility?

Description of “Functional Index Ranking:”

The “Functional Index Rank” is set for a task when the social worker evaluates the hours and type of care an IHSS consumer needs to remain independent. For example, a consumer can be ranked as a “3″ for meal preparation and as a “4″ for laundry.

Rank 1	Functioning is independent, and he or she is able to perform the function without human assistance, although the recipient may have difficulty in performing the function, but the completion of the function, with or without a device or mobility aid, poses no substantial risk to his or her safety.
Rank 2	Able to perform a function, but needs verbal assistance, such asreminding, guidance, or encouragement.
Rank 3	Can perform the function with some human assistance, including, but not limited to, direct physical assistance from a provider.
Rank 4	Can perform a function, but only with substantial human assistance.
Rank 5	Cannot perform the function, with or without human assistance.
Rank 6	Paramedical Services Needed *the IHSS CMIPS computer presently does not recognize “Rank 6″

The “Functional Index Score” is determined by the statewide computer for IHSS, after the social worker has input the individual case assessment and rankings.

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Preparing for an Assessment or Review; know your rights.

For your information, the maximum IHSS hours allowed per month are 283 for people who are “severely impaired” and 195 for “non-severely impaired”. IHSS only pays for specific tasks and you can not ask for time to do things that are not authorized (example; watering plants). The hours authorized for each consumer vary according to the case worker’s assessment of the consumer’s needs. This assessment is the case worker’s interpretation of the law. Although case workers use guidelines to determine the hours for each authorized task, they are still required by law to adjust time for task allowance (provide additional time) if it can be shown why it is necessary. If the case worker does not do this the consumer (or their representative) can ask for a hearing (appeal) before an administrative law judge. Also for your information, there is a category of IHSS called Protective Supervision (see below) that will authorize a “qualified” consumer for 195-283 hours.

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Know what IHSS will pay for:

All IHSS hourly “Needs Assessments” are based on what is required for health and safety (not comfort or companionship). Examples of “need” include:

Domestic & related chores; housekeeping, food preparation & menu planning, laundry, shopping, etc.Personal care services; ambulation (helping client move), bathing, bowel & bladder care, dressing, feeding, medications, etc.Para-medical services; wound care, injections, catheters etc.Medical transportation; to appointments with a doctor, dentist, or other medical professional.

Protective supervision; for clients that may be a danger to themselves if left alone. Complete list of categories and tasks that IHSS will pay for are listed in the following resources:

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“Log” Your Time:

To make sure the consumer’s rights are upheld and he/she gets the hours they are entitled to, keep a diary (log) of the actual time it takes to complete each task over a minimum ten day period. Since the time required often changes with the condition of the consumer, this allows the case worker to average the “good” days with the “bad” ones. Make sure to write notes about why time is necessary, so if it is outside the normal allowance the case worker can document the exceptions i.e. “Recipient eats in bed, therefore bed must be cleaned & vacuumed 3 times a day,” or “Respiratory condition requires extra cleaning for dust-free environment.”

Disability Rights California publishes excellent reference documents detailing what IHSS will pay for, along with worksheets to help you keep track of time for approved tasks.

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How to ask for documentation from your doctor and other health care professionals:

IHSS uses specific forms that you need to take to the consumer’s doctor or health care professional to have them sign.

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 need for IHSS. This is a one-time certification. In addition to this certification, your county will ask that the consumer have a Doctor sign forms for any “paramedical services” or authorizations for “protective supervision”.

The case worker or county should give or mail you these forms, although some are available online.

When asking your health care professional to verify the consumer’s need for services, you can use the log (record) you create to make a list of the tasks which the consumer must have assistance with to live safely in their own home. Many doctors do not know these personal details about their patients, even when they know their medical condition. Give the doctor your written record, and ask him or her to verify it and give you a copy of the signed paper that states the consumer’s needs or of any form required by the county. The doctor can verify any of these specific needs with your client through physical examination and office visit if necessary. Do not ask the doctor to verify how long it takes to do each task. You are asking for a clear list of the types of services that the consumer needs to live safely in their own home, based on the consumer’s physical capacity. Also get additional documentation for the consumer’s diagnosis, medications prescribed, and any other assistance prescribed by the doctor (like physical therapy, injections, use of catheter/colostomy etc.) All these things should be documented by the doctor as necessary.

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Do you have a client that can’t be left alone? They may qualify for Protective Supervision

This category is for monitoring the behavior of non self-directing, confused, mentally impaired, or mentally ill persons (examples; Alzheimer’s patients or the developmentally disabled). Protective Supervision is not based on physical disability, but on mental disability; where the person may harm themselves or others if left alone. Protective Supervision will qualify the consumer for 195-283 hours. Because this category is based on mental conditions it requires very specific documentation. IHSS case workers are supposed to inform home care providers about Protective Supervision.

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The consumer has a right to have an authorized representative present at the Needs Assessment, or at a Fair Hearing

Consumers are often embarrassed or intimidated about revealing what they can NOT do for themselves during the assessment process. IHSS case workers usually want to question the consumer directly (not the home care provider) about what they can do or can not do. However in some cases the consumer is not mentally or physically able to answer questions accurately. It is important that there be a witness or advocate present during the Needs Assessment process. This can be the home care provider, AND/OR a union representative OR a friend, OR a family member, OR an attorney, OR an advocate from the community.

If the home care provider is advocating (speaking) for their client it is important to address the case worker about the consumer’s needs — not your own need for additional hours. This distinction must be very clear.

Your local Office on Aging, or Independent Living Center can often provide an advocate free of charge. Consumers may also have someone represent them at a hearing before an administrative law judge (if the assessment is disputed). The consumer needs to authorize their representative by providing a signed, dated paper, stating that the person is authorized to represent the IHSS consumer. The resources below will have additional information about finding an advocate in your area if you need one.

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Understanding the Notice of Action (NOA):

Beginning in 2012, homecare providers will be sent an abbreviated version of this important document, which has previously only been sent to the IHSS consumer.

The “Notice of Action” is a legal document that the consumer should get in the mail after having an assessment (or annual re-assessment) in their home. If the county denies or intends to change the consumer’s IHSS services, the county must give a written notice to that person. Except in a few limited circumstances (like death or institutionalizing of the consumer) the county is legally required to mail the NOA at least 10 days before the effective date of the action. In cases where there is no change in services the county may take up to 30 days to send the NOA.

Since there are time deadlines involved in appeals, make sure to pursue this document by calling your IHSS regional office if the NOA has not been received. The NOA is a piece of paper that has “Notice of Action” written on it. The NOA states exactly how many hours per month the consumer has been authorized, and how much time is authorized for each category. The paper will list the tasks and name them (like “feeding,” or “dressing”), as well as naming the category (like “Personal Care,” or “Domestic”). The NOA will also have a date telling when the authorization of hours becomes effective. This date is very important when asking for an appeal. On the back of the NOA is a place to ask for an appeal, and the address where the request for appeal is sent.

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When to ask for a Re-Assessment:

The consumer or the home care worker can ask for a re-assessment at any time if the consumer’s condition has changed, or if the consumer or their representative(s) don’t agree with an assessment given by the case worker. The consumer should get a “Notice of Action” within 30 days after the IHSS case worker visits them in their home for an assessment. If the county plans to reduce or deny services then they are required by law to mail the NOA 10 days before the reduction or denial takes effect. When a “Notice of Action” (NOA) has been received that shows a reduction of hours, do the paperwork for the appeal immediately because there is often a very short deadline to keep the same hours while waiting for a hearing. The appeal must be filed before the date the reduction takes effect (this is on the NOA).

Because IHSS case workers often have large case loads, it is sometimes hard to get them to return your phone calls, when asking for a re-assessment. In this circumstance use a certified letter (that requires a signature on receipt). You may also ask to speak with the case worker’s supervisor. Always write down the name of who you talk to, and when you talked with them (you may need this information for a hearing).

The re-assessment is particularly important if the IHSS consumer has been in the hospital, as additional care such as assistance with physical therapy or apparatus such as catheters are often needed. The client’s IHSS case worker should be informed as soon as the client is admitted to the hospital, and should do a re-assessment as soon as they are sent home.

A re-assessment should also take place if the consumer moves, because the accessibility level in a home affects time for task determination. Also you should know that if the consumer moves to a different county the rate of pay may be different as well as the needs assessment. To see rates of pay in different counties go to our Statewide Information page. You can find additional information for UDW counties by clicking the name of the county on our County Pages.

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How to Appeal if you don’t agree with the assessment– Ask for a Fair Hearing before an Administrative Law Judge

When the consumer has hours authorized by an IHSS case worker, this assessment is the case worker’s interpretation of the law. Asking for a “Fair Hearing” is how you ask for a higher authority to re-assess the case when the consumer — or his/her representative(s) — don’t agree with what the IHSS social worker decided. The Fair Hearing takes place before an administrative law judge. This administrative law judge is highly trained in the law that covers your case, and also trained to be fair and impartial. The Fair Hearing process does require more paperwork, but you can get someone to help you. It is important to prepare for a hearing (see resources at the bottom of this section). The consumer or their representative should appear in person for the hearing.

How to get started: The consumer should get a “Notice of Action” in the mail within 30 days of the case worker’s home visit (assessment). This Notice of Action lists exactly which tasks the consumer is authorized for and how much time is authorized for each task. On the back of the document is the portion that can be filled out for an appeal (Fair Hearing) and the address where the appeal form is mailed. The Notice of Action also has a date that the new authorized hours take effect. It is necessary to fill out the request for appeal within 10 days of that date and ask for “Aid Paid Pending” if the consumer’s hours were reduced. The consumer should always keep a copy of the Notice of Action (after the Appeal portion is filled out) for their own records. If you are representing the consumer in a fair hearing, ask their permission to keep a copy for your own records. If the consumer’s hours have been reduced, it is even more important to act quickly (see below). Usually when you ask for an appeal, an appeal specialist for the county will re-examine the case worker’s Needs Assessment before going through the Fair Hearing process. The county will often make adjustments at this stage to avoid a hearing if possible. The consumer always has the right to appeal decisions of the case worker or IHSS supervisor, before an administrative law judge.

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How to keep the same hours while waiting for a Hearing:

Ask for an appeal, and state that you want ” AID PAID PENDING” (in writing) 10 days BEFORE the effective date on the Notice of Action. Make sure to keep a copy. This means the consumer can keep the same hours until they go to a hearing. Sometimes it takes weeks or months to complete the Fair Hearing process. The Aid Paid Pending the decision will not be considered an overpayment (you will not need to pay it back) even if the judge decides in favor of the county,

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If I lose my job as a homecare provider, can I collect unemployment insurance benefits?

Most IHSS providers pay in to (and become eligible for) Social Security, State Disability Insurance, Unemployment Insurance, Workers Compensation, and Earned Income Credit through their IHSS employment. Some family providers do not contribute to these programs and are therefore not eligible. Check with your local IHSS office or case worker to make sure you are paying in to these programs.

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What happens if I must leave work (my IHSS consumer) to care for a seriously ill parent, child, or spouse?

“California Paid Family Leave (PFL) program,” is an enhancement to the State Disability Insurance Program (SDI). It is intended to create a family temporary disability insurance program to help reconcile the demands of work and family for eligible California workers.

Home care providers who must leave work (their IHSS consumer) to care for a seriously ill parent, child, spouse, registered domestic partner, or bond with a new minor child are eligible. PFL can be used for a maximum of 6 weeks in a 12 month period. The provider will receive partial payment based on the prior quarter’s earnings — approximately 55% of lost wages.

Only those IHSS providers who have paid in to SDI are eligible. Family member providers (mother, father, son, daughter, brother, sister) do not pay in to SDI unless they elect to do so. Other providers pay in automatically. Home care providers can see on their pay stub whether SDI is being deducted. PFL is administrated by the state Employment Development Department (EDD) and applications are filed with them.

It is important not to leave your client/consumer without a home care provider if you use PFL. The consumer should be given as much notice as possible so that s/he can arrange for a replacement. The consumer is not required to hire the original home care provider once s/he has completed the PFL so it is important to talk this over together and come to a clear understanding.

Providers should also check their county’s health care benefit policy if they are using the health benefit provided with IHSS. PFL should not jeopardize their coverage if the county policy allows 3 months before they are termed out (due to hours falling below the requirement).

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This is all very complicated; where can I get help?

If you need help with an IHSS assessment or hearing, contact your local UDW office and explain that you need help with Advocacy.

There are also professional “advocates” or “benefit planners” in every community that have various skills and specialties.

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Guidelines for use and disclaimer

By providing information and links to other sites, UDW Homecare Providers Union does not in any way guarantee, approve or endorse the information or products available at these sites, nor does a link indicate any association with or endorsement by the linked site to UDW. We are making these resources available so that home care workers and their clients may streamline their research process as well as network on local, state, and national levels. Information about IHSS rules or legal issues given on this site is meant strictly to be a research starting point and is subject to current rules and law. While we try to publish the most current information available, the laws & rules that govern IHSS are complex and do change. Always use professional advice and verify all information to make sure it is current before making changes that might affect your eligibility.

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