DPSS ePolicy

All In-Home Supportive Services (IHSS) cases approved for services must have a completed SOC 873 or alternative documentation signed by a LHCP and filed in the appropriate electronic folder that indicates IHSS eligibility.

Staff must follow Electronic Document Management System (EDMS) procedures.

SOC 873:

1. Items #1 and #2 (#3 and #4, if applicable) must be completed as a condition of IHSS eligibility; and
   
   
2. Items #5 - #8 are to be completed to the best of the LHCP’s ability to assist the IHSS Social Worker (SW) in determining an individual’s IHSS eligibility.
   

Alternative Documentation must include that: 

1. The individual is unable to perform some Activity of Daily Living (ADL) independently; and
   
   
2. Without IHSS, the individual would be at-risk for out-of-home care.

Senate Bill 72 added Section 12309.1 to the California Welfare and Institutions Code (WIC) that required the California Department of Social Services (CDSS) to develop a medical form (now referred to as SOC 873, Health Care Certification) that must be completed by a LHCP prior to authorization of IHSS for a new applicant and to allow continuation of IHSS for recipients. In response to the new Health Care Certification requirement, CDSS amended Manual of Policy and Procedures (MPP) Section 30-701(l)(2) to clarify which LHCP’s are authorized to complete the IHSS Health Care Certification Form.

The SOC 873 includes a section for the LHCP-Health Care Certification (HCC) to provide a description of any condition or functional limitation that has resulted in, or contributed to the applicant’s/recipient’s need for assistance and a declaration that:

1. The applicant/recipient is unable to independently perform some ADL; and
   
   
2. Without IHSS, the applicant/recipient would be at-risk of placement in out-of-home care.

Counties implemented this State-mandated requirement on August 1, 2011. In December 2011, all references to the term medical certification were changed to health care certification.

ADL

Basic tasks of everyday life such as eating, bathing, dressing, toileting, and transferring.

Alternative documentation

Statement or description from the LHCP that:

1. Indicates the applicant/recipient is unable to perform independently one or more ADLs;
   
   
2. Describes the applicant’s/recipient’s condition or functional limitation that has contributed to the need for assistance; and
   
   
3. Is signed and dated within 60 calendar days of being given to the SW.

May include, but is not limited to, hospital or nursing facility discharge plans, minimum data set forms, and individual program plans.

 CDSS

The State agency responsible for oversight of the IHSS Program and Case Management, Information and Payrolling System (CMIPS).

CMIPS

A web-based, comprehensive case management system used to:

1. Record and track IHSS recipient and provider information;
2. Determine eligibility for IHSS; and
3. Manage payroll for IHSS providers.
   

LHCP-HCC

An LHCP-HCC is an individual licensed in California by the appropriate regulatory agency, acting within the scope of his/her license or certificate as defined in the Business and Professions Code, and whose primary responsibilities are to diagnose and/or provide treatment and care for, physical or mental impairments which cause or contribute to an individual's functional limitations.

SOC 873, In-Home Supportive Services (IHSS) Program Health Care Certification Form (10/16)

The form used to capture the LHCP declaration of an individual’s inability to safely perform ADLs and without IHSS would be at-risk for out-of-home placement.

SOC 874, In-Home Supportive Services (IHSS) Program Notice to Applicant of Health Care Certification Requirement (10/16)

The notice used to explain the health care certification requirement to IHSS applicants and provide the due date for the return of the completed and signed SOC 873.

SOC 876, In-Home Supportive Services (IHSS) Program Notice of Provisional Approval Health Care Certification Exception Granted (10/11)

The notice used to notify applicant of the temporary approval of IHSS pending the receipt of a completed and signed SOC 873.

 Requirement/Limit/Condition

Applicant

1. Has 45 calendar days from the date the SOC 873 is requested, to submit a completed and signed SOC 873 or alternative documentation.
   
   
2. Must inform the County of the need for a Good Cause Extension before 45 calendar days from the date on the SOC 874 has passed.

Note: Good Cause extensions apply to applicants who were granted an exception to be provisionally approved for IHSS prior to the return of a completed and signed SOC 873 or alternative documentation.

Recipient

Must have a completed and signed SOC 873 or alternative documentation on file.

Applicant and Recipient

1. May submit alternative documentation instead of the SOC 873.
   
   
2. SOC 873 is a one-time-only eligibility requirement and no further action is required once the SOC 873 is on file and indicates IHSS eligibility.
   
   
3. At its discretion, the County may request a new SOC 873.
    

Acceptable Documents

Eligibility
 

1. SOC 873 that is completed and signed by the LHCP within 60 calendar days of application and indicates eligibility; or
   
   
2. Alternative documentation that is dated within 60 calendar days of submission to the SW and includes:
   
   
   • A statement or description indicating applicant or recipient is unable to perform independently one or more ADLs;
     
     
   • A description of applicant or recipient condition or functional limitation that has contributed to the need for help; and
     
     
   • LHCP signature.
     
     

Examples include, but are not limited to:

• Hospital discharge plans;
  
  
• Nursing facility discharge plans;
  
  
• Minimum data set forms; or
  
  
• Individual program plans.
  
  Note: County-developed health care certification forms are not acceptable alternative documentation.