DPSS ePolicy

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Effective with this release, In-Home Supportive Services (IHSS) line staff must follow the enclosed instructions on how and when to reimburse incorrect share‑of‑cost (SOC) deductions from the IHSS provider’s pay warrant.

Staff must no longer refer IHSS recipients to CDSS to file an appeal for SOC reimbursement on behalf of their provider(s), as described in IHSS Call-Out 12‑10, Medi‑Cal SOC Reimbursement, dated September 5, 2012.

Currently, some Medi-Cal recipients are required to pay a SOC in order to receive Medi-Cal benefits, including IHSS.  When a provider for these individuals submits a timesheet, the IHSS Program Case Management, Information and Payrolling System Version 2 (CMIPS) interfaces with the Medi-Cal Eligibility Data System (MEDS) to determine if the IHSS recipient has an outstanding Medi-Cal SOC.  If so, that amount is deducted from the provider’s pay warrant for that pay period.

If the Medi-Cal SOC listed in MEDS is incorrect when the timesheet is processed, an incorrect deduction will be taken from the provider’s pay warrant.  If the amount deducted from the provider’s pay warrant is greater than the correct SOC, and if the recipient paid the provider the greater amount, the recipient is eligible to file a claim for reimbursement using the Beneficiary Reimbursement Process (Conlan 2 claim).

To remedy this issue, CDSS developed a process to directly reimburse a provider who had an incorrect Medi-Cal SOC deduction withheld from their pay warrant and they were not paid by the recipient.

Conlan 2 Claim

Claim submitted by IHSS recipients to the California Department of Health Care Services (DHCS) to get reimbursed for the incorrect Medi-Cal SOC they have paid to their provider.

IHSS Plus Option (IPO)

Cases that receive FFP through a waiver granted by the Centers for Medicaid and Medicare and include one or more of the following components:

• Advance Pay,
  
  
• Parent or spouse providers, and/or
  
  
• Restaurant Meal Allowance.
  

Have an IHSS funding code 2L.

IHSS - Community First Choice Option (CFCO)

Cases that receive FFP, meet the Nursing Facility Level of Care eligibility criteria, and have an IHSS funding source aid code of 2K.

IHSS Residual (IHSS-R)

IHSS cases not eligible for FFP and have an IHSS funding source aid code of 2N.

IHSS Personal Care Services Program (PCSP)

IHSS cases that receive FFP and do not receive Advance Pay or Restaurant Meal Allowance, do not have a parent/spouse provider, and have an IHSS funding source aid code of 2M.

Pay Period

The time period for which wages are paid.  There are two pay periods per month: the 1st of the month through the 15th of the month, and the 16th of the month through the end of the month.

SOC

Expense that some Medi-Cal recipients must pay in order to receive Medi‑Cal services, including IHSS.

Special Transaction

One-time payment or deduction for a recipient or provider for one of the following reasons:

• Advance Pay – Additional
  
  
• Advance Pay – Recovery Refund
  
  
• Health Benefit Refund
  
  
• Health Benefit Deduction
  
  
• Overpayment Recovery Refund
  
  
• Paramedical Reimbursement 
  
  
• Restaurant Meals – Initial
  
  
• SOC Refund

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