Medi-Cal Handbook In-Home Supportive Services (IHSS) 48 ...

1 Update # 2010-03 Revised 1/26/10 Medi-Cal Handbookpage 48-1In- home Supportive Services ( ihss )48. In-Home Supportive Services ( ihss )The ihss program has provided In-Home Services to the aged, blind and disabled population since 1973. These Services have enabled these individuals to remain in their homes and communities and thereby avoid institutional care. ihss Services are routine household tasks such as house cleaning, meal preparation, personal hygiene and transportation Services . These Services are provided to persons who are unable to perform these tasks for themselves because of personal functional limitations, and who otherwise could not remain in their own homes without this to June 2005, Medi-Cal was an automatic benefit for individuals approved for the ihss program (much like CalWORKs).

2 As of June 2005, a separate Medi-Cal determination must be completed for ihss applicants/recipients by a Medi-Cal EW using Medi-Cal rules, forms and ihss ProgramsThere are three programs providing In-Home ResidualIHSS Residual program is a state/county-only funded program that provides In-Home care such as: Protective supervision Restaurant meal allowance Domestic and related Services only Advance payment for Services Services , including personal care Services , that are provided by a spouse or parent of a minor ihss Residual program Services are available to individuals eligible under the current ihss regulations, but who are not eligible for federally-funded full-scope Medi-Cal . Revised 1/26/10 Update # 2010-03page 48-2 Medi-Cal HandbookIn- home Supportive Services ( ihss ) Care Services Program (PCSP)To qualify for PCSP, individuals not receiving SSI/SSP or Medi-Cal -linked to a cash-based program must be determined eligible for federally funded full-scope Medi-Cal by a Medi-Cal EW.

3 Effective May 1, 2004, the Medi-Cal State Plan regarding PCSP was expanded to include the following Services as federally funded PCSP: Ancillary Services , including domestic and related Services , under W&I Code, Section (d)(2), not provided by a spouse or parent of a minor child. Protective supervision not provided by a spouse or parent of a minor Plus Waiver Due to a budget shortfall, ihss Residual individuals were slated to lose their ihss Residual Services . In order to provide those Services , the State of California sought federal approval to implement the ihss Plus Waiver. Center for Medicaid Services (CMS) approval was received effective August 1, 2004. This program provides In-Home care to Medi-Cal eligible individuals with federal financial participation.

4 To qualify for this program, Medi-Cal eligibility is required and must be determined by a Medi-Cal EW. Individuals must also qualify for In-Home Services through a needs assessment completed by ihss Social Workers. ihss Plus Waiver Services are: Personal care; protective supervision; domestic and related Services ; heavy cleaning; accompaniment to medical appointments and alternative resources; removal of grass, weeds, rubbish, ice and snow; and teaching and demonstration, when they are provided by a spouse or parent of a minor child. Restaurant meal allowance Advance payment for In-Home care CodesThe following ihss Aid Codes are recorded on MEDS via Case Management, Information, and Payrolling System (CMIPS) interface on the Special Program Screen (INQ1, INQ2, etc.)

5 Medi-Cal EWs will not report these Aid Codes on MEDS. 2L - ihss Plus Waiver Update # 2010-03 Revised 1/26/10 Medi-Cal Handbookpage 48-3In- home Supportive Services ( ihss ) 2M - PCSP 2N - ihss Residual 2K - Community First Choice Option (CFCO).When individuals on Aid Codes 2L and 2M lose Medi-Cal eligibility, they become (2N) ihss Residual only; federal financial participation (FFP) is lost and the ihss case draws on State-only funds. If Medi-Cal eligibility is restored, the client regains FFP and the MEDS Aid Code changes back to either 2L or 2M the following First Choice Option aid code 2K is for tracking individuals receiving community attendant Services and SpenddownThe spenddown refers to those medical or In-Home Supportive Services paid by the ihss recipient.

6 And MEDS InterfaceMEDS provides a monthly ihss renewal file containing ihss recipient s Medi-Cal eligibility information for the upcoming month, including FFP status and the Medi-Cal SOC. Recipients can take receipts to their Medi-Cal EWs to have their payment recorded and applied to their Medi-Cal SOC amount. This must be completed manually online by the MTO via SC 1296. This includes any SOC amount they have paid directly to their ihss provider. Note:CMIPS does not calculate the Medi-Cal SOC; it is received from MEDS by CMIPS. The Medi-Cal EW is responsible for ensuring the correct Medi-Cal SOC is entered into MEDS. CMIPS will continue to calculate the ihss SOC using information entered by the ihss staff. Medi-Cal SOC is subject to Medi-Cal spenddown rules.

7 As such, the recipient must spenddown their entire Medi-Cal SOC each month before Medi-Cal will pay the remainder of recognized Medi-Cal covered Services for that month. Clients can Revised 1/26/10 Update # 2010-03page 48-4 Medi-Cal HandbookIn- home Supportive Services ( ihss )meet their SOC either via ihss payment to their provider or by obligation to pay other medically necessary expenses. This spenddown will occur through a Point of Service (POS) transaction. Note:Since there is no more Buyout, the Medi-Cal SOC is deducted from the provider s other Medi-Cal POS transactions, CMIPS does not interface directly with MEDS through an electronic device. Instead, when a timesheet is keyed in or entered, CMIPS will make a real-time virtual swipe of the BIC based on the CMIPS data to record the spenddown amount (up to the dollar value of the timesheet).

8 CMIPS will deduct the incurred spenddown amount from the provider s payroll warrant and issue any remaining wages to the provider. At that point, CMIPS will generate two letters: one to the recipient advising them of the amount they should pay their provider and one to the provider advising them of the amount they should collect from the ihss client. This interface with MEDS and potential spenddown will occur for each payroll period each month. Once the entire SOC amount has been paid by the recipient, the case is then certified for Medi-Cal purposes. If CMIPS virtual swipe does not identify any outstanding SOC for the month ( , client met his/her SOC by paying for prescription drugs or other medical expenses), no SOC will be deducted from the payroll warrant for the service :Provider timecards are processed after the 1st and the 15th of every month.

9 If the CMIPS virtual swipe is done on the 16th, MEDS SOC certification will still show as certified on the 1st (regardless of when the actual swipe was completed).MEDS ReportsThe following MEDS reports are only available and sent to ihss staff and not to Medi-Cal EWs. SOC Exceptions Report The SOC Exception report identifies ihss recipient cases where eligibility or SOC discrepancies exist between CMIPS and MEDS data. This report is only available to ihss staff and not to Medi-Cal EWs. Update # 2010-03 Revised 1/26/10 Medi-Cal Handbookpage 48-5In- home Supportive Services ( ihss ) Daily Medi-Cal Eligibility Exception Report When CMIPS processes the MEDS ihss daily response file, this report is produced and is accessible to counties through the CMIPS Online Report website.

10 The purpose of this report is to alert counties to the following: Eligibility Denied. This report lists new applicants who have been determined ineligible for Medi-Cal . Date of Birth (DOB) does not match MEDS. The report displays both the DOB from MEDS and CMIPS. ihss staff and Medi-Cal EWs will need to verify the correct DOB and update the appropriate system. Monthly Outstanding Case Report This report is generated monthly to remind counties of any cases with exceptions that remain unresolved. Some of these reports are: Medi-Cal Eligibility Terminated. This report lists recipients who were discontinued from Medi-Cal . Recipient Admitted to Long-Term Care and ihss Case Not in L Status. Cases appear in this report when MEDS eligibility status or primary aid code indicates that the client is residing in an LTC facility.