Department of Health and Human Services Senior and Adult Services Dr. Sherri Z. Heller, Director March 2016 In-Home Supportive Services

The In-Home Supportive Services (IHSS) Program provides domestic, related and personal care services to eligible aged, blind, and disabled individuals who are unable to perform the services themselves and who cannot remain safely in their own home unless the services are provided. IHSS is considered an alternative to out-of-home care. Most recipients receive IHSS as a benefit of Medi-Cal. March 2016 Sacramento County In-Home Supportive Services 2 WHAT IS IHSS

 California Resident  Financial Eligibility – FFP Medi-Cal or meet IHSS-R requirements  Live in Own Home  Health Care Certification Form (SOC 873)  Have Assessed Need for Services March 2016 Sacramento County In-Home Supportive Services 3 WHO IS ELIGIBLE

 Call (916) (Monday-Friday, 9am-4pm)  Please refer to IHSS Application Process flowchart for detail March 2016 Sacramento County In-Home Supportive Services 4 APPLICATION PROCESS

 Assessment based on functional ability to perform ADLs/IADLs  Functional Ranking  Hourly Task Guidelines – Range of Hours Corresponds with Functional Ranking March 2016 Sacramento County In-Home Supportive Services 5 IHSS NEEDS ASSESSMENT

March 2016 Sacramento County In-Home Supportive Services 6 IHSS AUTHORIZED TASKS

IHSS care providers can be : o A family member o A friend o A neighbor o A care provider selected from the Sacramento County IHSS Caregiver Registry March 2016 Sacramento County In-Home Supportive Services 7 WHO PROVIDES IHSS

 Attend IHSS new provider orientation at the IHSS Public Authority (Tuesday, Wednesday, & 9am)  Bring valid U.S. government-issued photo ID and original Social Security card  Submit the completed and signed IHSS Recipient Designation of Provider (SOC 426A) form  Complete and pass a California Department of Justice criminal background check px March 2016 Sacramento County In-Home Supportive Services 8 PROVIDER ENROLLMENT PROCESS

 Find, hire, train, supervise, and if necessary fire the provider  Set schedule for provider(s) and track the number of hours worked  Review and Sign timesheets March 2016 Sacramento County In-Home Supportive Services 9 RECIPIENT ROLE AS EMPLOYER

 Recipient characteristics as of February 2016 : active IHSS cases 50% are 65+ (oldest 106) 42% non-English speaking 24% (~5800 recipients) living alone 13% assessed with severe impairments in memory, orientation, and/or judgement March 2016 Sacramento County In-Home Supportive Services 10 SACRAMENTO IHSS STATISTICS

 active Care Providers  average 700~800 applications received each month  average 2000 annual caseload growth from 2013 to 2015  current average caseload per social worker is 350 March 2016 Sacramento County In-Home Supportive Services 11 SACRAMENTO IHSS STATISTICS

 Eligibility Unit o 7 Eligibility Specialist (ES), 1 Sr. ES, and 1 Supervisor  Social Worker Units o 30 Intake Social Workers, 69 Continuing Social Workers, and 13 Supervisors  Quality Assurance Unit o 4 Quality Assurance Social Worker and 1 Supervisor March 2016 Sacramento County In-Home Supportive Services 12 ORGANIZATIONAL STRUCTURE

 Payroll Unit o 14 Account Clerks, 2 Lead Clerks, 1 Senior Account Clerk, and 1 Supervisor  Family Service Worker Unit o 6 Family Service Workers and 1 Supervisor  Public Health Nurses o 7 Public Health Nurses and 1 Supervisor March 2016 Sacramento County In-Home Supportive Services 13 ORGANIZATIONAL STRUCTURE

Eligibility Specialist  Process IHSS referrals and applications  Identify priority cases  Handle Health Care Certification (SOC 873)  Process Health Care Certification related Denials March 2016 Sacramento County In-Home Supportive Services 14 ACTIVITIES AND STAFF RESPONSIBILITIES

Social Workers:  Intake Social Worker  Conduct initial intake assessment  Continuing Social Worker  Conduct annual reassessment, handle ongoing case related issues March 2016 Sacramento County In-Home Supportive Services 15 ACTIVITIES AND STAFF RESPONSIBILITIES

Quality Assurance Social Worker  Quality assurance reviews  Program integrity activities: o unannounced home visits o directed mailings o fraud detection and prevention - data match, paid claims, death match  Data reports - out of county provider, 60 days no timesheet, etc.  QA Driven Specific Areas – QA support referrals, PS reviews March 2016 Sacramento County In-Home Supportive Services 16 ACTIVITIES AND STAFF RESPONSIBILITIES

Payroll Staff  Enroll providers into payrolling system  Resolve provider timesheet issues  Respond to 800 to 1200 provider calls daily  Handle provider Worker Compensation claims  Provide staff support to the Adult and Aging Commission March 2016 Sacramento County In-Home Supportive Services 17 ACTIVITIES AND STAFF RESPONSIBILITIES

Family Service Workers  assist recipients in obtaining care providers  provide education services to both recipient/provider including responsibilities/duties, resources, timesheet completion  assess heavy cleaning needs March 2016 Sacramento County In-Home Supportive Services 18 ACTIVITIES AND STAFF RESPONSIBILITIES

Public Health Nurses  Provide health teachings such as nutrition, disease management  Assist recipients linking to physicians  Assist with durable medical equipment supply requests  Liaison with doctor’s to ensure accurate completion of medical forms (paramedical/HCC)  PHN assessment March 2016 Sacramento County In-Home Supportive Services 19 ACTIVITIES AND STAFF RESPONSIBILITIES

Implementation of Fair Labor Standards Act (FLSA) March 2016 Sacramento County In-Home Supportive Services 20 RECENT PROGRAM CHANGES

Impact of New Federal Rules to IHSS:  Provider Overtime Pay  Provider Travel Time Pay  Wait Time  New and Revised Forms  Weekly Service Hour Adjustment Requests  Provider Violations March 2016 Sacramento County In-Home Supportive Services 21 FLSA

FLSA Activities : ◦ Timesheet Workshops - February 1, 2016 through March 15, 2016 ◦ FLSA Related Forms  Payroll – handle form entry, scan, mailing and follow-up activities  FSW – assisting recipients with completing required forms ◦ Recipient Questions/Weekly Hour Adjustment Requests  Designated FLSA Social Workers ◦ Provider Violation Appeals  FLSA Supervisor March 2016 Sacramento County In-Home Supportive Services 22 FLSA