IHSS recipients are responsible for reporting work-related injuries to the Public Authority. Placer County IHSS Recipients should mail the completed form: Placer County IHSS, 11512 B. Ave., Auburn, CA 95603 We will also accept the completed form via email or fax to: Email: IHSSpayroll@placer.ca.gov Fax: 530-886-3690 Remember, the form must be signed by both Provider and Recipient, digital/electronic signatures will NOT be accepted Change the blanks with exclusive fillable areas. You have the right to interpreter services provided by the County at no cost to you. (MPP 30-767.6) The county also has a grievance procedure it must follow when a grievance or complaint is received about the processing of payment for IHSS services for recipients that get IHSS under the Personal Care Services (PCSP) Program. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. This cookie is set by GDPR Cookie Consent plugin. It does not store any personal data. You must sign the acknowledgement in PART C of this form. The cookie is used to store the user consent for the cookies in the category "Other. Those who are not yet eligible for a booster dose must comply within 15 days after the recommended time frame for the booster. Open it using the online editor and start altering. You also have the option to opt-out of these cookies. Recipients can contact Public Authority for assistance in finding another Provider to fill in. Please join us! COVID-19 sick leave benefits are available for IHSS & WPCS providers. This cookie is set by GDPR Cookie Consent plugin. Recipient Phone: 510.577.1980. The applicants protected date of eligibility is the date the applicant requests services. 4. Call (415) 557-6200. COVID-19 VACCINE BOOSTER DOSE REQUIREMENT. Mail In-Home Supportive Services PO Box 11018 San Jose, CA 95103-1018 Email SSA_IHSS_ARCCI_Fax@ssa.sccgov.org In Person If you are injured while performing your job-related duties, you must immediately report the injury by calling (866) 985-6322 (option 3, then 6); or in person by visiting our main office at 784 E. Hospitality Lane, San Bernardino, CA, 92415. If denied, you will be notified of the reason for the denial. When you qualify for IHSS, you can receive help at no or little costwith bathing, dressing, meal preparation and clean up, bowel and bladder care, light housekeeping, laundry, and shopping. How to Apply Contact IHSS at (408) 792-1600 or fill out the application and submit using one of the options below. A Share of Cost (also referred to as a SOC) is the amount of money you are responsible to pay towards your medical related services, supplies, or equipment before Medi-Cal will begin to pay. Once your application is reviewed, you mustqualify for Medi-Cal. CFCO provides States with 6% additional federal funding for services and supports. In an attempt to provide more services to the most vulnerable, the state Health and Human Services Agency created a new office to improve mental health care. We also use third-party cookies that help us analyze and understand how you use this website. You, as an IHSS recipient, may have to pay a certain dollar amount each month toward your medical expenses as part of your SOC. You can contact the PASC for assistance in locating a provider to interview for hire. This cookie is set by GDPR Cookie Consent plugin. Box 1677 West Sacramento, CA 95691-6677 What do I do for wages paid before my Self-Certification Form is received? Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. Photo: Associated Press Providers who are eligible for the booster dose must comply byMarch 1, 2022. Existing Recipients and Providers: Clients: to access your case information, click here. The Extraordinary Circumstances exemption is available to care providers working for multiple recipients who are at risk of out-of-home placement. Address: 20101 Hamilton Avenue Suite 250 Torrance, CA 90502, Hours of Operation: Monday - Friday from 8:00 am to 5:00 pm, ___________________________________________________________________________________________________________________________. The In-Home Supportive Services (IHSS) program can provide homemaker and personal care assistance to eligible individuals who are receiving Supplemental Security Income or who have a low income and need help in the home to remain independent. S.F. Contact Us By PhoneToll Free: 877-565-4477Fax: 818-206-8000TTY: 626-737-7512Contact Usinfo@pascla.org, AboutProgramsProviderConsumerCalendarNewsResourcesPolicies and ProceduresComplaint Policy & ProceduresNon-discrimination Policy. Home and Community Based Alternatives Waiver Agencies (in Los Angeles): Be 65 years old or older, blind, and/or disabled as defined by Social Security Administration (SSA) standards. Continue reporting your hours worked on your timesheet as you always have. You may also be asked for a list of your prescribed medications and doctors information. You have the right to interpreter services provided by the County at no cost to you. You may be asked to perform or describe simple tasks, such as range-of-motion demonstrations. Attending mandatory State training after you start working. To be exempted, your provider must provide you a signed copy of theCOVID-19 Vaccination Exemption Form. hVRHyu4R2@IP~EI&nid,Cdn}s'lKIZ&NbeJ Recipients of IHSS may hire any person of their choosing to be the in-home care provider. Be signed and dated by the LHCP within 60 calendar days of submission to the Social Worker. To be eligible for the Extraordinary Circumstances exemption, the provider must work for two or more IHSS recipients whose circumstances put them at risk of placement in out-of-home care. Providers are required to maintain their own records of vaccination, or COVID-19 test results if applicable, an must provide them if asked by their Recipient. The In-Home Supportive Services (IHSS) program is designed to provide assistance to older adults and individuals with disabilities, who without this care, would be unable to remain safely in their home. Fill in the empty fields; engaged parties names, places of residence and numbers etc. The county is required to respond and resolve payment inquiries from recipients and providers. Repair services Sitting with you to visit or watch TV Taking you on social outings Applying as a Care Recipient 1. Cant work more than 66 hours per workweek unless granted an exemption; Can work up to a maximum of 90 hours per workweek, if granted an exemption; and. The California Department of Public Health issued a public health order on September 28, 2021, requiringcertainproviders to be fully vaccinated with the COVID-19 vaccine by November 30, 2021. IHSS recipients must obtain County approval whenever you need your IHSS provider to work more than his/her maximum weekly hours when the adjustment in the work schedule results in the provider: To request the one-time exception, contact the IHSS Helpline at (888) 822-9622. The applicants protected date of eligibility is the date the applicant requests services. Call(415) 557-6200. That form states that I have the legal right to work in the United States. Need a COVID-19 vaccination? In-Home Supportive Services. Is my provider allowed to claim this time? Visit the IHSS Helpline Community Apply By Mail Complete the SOC 295 Application For IHSS Print and mail to: Housing and Urban Development Secretary Julin Castro talks to the media about President Barack Obama's budget for fiscal 2015 at the Treasury Department in Washington, D.C., Wednesday, October 13, 2014. Prior to authorization of IHSS services, recipients must submit a Health Care Certification form (SOC 873) completed by a licensed health care professional, except when the recipient is at imminent risk of out of home placement. By using this site you agree to our use of cookies as described in our, Something went wrong! P.O. This website uses cookies to improve your experience while you navigate through the website. You must also: 1. For purposes of monitoring counties compliance with application processing, CDSS will use the protected date of eligibility, and a 90-day timeframe to allow for the 45 days which may be necessary to complete the required Medi-Cal eligibility determination and the Health Care Certification form. I attended the required provider enrollment orientation for IHSS providers and I . Get the Ihss Reassessment you require. The cookies is used to store the user consent for the cookies in the category "Necessary". If approved, you will be notified of the. To enroll, IHSS recipients will choose a Recipient Authentication Number (RAN) which is similar to a PIN. Preparing for Power Outages - Recipient Registration Register for the IHSS Website to: View your timesheet and payment statuses Enter and submit timesheets No longer mail paper timesheets Request additional timesheets Enroll in direct deposit Claim sick leave Registration FAQs (PDF) If you are approved for IHSS, you must hire someone (your individual provider) to perform the authorized services. Photo: Scott Strazzante, The Chronicle Buy photo You must live at home or a dwelling of your own choosing (acute care hospital, long-term care facilities, and licensed community care facilities are not considered "own home"). Analytical cookies are used to understand how visitors interact with the website. For questions regarding SOC, contact your Social Worker at (888) 822-9622. M$:%F[zF{F|7htmhSz]1wx&L4ZQqg*6r}kMhz9Bb|8N. R__(:d>b]^K(6.d&t,zn.oUz3PQ]3{jYhy)0On5]J40!C`wq89.p1>3 Expect an eligibilityworker to contact you to schedule an interview. Change the blanks with unique fillable areas. Additionally, if a Provider tests positive for COVID-19 they should not be providing IHSS services for any Recipient as specified by the Dept. If the county has the capability, it must also accept applications online and by email. Provider Phone: 510.577.5694. 7 Note: the current SOC 321 Form (discussed further below) limits who can authorize paramedical services to a "Physician/Surgeon," "Podiatrist" and "Dentist." IHSS Recipient Become an IHSS Recipient 1 Meet eligibility criteria Live at home or in a shelter, but not in a board and care facility, nursing home, or hospital. Once completed and signed by the Recipient (or their authorized representative), the Hiring Agreement can be submitted by: Mail to: County of Fresno Department of Social Services. Care providers may be family members, friends, neighbors or registered providers through the Public Authority. SOC 2298 - In-Home Supportive Services (IHSS . You may submit other acceptable forms of alternative documentation, signed by a LHCP, if the SOC 873 is not available. Complete an IHSS Application or Referral County of San Luis Obispo Residents can start an application by calling the Atascadero Office at (805) 461-6110, Arroyo Grande Office at (805) 474-2103, or by completing the Online Application Form. Forms; Become a Provider; IHSS Care Providers Support (SIP) IHSS Public Authority; . Find out how to schedule your vaccination. Quick steps to complete and design IHSS Change Of Address online: Use Get Form or simply click on the template preview to open it in the editor. Necessary cookies are absolutely essential for the website to function properly. 1. Here's the CA IHSS. Please note Placer County IHSS and Public Authority do not require proof of vaccination or exemption. Please return this completed and signed form to the county. Learn more at:Questions & Answers: Adult Care Facilities and Direct Care Worker Vaccine Requirement. If you do not work for Placer County - Contact your IHSS county for submission instructions. Provider Forms. Disabled children are also potentially eligible for IHSS; Live in your own home. How to Submit Forms to IHSS There are three ways that you can submit forms to IHSS: By US Mail: DSS- IHSS PO Box 1912 Fresno, CA 93718-1912 By Fax: (559) 600-5400 (health care certifications, paramedical and protective supervision forms) (559) 600-7762 (change of address, provider terminations) Current information for IHSS Providers and Recipients. Remember, the SOC is part of provider's salary. The provider is active on the recipients case at the time of the vaccine appointment(s); The vaccine appointment(s) are separate from your typical medical appointments currently captured in your IHSS case authorization (if you are unsure what medical appointments are currently authorized in your case, contact your assigned case worker), If you are 65+ and received the vaccine(s) already you may submit a claim going back to January 1, 2021 if your provider assisted you with your appointment(s) and you meet all the criteria listed above, Recipients age 16-64 became eligible to receive the vaccine on March 15, 2021, Up to 2 hours for each appointment, with a maximum of 4 hours for each Recipient, If the same provider is accompanying you to both of your vaccine appointments, it is preferred that you wait to submit, If different providers are accompanying you to your two vaccine appointments, you will need to submit two claims (one for each appointment/provider), Yes, a separate claim must be submitted for each recipient the provider is assisting. NOTE:All other provisions of the September 28, 2021, order are still in effect, including exceptions and exemptions. To keep you safe during COVID-19,we're here to assist you by email and phone, Monday-Friday, 8:00 a.m. to 5:00 p.m. Emailihsspaymentunits@sfgov.org. Sacramento, CA 95814, Summaries of select CalWORKs, CalFresh, Health and Housing Regulations, Individuals have the right to apply for IHSS services or make an application through another person on their behalf. The paper enrollment form is available on the CDSS website for those who want to use it. Find out about other options for in-home services by visiting: Live at home or in a shelter, but not in a board and care facility, nursing home, or hospital. If you have determined that your provider is eligible for one of the exemptions, then, you must require your provider to: NOTE:As the recipient and employer of record, you are responsible for requesting from your provider the proof of vaccination or the completed and signed vaccination exemption form, determine whether your provider is eligible for an exemption, and enforce the vaccination requirements. Fill out, sign and return this form in person to the office or location designated by the county. The California Department of Social Services (CDSS) reiterates the In Home Supportive Services (IHSS) requirements for processing applications, completing reassessment, and issuing Quality Improvement Actions Plans. Hospitals, nursing homes, and licensed community care facilities are not considered own home; Participate in a home assessment interview; and, Obtain a health care certification from a licensed health care professional (LHCP) such as a physician, psychiatrist, psychologist, etc., indicating that you are unable to safely perform one or more activities. The SOC may change from month to month. You, as the IHSS recipient, must pay the SOC, if any, to the provider monthly. Open it up using the cloud-based editor and start adjusting. Will receive a violation whenever the maximum workweek limits for OT or travel time are exceeded. For questions regarding a pending Extraordinary Circumstances request, contact the IHSS HelpLine at (888) 822-9622 (Monday through Friday from 8:00 a.m. to 5:00 p.m.). Plan for this interview to take up to 90 minutes and to show proof of income and resources (bank statements). To add or change a provider, please call the IHSS Help Line at (888) 822-9622. 3. On Friday, September 1, 2014. 2016 Fair Labor Standards Act (FLSA) New Program Requirements, IHSS Program Rules - Overtime, Travel Time and Wait Time. In-Home Supportive Services, also known as IHSS, can help pay for services if youre a low-income elderly, blind or disabled individual, including children, so that you can remain safely in your own home. Amendment to the September 28, 2021, Public Health Order, Questions & Answers: Adult Care Facilities and Direct Care Worker Vaccine Requirement, COVID-19 Vaccination Exemption Form- Spanish(Espaol), COVID-19 Vaccination Exemption Form- Armenian(), COVID-19 Vaccination Exemption Form- Chinese(), COVID-19 Vaccination Exemption Form- Cambodian(), COVID-19 Vaccination Exemption Form- Farsi(), COVID-19 Vaccination Exemption Form- Korean(), COVID-19 Vaccination Exemption Form- Russian(), COVID-19 Vaccination Exemption Form- Tagalog(Tagalog), COVID-19 Vaccination Exemption Form- Vietnamese(Ting Vit), Personal Assistance Services Council (PASC), SOC 873 - In-Home Supportive Services Program Health Care Certification Form, Provides services to a family member(s); and, Obtain a weekly COVID-19 test at one of the State testing sites (, Wear a surgical mask or N95 mask, at all times, while providing services in your home. In-Home Supportive Services Referral Form Date Sent Please answer all questions and print clearly Fax to SF HSA Department of Aging and Adult Services Program 415 557-5271 Questions Call 415 355-6700 or email us at ihss ci. RECIPIENT DESIGNATION OF PROVIDER. Counties must reassess individuals IHSS eligibility every year, and each time a recipient notifies the county of a change in circumstances. : Associated Press providers who are eligible for a booster dose must comply within 15 days after the time! For Medi-Cal website uses cookies to improve your experience while you navigate through the Public Authority are... } kMhz9Bb|8N, CA 95691-6677 What do I do for wages paid before my Self-Certification form is received ).... Outings Applying as a Care Recipient 1 it using the cloud-based editor and altering. Improve your experience while you navigate through the Public Authority ; a PIN Usinfo @ pascla.org, and! 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Is used to understand how visitors interact with the website to function properly will be notified of the 28! Not been classified into a category as yet into a category as.. Of provider 's salary Facilities and Direct Care Worker Vaccine Requirement similar to a PIN county IHSS and Public.... Responsible for reporting work-related injuries to the provider monthly for the cookies is used to understand how visitors interact the!, contact your Social Worker you, as the IHSS Recipient, must pay the,. Require proof of income and resources ( bank statements ) Public Authority assistance. Submit using one of the options below you use this website with 6 % additional federal funding services! Acceptable forms of alternative documentation, signed by a LHCP, if any, to office...