STATE CAPITOL UPDATE
PROPOSED IHSS PARAMEDICAL REGULATIONS FORMALLY WITHDRAWN BY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES (CDSS)
Department Previously Announced September 6th That It Would Not Proceed With Controversial Proposed Regulations
SACRAMENTO, CA [BY MARTY OMOTO, CDCAN LAST UPDATED 09/20/2019 03:30 PM] - The California Department of Social Services (CDSS), the state agency that oversees statewide the In-Home Supportive Services (IHSS) program, formally posted this afternoon (September 20th, Friday) its decision not to proceed with controversial proposed state regulations regarding Paramedical Services within the IHSS program. The decision not to proceed was also published by the Office of Admininstrative Law (OAL) today in the state's official publication covering state regulatory actions (see below).
The official posting and publication of the decision not to proceed means the proposed IHSS Paramedical Services Regulations will not be implemented and the existing state regulations covering those services will remain unchanged.
As previously reported by CDCAN Report, the California Department of Social Services previously announced on September 6th (Friday) that it would not proceed with those proposed regulations, though that announcement was not official until it was officially posted on the department's website and posted with the Office of Administrative Law (OAL) that monitors the state's regulations.
The action not to proceed by the department is seen as a major victory by advocates for people with disabilities, seniors, mental health needs and people who are blind who receive IHSS and may have been directly impacted by the proposed (now withdrawn) paramedical regulations. Advocacy organizations and individual advocates including Paula Herman in Los Angeles County and Connie Arnold in Sacramento County and others across the state, raised major concerns about the impact of the proposed IHSS Paramedical Regulations on people with disabilities and older Californians in the IHSS program.
The In-Home Supportive Services (IHSS) program provides in-home assistance to eligible persons who are older Californians, persons who are blind, and persons who have diabilities (including developmental) and as an alternative to out-of-home care and enables individuals to remain safely in their own homes.
According to recent state data, over 506,000 people are IHSS providers (workers) who currently serve over 593,000 children and adults who receive IHSS.
Text of the Document Issued by Department Withdrawing Proposed Regulations
The following, compiled by CDCAN (see link below for actual pdf document) is the complete text of the document posted today by the California Department of Social Services, withdrawing the proposed IHSS Paramedical Regulations:
ORD #0915-11
NOTICE OF DECISION NOT TO PROCEED REGARDING PROPOSED CHANGES IN
REGULATIONS OF THE CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
RULE
: Pursuant to Government Code section 11347
ITEM
: In-Home Supportive Services (IHSS) Paramedical
The California Department of Social Services (hereafter known as the Department), in accordance with Government Code section 11347, hereby gives notice of its decision not to proceed with the rulemaking action published in the California Regulatory Notice Register, Register 2018, Number 45Z, November 9, 2018
(
https://oal.ca.gov/wpcontent/uploads/sites/166/2018/11/45z-2018.pdf
).
The proposed rulemaking addressed sections of IHSS program areas including, but not
limited to: establishing a clear definition of a licensed health care professional for the purpose of ordering paramedical services (LHCP−PM); assigning an indicator of 6 for identifying level of functioning, which is used in the assessment process; and setting protocols and specifications to ensure counties more clearly understand the definitions and parameters of paramedical services.
Please direct any inquiries regarding the decision not to proceed for these proposed
regulations to:
California Department of Social Services
Office of Regulations Development
744 P Street, MS 8-4-192
Sacramento, CA 95814
Tel: (916) 657-2586, Fax: (916) 654-3286
PUBLIC POSTING: The Department will post this notice on the In-Home Supportive
Department Issued On August 16th Revised Proposed Regulations
As previously reported, the California Department of Social Services issued on August 16th, a 99 page revised version of the proposed state regulations regarding paramedical services in the IHSS program that triggered a 15 day public comment period that ended September 3rd.
The changes that were contained in the revised proposed state regulations impacting IHSS paramedical services reflected public comments made when the original proposed regulations were released last year. The public comment period for the original proposed regulations had a deadline originally of December 27, 2018, that due to significant interest from the public, was extended to January 18, 2019, with hearings held on both dates.
The California Department of Social Services said, when issuing the original and revised proposed regulations, that the proposed regulations were meant to clarify existing state law by providing a "clear definition of a Licensed Health Care Professional" for the purpose of ordering paramedical services in the IHSS program. State law and regulations regarding paramedical services under the IHSS program have not been changed for decades.
Many advocates, including families with children and adults with developmental disabilities, have raised major concerns to the original proposed regulations last January and in the recent public comment period that closed September 3rd, argued that the proposed regulations went beyond simply clarifying state law arguing that instead, would, if implemented, seriously undermine the health and safety for people receiving paramedical services under the IHSS Program.
LINKS FOR MORE INFORMATION
The following, updated today (September 20th) and compiled by CDCAN, are links for more information about the IHSS program and also about paramedical services under the IHSS program:
NEW OFFICIAL NOTICE - DECISION NOT TO PROCEED - CALIFORNIA DEPARTMENT OF SOCIAL SERVICES (CDSS) - PD
F Document (1 page) - from the California Department of Social Services Regulations webpage:
NEW CALIFORNIA REGULATORY NOTICE REGISTER
- Office of Administrative Law (OAL) - September 20, 2019 - PDF Document (17 pages) - from the Office of Administrative Law website - CDCAN Note: the withdrawal notice by the California Department of Social Services is on page 1282:
IN-HOME SUPPORTIVE SERVICES (IHSS) WEBPAGE - CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
- webpage containing links to documents and more information about the IHSS program:
STATE LAW - IHSS PARAMEDICAL SERVICE
S (Welfare and Institutions Code) - from California Legislative Information website:
STATE REGULATIONS - IHSS PARAMEDICAL SERVICES
- IHSS state regulations are contained in what is called the "Manual of Policies and Procedures" or "MPP" that also covers many other services under the California Department of Social Services. The brief specific references to paramedical services in the "Manual of Policies and Procedures - Social Services Standards Program No. 7: In-Home Supportive Services" is on page 72 in the first part of the two part manual covering IHSS (Sections 30-700 thru 30-764). The proposed revised paramedical regulations (now withdrawn) would have changed those existing regulations:
PUBLICATION
- "The IHSS Program covers Paramedical Services!" - October 1, 2014 - By Disability Rights California (DRC) - Publication #F044.01 - This publication provides information about IHSS “paramedical” services. It tells a person how to ask for those services. The Disability Rights California summary of this publication says that paramedical tasks "...are tasks such as sticking a needle in your arm or taking your temperature. It also requires judgement by the person doing the task. This means they have to make a decision based on training by a doctor or follow doctor’s orders". CDCAN Note: while the publication is almost 6 years old, muchg of the information in this publication is still current - and still useful to provide a basic understanding of paramedical services in the IHSS program, especially with the proposed Paramedical Regulations now withdrawn.
PDF Document - English (5 pages):
PDF Document - Spanish [El programa de Servicios de Apoyo en el Hogar (IHSS) cubre los servicios paramédicos] (5 pages):
STATE LAW REGARDING PARAMEDICAL SERVICES FOR IHSS
The following, compiled by CDCAN, is the references in existing state law in the Welfare and Institutions Code, specifically referring to paramedical services within the IHSS program (CDCAN Note: CDCAN highlighted in bold):
ARTICLE 7
. In-Home Supportive Services [12300 - 12318] ( Article 7 added by Stats. 1973, Ch. 1216. )
12300. (a) The purpose of this article is to provide in every county in a manner consistent with this chapter and the annual Budget Act those supportive services identified in this section to aged, blind, or disabled persons, as defined under this chapter, who are unable to perform the services themselves and who cannot safely remain in their homes or abodes of their own choosing unless these services are provided.
(b) Supportive services shall include domestic services and services related to domestic services, heavy cleaning, personal care services, accompaniment by a provider when needed during necessary travel to health-related appointments or to alternative resource sites, yard hazard abatement, protective supervision, teaching and demonstration directed at reducing the need for other supportive services, and paramedical services which make it possible for the recipient to establish and maintain an independent living arrangement.
(c) Personal care services shall mean all of the following:
(1) Assistance with ambulation.
(2) Bathing, oral hygiene, and grooming.
(3) Dressing.
(4) Care and assistance with prosthetic devices.
(5) Bowel, bladder, and menstrual care.
(6) Repositioning, skin care, range of motion exercises, and transfers.
(7) Feeding and assurance of adequate fluid intake.
(8) Respiration.
(9) Assistance with self-administration of medications.
(d) Personal care services are available if these services are provided in the beneficiary’s home and other locations as may be authorized by the director. Among the locations that may be authorized by the director under this paragraph is the recipient’s place of employment if all of the following conditions are met:
(1) The personal care services are limited to those that are currently authorized for a recipient in the recipient’s home and those services are to be utilized by the recipient at the recipient’s place of employment to enable the recipient to obtain, retain, or return to work. Authorized services utilized by the recipient at the recipient’s place of employment shall be services that are relevant and necessary in supporting and maintaining employment. However, workplace services shall not be used to supplant any reasonable accommodations required of an employer by the Americans with Disabilities Act (42 U.S.C. Sec. 12101 et seq.; ADA) or other legal entitlements or third-party obligations.
(2) The provision of personal care services at the recipient’s place of employment shall be authorized only to the extent that the total hours utilized at the workplace are within the total personal care services hours authorized for the recipient in the home. Additional personal care services hours may not be authorized in connection with a recipient’s employment.
(e) Where supportive services are provided by a person having the legal duty pursuant to the Family Code to provide for the care of his or her child who is the recipient, the provider of supportive services shall receive remuneration for the services only when the provider leaves full-time employment or is prevented from obtaining full-time employment because no other suitable provider is available and where the inability of the provider to provide supportive services may result in inappropriate placement or inadequate care.
These providers shall be paid only for the following:
(1) Services related to domestic services.
(2) Personal care services.
(3) Accompaniment by a provider when needed during necessary travel to health-related appointments or to alternative resource sites.
(4) Protective supervision only as needed because of the functional limitations of the child.
(5) Paramedical services.
(f) To encourage maximum voluntary services, so as to reduce governmental costs, respite care shall also be provided. Respite care is temporary or periodic service for eligible recipients to relieve persons who are providing care without compensation.
(g) A person who is eligible to receive a service or services under an approved federal waiver authorized pursuant to Section 14132.951, or a person who is eligible to receive a service or services authorized pursuant to Section 14132.95, shall not be eligible to receive the same service or services pursuant to this article. In the event that the waiver authorized pursuant to Section 14132.951, as approved by the federal government, does not extend eligibility to all persons otherwise eligible for services under this article, or does not cover a service or particular services, or does not cover the scope of a service that a person would otherwise be eligible to receive under this article, those persons who are not eligible for services, or for a particular service under the waiver or Section 14132.95 shall be eligible for services under this article.
(h) (1) All services provided pursuant to this article shall be equal in amount, scope, and duration to the same services provided pursuant to Section 14132.95, including any adjustments that may be made to those services pursuant to subdivision (e) of Section 14132.95.
(2) Notwithstanding any other provision of this article, the rate of reimbursement for in-home supportive services provided through any mode of service shall not exceed the rate of reimbursement established under subdivision (j) of Section 14132.95 for the same mode of service unless otherwise provided in the annual Budget Act.
(3) The maximum number of hours available under Section 14132.95, Section 14132.951, and this section, combined, shall be 283 hours per month. Any recipient of services under this article shall receive no more than the applicable maximum specified in Section 12303.4.
(Amended by Stats. 2004, Ch. 229, Sec. 40. Effective August 16, 2004.)
MARTY OMOTO YOUTUBE CHANNEL
CDCAN youtube channel was set up to eventually have various videos covering issues important to people with disabilities, mental health needs, the blind, seniors and low income families and individuals. Currently videos posted are from past events or presentations.
To see the current videos, including March 2014 San Andreas Regional Center Aptos Legislative Breakfast, January 2014 panel discussion on services for adults with autism spectrum and related disorders in Palo Alto, and older videos including video of April 2003 march of over 3,000 people with developmental disabilities, families, providers, regional centers and others from the Sacramento Convention Center to the State Capitol (to attend and testify at budget hearing on proposed massive permanent cuts to regional center funded services, go to the CDCAN (Marty Omoto) Channel at:
https://www.youtube.com/channel/UCEySEyhnr9LQRiCe-F7ELhg
More videos – including new current videos (an interview with longtime advocate Maggie Dee Dowling is planned, among others) – plus archive videos of past events – will be posted soon.
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