In-Home Support Services (IHSS) Program - Appeals Process

• Uploads and copies un-calendared hearing list from the SHS on Friday of the current hearing week, or on Monday of week #1, and gives to Appeals Supervisor.
• Uploads and copies calendared hearing list from the SHS on Thursday or Friday of week #1, and gives copy to Appeals Supervisor.

For hearing Week Patterns

• Enters all available information from the uncalendared hearing cases into the Excel Spreadsheet on the “S” drive to complete the following columns: Case name, State Fair Hearing #, IHSS case # or SSN, hearing Date/Time, Appeals Officer, Social Worker, APP, Notes.
• Emails IHSS Excel Spreadsheet (IHSS Hearing Log) to IHSS SSPM and Appeals Officers with as much information as possible, by the end of the current Hearing Week or by first day of Week # 1.
• Update IHSS Spreadsheet on the “S” drive with Hearing Date/Time and any other information that is available. Include comments on this lists as appropriate.
• Emails updated IHSS Excel Spreadsheet to IHSS SSPM and Appeals Officer by Friday of Week #1.

• Receives the IHSS Excel Spreadsheet from Appeals Supervisor
• Validates the information on the Spreadsheet in accordance to scheduled hearings
• Prepares SCD 2597 and sends directly to IHSS SSPM for Social Worker assignment.
• Enters appropriate notes in the IHSS Excel Spreadsheet for hearing cases.
• Submits updated/validated list to Appeals Supervisor

Reminder: Re-hearing cases do not required a new SCD 2597. However this must be noted in the IHSS Excel Spreadsheet.

Example Example “Re-hearing case. No SCD 2597 needed” 

• Receives updated/validated list from all Appeals AOs
• Resubmits updated/revised IHSS Excel Spreadsheet to IHSS SSPM and Appeals Officers.

• Enters the assigned Social Worker’s (SW) name on the IHSS Spreadsheet.
• Enters the IHSS Fair Hearing information into the Case Management Information and Payrolling System (CMIPS) II.
• Emails the completed IHSS Excel Spreadsheet back to the Appeals Supervisor, by Wednesday of Week #2. Include comments on this lists as appropriate.

• Reviews the hearing request to determine the issue and eligibility for APP
• Completes the SCD 2597 as follows:
  • Section “TO”:
    • Office: IHSS - 1888 Senter Rd
    • Supervisor: SSPM’s name and H4AA
    • Liaison: Leave blank
    • Date: Current date
    • Case Name: Claimant’s Name
    • Case Number: Claimant’s CMIPS II number or if unknown, claimant’s SSN
  • Section “FROM”:
    • 1st line: Enters who the hearing request is from (if from AR, enter AR’s name and organization)
    • State Hearing #: Enters State hearing Number
    • Filing Date: Enters the Filing Date
    • Notice of Action (NOA) Date: Enters NOA date or leave blank if unknown.
  • Section “ AID/SERVICES PAID PENDING STATUS”:
    • 1st box: Checks the first box if eligible for APP and enters “IHSS” on the corresponding line
    • 3rd box: Checks the third box if eligible for APP. Enters APP beginning date on the corresponding line (if known)
    • 4th box: Checks the fourth box if NOT eligible for APP. Enters the aid type on the corresponding line and selects the box that most fits the issue.
  • Section “FAIR HEARING ASSIGNED TO”:
    • Assigned to: Enters Appeals AO’s name and worker number
• Prints completed SCD 2597
• Attached completed SCD 2597 to a copy of the hearing requests and place it in the Appeals clerk snap scan basket.

• Snap scans SCD 2597 and Hearing requests and forwards to IHSS SSPM
• Date stamps and initials SCD 2597
• Returns SCD 2597 and copy of hearing request to the Appeals AO.

• Receives SCD 2597 and hearing request
• Logs into CMIPS II
• Emails SCD 2597 and hearing request to the assigned Social Worker (SW) and Social Work Supervisor (SWS)
• Emails Appeals AO with the name of the assigned SW and SWS.

• Sends an email invite to the SW cc’s SWS for the scheduled hearing. (provides hearing date and time)

  • Note: This invite serves as a reminder of their mandatory attendance.

• Reviews the Hearing requests to try to resolve the issue. If the issue is: 
  • Resolvable:    
    • Notifies IHSS SSPM and Appeals AO and provides and explanation on how it was resolved.

      • Note: The Appeals AO uses this information to determined if a withdrawal or conditional withdrawal is needs to be sent to the claimant.

  • NOT resolvable:    
    • Notifies IHSS SSPM and Appeals AO for a regular State hearing process.
    • Emails Appeals AO Forms and Verifications needed for Hearing NO later than Tuesday of Week #3

      • Important: The Forms and Verifications must be submitted timely in order to prepare the State required Statement of Position.

• Sends an email to the SW/SWS immediately to requests Forms and Verifications, IF NOT provided.
• Reminds the SW/SWS via email of their mandatory attendance to the scheduled State Hearing.

• In Home Support Service Program - Paramedical Service Form (SOC 321)
• In-Home Support Services Program - Health Care Certification Form (SOC 873)
• In Home Support Program - Assessment of Need for protective Supervision (SOC 821)

Note: This form is needed if a review for Protective Supervision is conducted. This form must be accompanied by notes/comments related to the issue.

• Both sides of current NOA mailed out to the client, including its attachments. (all programs).
• Case comments and narratives related to the assessment.
• Service Evidence screens (showing the ranks of each need and hours assessed).
• View Service Type Detail screen for each task whether or not hours were given.
• Program screen (providing home visit date).

• Receives Hearing Decision from the State
• Emails copy of hearing decision to Appeals AO

• Receives hearing decision from Appeals Clerk
• Completes the "Fair Hearings Communication" SCD 2597 form as follows:
  • DATE: Current date
  • TO: IHSS QA Manager's name and the QA Manager's worker number
  • FROM: Appeals Officer's name, worker number, works address and email address
  • CASE NAME: Claimant's Name
  • CASE NUMBER: CalWIN case number
  • ST. FH#: State Fair Hearing Number
  • REMARKS: Check all boxes that pertain to hearing decision. Check the box "Other" to enter any necessary comments.
• Completes the “Fair Hearing Communication” (SCD 2597) form, for granted or partially granted decisions, as follows:
  • IHSS QA manager’s name
  • Case name
  • Case Number
  • State FH #
  • Name and worker number of Appeals Officer
  • Date Compliance to be returned by (Usually the 30th day after the Decision is being sent to the QA Manager)
• Scans completed SCD 2597 and Hearing Decision
• Forwards the scanned documents to the IHSS QA Manager using the following email format:
  • Email Subject Line: Decision from Fair Hearing and Claimant’s name
  • Email Body: IHSS case number, State Fair Hearing number
  • Any important information pertaining to IHSS.
• Scans and emails copy of denied/dismissed decision to IHSS QA Manager.

Reminder: Any decision, whether granted or denied/dismissed, must to be forwarded to IHSS QA Manager.

• Receives the email from the Appeals Officer
• Assigns to QA SW
• Replies to the Appeals Officer’s email with the assignment information (QA SW’s name and worker number)

• Receives Hearing Decision from the IHSS QA Manager
• Complies with the Hearing Decision
• Enters all necessary information into CMIPS II
• Completes the SCD 2597 and emails back to Appeals Officer along with a copy of the NOA.

• Receives completed SCD 2597 from the IHSS QA SW
• Files it in the Appeals case folder
• Closes out the Appeals case folder and gives to Appeals clerk to file in Appeals closed files and IDM.