Your Notice of Action (NOA) from IHSS explains how many hours your child is authorized for and in what categories, but this document can be a bit tricky to read. Hear from Undivided Public Benefits Specialist Lisa Concoff Kronbeck about what to pay attention to when you receive your NOA so that you know how many hours your child is authorized for (and if it should be more), what else they could potentially qualify for, how to submit an appeal if your child isn’t getting enough hours, and more.
Here are links to the Undivided articles and other resources included in the training:
For Functional Index Rankings and Hourly Task Guidelines, check out our IHSS Protective Supervision and Paramedical Services article.
Find the functional index rankings and hourly tasks here on cdss.ca.gov.
Find the In-Home Supportive Services Assessment Criteria Worksheet here on disabilityrightsca.org.
For more information on submitting an IHSS appeal, go to our resource How to Appeal an IHSS Decision and find our step-by-step guide.
To find your federal representative, visit findyourrep.legislature.ca.gov.
So a couple of things to keep in mind. As always, please be aware that the information that we're talking about here is not legal advice. It's publicly available information. We're here to help you navigate the system and give you some sort of confidence, and make this information less intimidating, but we are not authorized to provide legal advice. If you need legal advice, please consult with an attorney who you can discuss your case with. Again, as Jen said, there's a lot of information. You don't have to remember everything that we talk about here. You can take notes in the app, and you'll be able to review the recording, and all this information is repeated in the goals that you can access within the Roadmap.
So let's talk about this. What is a Notice of Action? So when you get the Notice of Action, once you've been approved for IHSS hours, what you're gonna get is basically it looks like a big spreadsheet. It is a big spreadsheet, and it can be really confusing the first time you get it. So, we're going to sort of look over some screenshots of a Notice of Action and sort of dissect it and look at the different parts and talk about what each of those things mean. So... and again, as always, you can go into the app and look at your Roadmap and add the skill to your Roadmap. Okay, so what is a notice of action. So what is a Notice of Action? Notice of Action is what tells the the consumer, the recipient, number one, whether or not IHSS has been approved. And two, if it has been approved, the breakdown of where hours and minutes were authorized in each category of eligible... each eligible category of tasks. So it's going to list all of this time in separate categories, so there's going to be a section for domestic services, which are usually not available to minors. There's a section for related services, which have limited availability for minors. And then there's the non-medical personal care services, accompaniment, protective supervision, and paramedical services.
So let's look at this document. It's just... at first glance it's a giant mess of numbers. What’s it all mean? Let's look at this. So the very top is... the very top of the table is going to show the effective date of the Notice of Action. So that's not the date that they're mailing it to you, but the date that this authorization goes into effect. It might be before the actual date that you're reading it. It might be after the actual date, depending on the status of your IHSS application. So it's going to say the total number of minutes, and it's going to say, if you've had IHSS previously, it's going to say whether this is an increase or decrease in hours from the last Notice of Action. That's the top. The second section is where all the services are, and it's going to tell you which service is being provided. It's going to tell you the total amount that you... that your child needs each week, but it's also going to show any adjustment or proration for others in the home, which is not... used to happen for protective supervision, but not anymore. But sometimes when there's other people in the home, if they're not receiving IHSS assessment, they're adults, but you're providing that care, they may deduct from that. Any services that you get from other people and that that means time that your child is at school. So if you get... For example, if your child is on g-tube feeds and they get one of their daily feeds at school, there might be some time deducted for time they’re at school, and that's also the case very often for protective supervision, and we'll talk about that a little bit later. But it's going to show time that somebody else is doing the task, and you're not going to get paid for that, obviously. So they're going to deduct that from the total authorized time.
And then the final column, at the very end on the far right, tells you the total amount, what it was before and whether that's an increase or decrease and by how much. So domestic services, you generally are not going to get domestic services for minors. Related services though, there are some situations where you might get meal preparation and clean up, you might get routine laundry, especially if your child has a feeding tube or an ostomy, or is older than... is four or older and is still in diapers. You may be able to get laundry time because it's extraordinary need relative to a typically developing child who needs laundry done less frequently, because they don't have all the medical complications that result in never ending laundry. So these are generally going to be listed on a monthly basis. The domestic services are going to be listed on a monthly basis, and then the related services are listed by the week. So what you're going to see later is that all of these numbers are on a weekly basis, and then at the very end, it's going to calculate it all and then spit out a number for the month's authorization. Because when you talk about, oh, how much IHSS do you get, you think about it as this is how many hours I get per month, but the Notice of Action is talking about how many hours they're authorizing per week, and then they'll add it up and we'll talk about how they calculate that too. Okay, so let's look at the non-medical personal care services. So this is... and we're going to include accompaniment here too.
So as you can see this person got bowel and bladder care. It was not a change, so it's the same amount that they got last time under accompaniment. It looks like they got a little bit more. They got seven more minutes per week. Most of the time for... Generally speaking, for a child, this is where most of the hours are going to be, aside from paramedical and protective supervision. And then as you can see here in the column of services that you get from other people, there's ten minutes deducted for food, so they're accounting for the fact that five days a week the child is at school during the meal time. Okay. Protective supervision is the area where I see the most questions about the Notice of Action, because it can get pretty confusing. So this first column, the number of minutes that you need, where it says the total amount of services needed, that's always going to say 168. And why is that? Because there's 168 hours in the week. It's always going to say 168 in the first column, because that's 24 hours times seven days, but we know that IHSS does not cover 24/7 supervision, so this number is not... the 168 in that first column is never going to be the same number that's in the the final column, right? So let's look at how they might deduct that. So the amount of service that you need will be the sum of the total... the total 168 minus all of the other services, so they're going to take out hours that somebody else is doing, but they're also going to subtract from 168 any other hours that you were authorized for other services, because the presumption is that while you're feeding them, while you're changing their diaper, while you're doing paramedical care, you're also providing supervision. So they're not going to... they're not going to double up on those hours. There's only 168 hours in the week, so they're going to subtract the number of hours that you're going to get from other services. So you can see here that they took out 34 hours per week here because the person is at school, probably because the person is at school for the 34 hours, and then the very last number, you're asking yourself, like, where did this come from? Why 45:02 and this is 156? Well, the maximum number of hours for protective supervision in a month is 195. So if this... And 195 divided by 4 or divided by 4.33, because that's what they assume is roughly in a month. 195 divided by 4.33 is 45 minutes... 45 hours and two minutes. So this is always going to be 45:02, unless there are so many other services that the total number of hours in the month gets deducted even further, if that makes sense. Like if you already have... if you already have the maximum number of hours per week, and we're going to look at an example of this, you already have so many other services that there's just no room for 195 supervision hours or for 45:02 in the week, then you'll start to see that 45:02 decrease.
So if you see that number is lower than 45 hours and two minutes, that means that you've got so many other hours in the week that it's subtracting from that. So let's look at an example. So this is an example of a Notice of Action for somebody who has, as you can see, who has 65 hours a week of paramedical services, so the maximum monthly hours are 283, and so the maximum weekly hours that you can get is 65:22. So you're going to see that although this person has protective supervision, the paramedical services and other care services that are authorized are so high that in the end, there's no actual hours authorized for protective supervision because all the other care hours add up to more than that. So that doesn't mean the person doesn't still have protective supervision. It just means that there aren't... there are some... that there's... that there are so many other hours that there's no... because protective supervision, if you have a lot of hours, it's just going to bring you up to the maximum. So if this person had like 63 hours or 64 hours, this might be two hours, and that doesn't mean they only need two hours of supervision. It just means that when you add and subtract all the hours, that's what brings them up to 283 hours. So the last section is going to be the total number of hours that you can get.
Now the total number of hours, it's going to add up all the number of hours in the week, and then it's going to multiply it by 4.33, and that's because in the average month there's roughly four and a third weeks. So that's how they get the final number of hours that you can get authorized in a month, and I'm going to talk about something here that I don't think I actually put into the presentation, but it gets really confusing for people when they get their provider notice, because when you get the provider notice, it tells you your maximum hours that you can bill, but then it also tells you the number of hours per month, and you can see that the maximum number of hours that you can bill is usually higher than... it’s almost always higher than the total weekly hours authorized, and the reason for that is because, need shuffles around a little bit, but they're not telling you how many hours you're going to get every week. If you have max hours, 283 hours, the maximum weekly hours are 70 hours and 45 minutes, because that's 283 divided by four.
So the maximum number of hours that you can bill as a provider in any given week is the total number of hours per month divided by four, but that is just the maximum that you can bill without getting a timesheet violation. It's not the number of hours that you're going to bill every single week, except in February, because there's only 28 days. It's just kind of... They're telling you don't ever bill more than this or you'll get a violation, but usually it's going to be roughly the total number of hours divided by 4.33 because that's more what the month looks like. So now I want to go back to something that I've talked about in a previous presentation, and this is what do all these numbers mean when you look at how many hours they gave you for any given task. So this is the hourly task guideline. The hourly task guidelines tell you, generally speaking, we talked in the last presentation about the different ranks and it’s generally ranked from rank one, which means either that the task is parent responsibility or that the child is able to do the task independently.
So rank one, they're not going to authorize any hours, but rank two through five or six... six is paramedical services, but rank one through five, and they're going to assign the rank based on what you tell them. You don't need to assign rank, but it generally is rank two means that they can do the task physically, but might need some verbal reminders, and then three through five, three and four, depending on how much help they need, and then five means that they rely totally on the caregiver for that task. So you can see how they break it up, where is it the low end of rank two? Is it the high end of rank two? This is another version that you'll find online, where it just shows the low and high and doesn't show the midpoint, but if you look at your Notice of Action, you can see roughly where somebody fell in. So let's let's go back to one. So you can see that this person got two hours and 15 minutes for bowel and bladder care. So let's look at where two hours and 15 minutes falls under bowel and bladder care. You can see that they ranked it around the middle of rank three.
So this is really where you have the ability to go back and look at your notice of action and think of... and use those times, those specific times and cross-check them with the hourly task guidelines, and take a look at it and see if you feel like they ranked your child appropriately based on your child's needs and skill levels. So, if you look at rank, this person got rank three in the middle for bowel and bladder care. Well, is this a child who is still in diapers? Is this a child who needs some help cleaning up after using the bathroom? If the child is still in diapers and they're not able to help change their diaper, then rank three might not be the most appropriate ranking, and you may want to look at whether rank four or five might be more appropriate if that child is totally incontinent and is not able to use the bathroom at all. Another area where you might think about asking for additional bowel and bladder care, and they may or may not give this, but you should mention it, is that laundry is generally limited to one hour per week. Now, if you have a child who has a g-tube or is in diapers and the diapers don't contain everything, you know that you're doing a lot more than one hour per week, and that is above and beyond what would be expected of the laundry of a typically developing child, so if you are constantly having to change the laundry, the bed sheets, because you're... less so because of a g-tube, but if there's an ostomy bag, and that creates laundry, if there's... if your child's on Lasix and they're constantly having wet diapers and they're leaking, that... you might talk... you might consider asking them for additional bowel and bladder hours to account for all the additional laundry that you have to do that's far more than one hour per week. If you're having to change your child's bed sheets every single day, that is not what you would expect for a typically developing child, and so you may consider asking for additional bowel and bladder care in that time. So again you want to go back and look at your... at your Notice of Action. And let's look at another one of these just to see. So for dressing, this person got one hour and 26 minutes.
So let's look at dressing. Let's find one hour and 26 minutes. So again, this person was ranked rank three, dressing, right in the middle of rank three. So as you can see, usually... sometimes these will not line up perfectly. Sometimes it'll be toward the low end or toward the higher end, but often the specific time, you'll be able to find it, especially on the chart that shows the mid range. You'll very frequently be able to find the specific time that corresponds. And so think about where your child is. Can they do the tasks just with a little bit of reminders? Do they need just a tiny bit of hands on help? Do they need really involved... they're kind of going through the motions, but you're the one who's really doing it, or are you just basically doing the entire task? And you can sort of look at that for each of your guidelines. This is especially helpful to do, number one, right when you get your Notice of Action, so that you can see whether you agree with it or you want to appeal. And number two, in preparation for your next annual visit, you can look at your last Notice of Action and see where maybe the needs have increased, or where it wasn't described accurately, but you didn't have a chance to review it last time. Okay, so hearing rights. So page two is going... is just like the description of your hearing rights, how to request a hearing.
This is an older version of the Notice of Action so it doesn't include the website, but there is also a website where you can look up... where you can file it, ACMS. There's a website where you can file an appeal online, but this is already a few years old, so I don't think it has... it doesn't have the website. Page three... Page two, that's only if you're going to appeal. Page three often contains a lot of very valuable information. So, number one, it gives kind of a summary of what changes took place on your Notice of Action compared to the last time. Number two, it will usually show... this... It doesn't look like this one does, but often if it makes a difference, it will show which stream of funding your IHSS is coming from. So basically there’s... IHSS is funded by a few different programs depending on the... sort of the qualifications and the situation of the recipient. Yeah, this one actually does. Yeah. See, it says the maximum number of protective supervision hours is 195 because you receive your IHSS services through the CFCO program.
So there's a few different funding streams, and it largely depends on the status of the recipient, but it may change the maximum number of hours that you get. So under some programs for IHSS, the maximum hours for non-severely impaired is 195 and the maximum for severely impaired is 283. And that 195 is the maximum regardless of whether or not protective supervision is in place, so if protective supervision is awarded, it will still only go up to 195. Now, on the CFCO program, which is where most of our kids are going to be who are Regional Center clients on the waiver, that... the maximum number of hours is... for non-severely impaired is the total number of hours awarded per month for other tasks, plus 195 for protective supervision, so you might see a child who has 220 or 230 hours a week, and that's because they had a few care services, and then the 195 on top of that with protective supervision. If you are receiving IHSS and you have been for a long time, and all of the sudden you log into your portal to track your hours, and there's only 195 hours available, and you've been receiving more than that for a long time, and suddenly it says 195 hours, usually that means that something is wrong with your Medi-Cal enrollment, so if you see that, the first thing that you should do is check the status of your child's Medi-Cal enrollment and make sure that it's still intact and still the same, because sometimes what happens is, if somebody's Medi-Cal has been suspended temporarily, then they put you into the IHSS residual program temporarily, which has a maximum of 193 hours or 195. So just, keep in your mind that if you ever see it, just shrink to 195. First thing to do is check your Medi-Cal enrollment.
The other thing that's going to be documented on page three, and this can also be really important, and I'll explain why, is if there are hours that are above and beyond the maximum, but IHSS has assessed that you need them, you're not going to get above the maximum, but the notice of action will say you have a total of this many hours and this many minutes of unmet need. And so when they're doing your assessment, if they ever say, “Well, you know, he might qualify for more hours in this area, but you're already getting the maximum, so it doesn't matter,” ask them to document it anyway, because if your child has hours of unmet need, you want that documented on the Notice of Action for a few different reasons. One is that the last time that there were IHSS cuts, and I will talk about this too, the original proposals were that those cuts would come out of unmet need first, so if they... they tried to pass a cut of 20% across the board, but if people had documented hours of unmet need, then that 20% would've come off of the unmet need first. They would have taken the total number of hours needed and cut 20% instead of just the maximum hours, 20% off of that. So that's one reason that it's really important to have unmet need documented. The other reason is that if you're going back to, say, for example, the Regional Center and asking for additional respite hours or asking for personal assistance hours, or for example, you're on the HCBA waiver and you're looking at waiver personal care hours, if you have documented unmet need, then it gives you a little bit more of a case to ask for additional hours in other areas like respite, like personal care, because you have documented unmet need that IHSS isn't covering. So that's... those are some of the main reasons to make sure that... so again, when they’re doing the home visit and they say, “Oh, we don't really need to look at that because they're already getting maximum hours, so it's not going to make a difference,” it still may make a difference. So make sure that they are still documenting it even though it's not going to make a difference on the number of hours that are authorized. Now note, though, that protective supervision is not included in unmet need, so if your hours, like on that one Notice of Action that showed that there were no protective supervision hours authorized because the other hours were so high, protective supervision just brings you up to the maximum. They're not going to slap 195 hours of unmet need on top of that. It just brings you up to the maximum number of hours. Or if it's not severely impaired, then it... they add 195.
Okay, so the next few pages just talk about the description of services, what each service category entails, what each of them means, and then again, the... I guess I did include this. So the provider notification, again this is... it's going to tell you the total number of hours. It's going to tell you the maximum weekly hours. Again, that is not the number of hours you were going to bill every week. That is the total number of hours that you can bill in a single week without receiving a violation. So again, the average number of hours that you're going to bill each week is 244 and 22 minutes divided by 4.33. The only month that this is actually the number of hours that you will bill is February because there's generally only 28 days, which is divided by four weeks, so in February you will bill the maximum each week. And then again, the pages following that will be a description of services, and there will be a little X mark next to the ones that have been authorized.
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