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Attending therapy does not automatically reduce a child’s total IHSS hours. However, a parent provider generally may claim only the authorized services actually provided during the reported time.
Therapy can affect claimable hours when the therapist, clinic, school, or another program is meeting the child’s needs during the appointment. It may also affect whether travel, accompaniment, waiting, or Protective Supervision can be claimed.
The answer depends on:
A child’s monthly IHSS hours are established through an individual county assessment. The social worker determines which services the child needs and how much time should be authorized for each service.
Starting occupational therapy, speech therapy, physical therapy, behavioral therapy, or another service does not automatically remove hours from the child’s IHSS case.
The county must evaluate whether the therapy changes the child’s actual need for IHSS services. A reduction should ordinarily be communicated through a new Notice of Action rather than being made informally by telling the parent to claim fewer hours.
Even when the child’s monthly authorization remains unchanged, the provider may claim only authorized IHSS services that were actually performed.
California’s provider notice states that IHSS pays only for authorized hours and services. A provider should not claim time merely because the hours appear on the child’s Notice of Action.
For example, a parent generally should not claim personal-care time during an appointment if the therapist or clinic staff performed the entire task and the parent provided no authorized assistance.
The parent may still perform other authorized services before, during, or after the appointment, such as:
The provider’s timesheet should reflect the services actually performed, not simply the length of the therapy appointment.
A therapy program may be treated as an alternative resource when it provides services that would otherwise be provided through IHSS.
California requires social workers to identify services available through other agencies or programs and use those resources in place of IHSS-funded services when they meet the assessed need at no cost to the recipient or the IHSS program.
This does not mean that every therapy appointment replaces all IHSS services. The county should identify the specific service the therapy program provides and determine whether it actually duplicates an authorized IHSS service.
For example, a one-hour speech therapy appointment does not necessarily replace assistance with bathing, dressing, feeding, toileting, meal preparation, or other care required throughout the week.
Protective Supervision may be provided through IHSS, alternative resources, voluntary resources, or a combination of those arrangements. Alternative resources may include child day care centers, community programs, or respite centers.
A therapy program may function as an alternative resource during the period when its staff assumes responsibility for supervising the child. In that situation, the parent generally should not claim Protective Supervision for the same period merely because the parent remains nearby.
The facts may be different when:
Parents should document exactly what the therapist handles and what the parent must continue doing. Simply being required to remain at the facility does not always establish that the parent is providing a compensable IHSS service.
IHSS may authorize accompaniment to appointments with physicians, dentists, and other health practitioners when the recipient requires assistance to accomplish the travel.
Medical accompaniment is not intended merely to pay for transportation. The child must need assistance with an authorized IHSS task while traveling or while getting to and from the destination.
Possible examples include assistance with:
Do not assume that driving a child to therapy is automatically payable. Ask the social worker whether accompaniment has been assessed and included in the child’s authorized services.
Whether wait time is compensable depends on whether the provider is “engaged to wait” or “waiting to be engaged.”
A provider may be engaged to wait when the appointment’s duration is unpredictable and the provider cannot leave or use the time for personal purposes because assistance may be required at any moment.
Wait time at an alternative-resource site is not typically compensable when the child can be dropped off and picked up later, allowing the provider to use the appointment time for personal activities.
Important questions include:
Remaining in the lobby by choice does not necessarily make the entire appointment payable.
Parent training and participation may be important parts of a child’s treatment, but not every activity required by a therapist is automatically an IHSS service.
The county should determine whether the parent is performing an authorized IHSS task or participating as part of the therapy program.
For example, a therapist may ask a parent to observe a session, learn behavioral techniques, or discuss the child’s progress. These activities may be valuable but are not necessarily covered IHSS services.
The analysis may be different when the parent must provide an already-authorized service during the appointment, such as toileting assistance, transfers, feeding, mobility assistance, or a paramedical procedure.
Ask the therapist to provide a written explanation of:
This information can help the social worker decide whether accompaniment, wait time, or another IHSS service should be authorized.
The presence of a therapist in the home does not automatically suspend every IHSS service.
The relevant question is who is performing the authorized task. A parent may continue claiming an authorized service when the parent is actually providing it and the therapist is not.
However, the parent should not claim time for a task performed entirely by the therapist or another paid program. IHSS generally should not pay twice for the same service during the same period.
Keep a clear record showing:
Therapy may eventually improve a child’s ability to perform certain tasks. If the child becomes more independent, the county may reassess the time needed for those particular services.
Attendance alone does not prove improvement. The county should evaluate the child’s current functioning and the assistance still required.
For example, attending occupational therapy does not establish that a child can now dress independently. The assessment should consider whether the child can complete each part of dressing safely, reliably, and without unreasonable physical or emotional stress.
Parents should describe what the child can do independently, what still requires assistance, how often prompting is needed, and whether skills demonstrated in therapy carry over into everyday life.
Maintain records showing how therapy affects the child’s care.
Include:
Also keep appointment confirmations, treatment plans, therapist statements, attendance records, and the child’s IHSS Notices of Action.
When a social worker says therapy will reduce IHSS hours, ask which specific service is being reduced and why.
Questions may include:
Do not voluntarily reduce the hours claimed based only on a vague verbal statement. At the same time, do not claim appointment time unless an authorized IHSS service was actually provided.
Attending therapy does not automatically reduce a child’s IHSS authorization. Therapy may affect claimable time when another resource assumes responsibility for the child or provides the same service IHSS would otherwise cover.
An IHSS attorney or qualified advocate can review the child’s Notice of Action, therapy schedule, Protective Supervision calculation, and the services the parent performs during appointments. They can also help determine whether accompaniment or wait time should have been assessed.
Need help? In California, the In-Home Supportive Services (IHSS) program provides crucial financial help for families raising children with special needs. American Advocacy Group is on the front lines every day, making positive change happen for people diagnosed with autism, Down syndrome, and a range of diagnoses across the continuum. As a leading advocate for all people with intellectual and developmental disabilities and their families, and the premier provider of the support and services people want and need, we understand the system and know how to take action regarding your best interests.
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