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Report Number: 2016-128

In-Home Supportive Services
The State Could Do More to Help Providers Avoid Future Payment Delays



Summary

The In‑Home Supportive Services (IHSS) program employs individuals who provide in‑home services to eligible people so they may remain in their homes as an alternative to receiving out‑of‑home care. These caregivers, known as IHSS providers, perform ongoing services for eligible IHSS recipients and receive payment for these services. More than 460,000 providers in California deliver in‑home services to nearly 548,000 eligible individuals—low‑income people who are also aged, blind, or disabled located throughout the State.

The State and counties share administrative responsibilities for the IHSS program, with the California Department of Social Services (Social Services) coordinating the program at the state level and each county administering the program for recipients and providers within its jurisdiction. Social Services contracts with another state agency, the Office of Systems Integration (OSI), to act as the project manager for the Case Management, Information and Payrolling System (CMIPS II), which is a web‑based system that is used to manage the IHSS program and calculate payments for providers, among other tasks. CMIPS II receives and processes provider timesheets at a single statewide location and forwards timesheets with exceptions, such as those missing signatures or containing unreadable entries, to the applicable county office. In this audit, we reviewed the roles and responsibilities of state and local agencies regarding the processing of timesheets and paychecks for IHSS providers. This report draws the following conclusions:


Social Services has not provided adequate direction or the appropriate tools for counties to effectively monitor and resolve provider timesheet exceptions.

Social Services does not require counties to initially review and attempt to fix timesheet errors, known as exceptions, and instead allows counties the option to direct providers to resolve their own exceptions and submit replacement timesheets. Counties can quickly resolve many exceptions by reviewing a scanned image of the timesheet in CMIPS II or calling the provider to verify the accurate entry. However, not all counties have processes to instruct their staff to correct timesheet exceptions in this manner. Moreover, when counties direct providers to correct errors by completely redoing their timesheets and resubmitting them—an alternative that counties may use instead of manually correcting the error in CMIPS II—it may increase the likelihood that providers will make errors on the sections of their timesheets that had originally been submitted correctly. The time required to address timesheet exceptions can delay, sometimes significantly, the issuance of paychecks to providers, which can result in financial hardship. Providers in these difficult financial situations may be forced to seek other employment to meet their needs and, as a result, may not be able to continue serving IHSS recipients, thereby precluding eligible individuals from remaining in their homes and avoiding placement in out‑of‑home care

Also, CMIPS II does not report on timesheet exceptions at a level of detail that would allow counties to identify trends, such as providers who repeatedly make timesheet errors or experience payment delays. If this information were available, counties would be able to identify such providers and could target their support efforts to ensure that subsequent timesheets are submitted accurately and paychecks issued promptly.


Social Services and OSI have not analyzed key information that could aid in monitoring timesheet exceptions and payments.

Social Services and OSI have not obtained and reviewed information from the State’s CMIPS II contractor on the time it takes to process timesheets, the number of timesheets with exceptions for each county, and the time it takes to resolve exceptions, even though the agreement with the contractor specifically requires this information. Having information on the overall number of timesheets with exceptions, the number that were sent to each county, and the time taken to resolve them would help Social Services identify and target problem areas or trends within IHSS. Additionally, Social Services does not have processes for monitoring whether the CMIPS II contractor and the state agencies responsible for processing, printing, and mailing timesheets and paychecks are meeting key contractual obligations.


The complexity of certain time‑reporting protocols hinders providers’ ability to accurately complete their timesheets.

The IHSS program requires providers to adhere to conflicting time‑reporting protocols, resulting in the potential for providers to exceed their recipients’ authorized hours, thus jeopardizing the providers’ continued participation in the program. Recent changes in state law limit the number of hours a provider can work in a workweek. However, the misalignment of pay periods used on timesheets and the workweek defined in state law has resulted in some providers inadvertently exceeding their limit for hours and being suspended from the IHSS program.



Summary of Recommendations

Legislature

To facilitate providers’ efforts to report their time, and to reduce the potential for them to be inadvertently suspended from the IHSS program, the Legislature should amend state law to align the IHSS workweek with the pay period.

Social Services

To ensure that counties are handling timesheet exceptions consistently and minimizing delays, Social Services should develop and issue procedures by July 2017 to require the counties to first attempt to correct timesheet errors for specific types of exceptions before mailing blank replacement timesheets to providers.

To assist counties in resolving exceptions efficiently, Social Services should by December 2017 develop a timesheet exceptions report in CMIPS II that enables county staff to categorize common exceptions and identify providers with recurring exceptions.

To ensure that OSI is adequately monitoring the CMIPS II contractor, and to allow for more proactive management of the IHSS program, Social Services should work with OSI to enforce the contract provision requiring the contractor to submit monthly data on the number of timesheets with exceptions by county and the time taken to resolve those exceptions. Moreover, Social Services should develop a process for regularly reviewing these data to detect any discrepancies among the counties’ processes for handling timesheets with exceptions.

To ensure compliance with the time frames required in its agreements with state agencies to print and mail timesheets and paychecks, Social Services should perform monthly reviews of these activities. Additionally, Social Services should implement a process to regularly test the processes of these state agencies to ensure that they are within the required time frames.

OSI

To ensure that the reports it receives from the CMIPS II contractor are complete and allow it to better manage CMIPS II and support the IHSS program, OSI should enforce its agreement requiring the contractor to submit monthly data on the number of timesheets with exceptions by county and the time taken to resolve them.


Agency Comments

Social Services indicated that it is taking steps to implement most of our recommendations. However, it believes that there would be a significant cost and technical effort needed to create functionality within CMIPS II to allow replacement timesheets to be printed with data from the original timesheet that were submitted correctly. OSI also indicated that it is addressing our recommendations.

To review the respective agencies’ responses and our comments to those responses, please see the Responses section.



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