Breaking misconceptions about IHSS

IHSS program rules waive certain provisions of the Colorado Nurse Practice Act and Colorado Nurse Aide Practice Act to allow this service to be provided to people who otherwise would be living in a nursing home rather than independently, in their own residence.  A Registered Nurse provides oversight not actual care.

IHSS services will be allowed as a supplemental benefit for Medicare Advantage (MA) Plans in 2019 forward.

IHSS agencies are required to be licensed as home care agencies by CDPHE, and as licensed home care agencies, they must adhere to the standards of care established by

the Colorado State Board of Health, which is located in CDPHE.

The Medical Services Board, located in HCPF, is charged with adopting rules for the implementation and administration of IHSS for Medicaid reimbursement, which it has
done. HCPF has delegated the monitoring of the standards of care to CDPHE.

An IHSS agency is different from other Class B agencies since it must contract with or employ a licensed healthcare provider, such as a registered nurse, to verify the skills
and competencies of attendants. This is not necessary for other Class B agencies since they do not provide healthcare services.

This step is necessary because IHSS agencies are different from other Medicaid certified home care agencies.

For one, an IHSS agency is defined by statute as providing independent living core
services, which include:
 Information and referral services;
 Independent living skills training;
 Peer counseling, including cross-disability peer counseling; and
 Individual and systems advocacy.
These responsibilities are not required of other home care agencies

Another reason IHSS agencies are different from other home care agencies is because IHSS participants may select and train their own attendants, and certain provisions contained in the Nurse Practice Act and the Nurse Aide Practice Act are waived. This enables attendants, who may be lay persons, to provide some services (such as wound care, catheter irrigation, and medication administration) that might otherwise be considered the practice of nursing. 

For example, an attendant for someone with cerebral palsy may not be a licensed nurse, but he or she may be trained to provide gastronomy tube feedings in order to prevent malnourishment. Again....an RN is for oversight not actual care.  

By participating in IHSS, individuals with significant health care needs are able to keep the cost of care down by employing a lay person rather than a skilled nurse. Otherwise, the cost of care at home or in the community may exceed the limits set by Medicaid, and the individual would be required to move into a nursing home.

Unlike other Class B agencies, an IHSS agency is required to contract with or hire a licensed healthcare professional, who is in charge of, among other things, verifying the skills and competency of attendants, consulting with clients in case medical issues arise, and assuring attendants are following care plans.

For a home care agency to provide IHSS, it must have at least a Class B license and have basic HCBS certification. Although IHSS attendants may provide health-related services, they only provide assistance with specific health maintenance tasks that they are trained to do by the clients and verified by the IHSS agencies. IHSS attendants do not provide skilled nursing care to a general population as a nurse in a Class A agency does.

IHSS agencies must renew their home care agency licenses every year, and CDPHE conducts periodic surveys to ensure that IHSS agencies are in compliance with the home care standards and, per interagency agreement with HCPF, current HCBS and IHSS regulations.

Individual Participation in IHSS: In order to receive long-term care through Medicaid, individuals must go through a
regional case management agency. Colorado has 23 case management agencies, called Single Entry Point (SEP) agencies, which determine eligibility for long-term care
clients who may be eligible for IHSS. A case manager works with an applicant to determine the need for long-term care services and select a long-term care provider. The cost of IHSS cannot be more than the cost of placement in a long-term care facility.