Form Soc 2271 - In-Home Supportive Services (Ihss) Program Provider Notification Of Recipient Authorized Hours And Services And Maximum Weekly Hours Page 2

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Auth
Service Types
Description of Services
Domestic Services
Household chores to maintain the cleanliness of the home including sweeping, vacuuming,
washing and waxing of floor surfaces, dusting, and picking up. MPP 30-757.11
Meal Preparation
Planning menus, preparing food, cooking and serving meals. MPP 30-757.131
Meal Clean-Up
Cleaning up the cooking area and washing, drying and putting away cookware, dishes and
utensils. MPP 30-757.132
Laundry
Washing, drying, folding and putting away clothes and linens. If in-home laundry facilities are
not available, this service will include travel to an out-of-home laundromat. MPP 30-757.134
Shopping for Food
Making a grocery list, traveling to/from the store, shopping, loading, unloading and storing food
purchased. MPP 30-757.135(b)
Other Shopping
Includes, 1) Shopping for other necessary supplies, and 2) Performing small and necessary
and Errands
errands, e.g., picking up prescription. MPP 30-757.135(c)
Respiration
Assisting recipient with nonmedical breathing related services such as self-administration
Assistance
of oxygen and cleaning breathing machines. MPP 30-757.14(b)
Bowel and/or
Assisting the recipient with using the toilet, bed pans/bedside commode or urinal; emptying/
Bladder Care
cleaning ostomy, enema and/or catheter receptacles; applying diapers, disposable
undergarments and disposable barrier pads, wiping/cleaning recipients; washing/drying
recipient’s hands. MPP 30-757.14(a)
Feeding
Assisting the recipient to eat meals, including cleaning his/her face and hands before and after
meals. MPP 30.757.14(c)
Routine Bed Baths
Giving a recipient who is confined to bed a routine sponge bath. MPP 30-757.14(d)
Dressing
Assisting the recipient to put on and take off his/her clothes as necessary. MPP 30-757.14(f)
Menstrual Care
Assistance with the external placement of sanitary napkins and barrier pads. MPP 30-757.14(j)
Ambulation
Assisting the recipient with walking or moving about the home, including to/from the bathroom
and to/from and into/out of the car for transporting to medical appointments and/or alternative
resources. MPP 30-757-14(k)
Transfer
Assisting recipient from standing, sitting, or prone position to another position and/or from one
piece of furniture or equipment to another. MPP 30-757.14(h)
Bathing, Oral
Assisting the recipient with: bathing or showering, brushing teeth, flossing, and cleaning
Hygiene and
dentures; shampooing, drying, combing/brushing hair; shaving; applying lotion, powder and
Grooming
deodorant. MPP 30-757.14(e)
Rubbing Skin and
Rubbing skin to promote circulation and/or prevent skin breakdown; turning in bed and other
Repositioning
types of repositioning; and supervising range of motion exercises. MPP 30-757.14(g)
Care and Assistance
Taking off/putting on and maintaining and cleaning prosthetic devices, including vision/hearing
w/Prosthetics &
aids; reminding the recipient to take prescribed and/or over-the-counter medications, and
Medication
setting up medi-sets. MPP 30-757.14(i)
Accompaniment
Accompanying the recipient during necessary travel to and from health related appointments.
to Medical
If you are required to stay to provide authorized services for your recipient during the
Appointments
appointment, you will be paid for the time that you are “engaged to wait” for the services that
must be provided. MPP 30-757.151
Accompaniment to
Accompanying the recipient during necessary travel to and from alternative resources.
Alternative Resources MPP 30-757.154
Heavy Cleaning
Thorough cleaning of the home to remove hazardous debris and dirt. (One time only)
MPP 30-757.12
Yard Hazard
Light work in the yard to remove high grass or weeds, and rubbish when these materials
Abatement
pose a fire hazard. MPP 30-757.16
Removal of Ice
Light work in the yard to remove ice and snow or other hazardous substances from entrances
and Snow
and essential walkways when these materials make access to the home hazardous.
MPP 30-757.162
Protective
Observing the behavior of a non-self-directing, confused, mentally impaired or mentally ill
Supervision
recipient and intervening as appropriate to safeguard the recipient against injury, hazard or
accident. MPP 30-757.17
Teaching and
Teaching and demonstrating services handled by the IHSS provider to help the recipient
Demonstration
perform these services on his or her own. MPP 30-757.18
Paramedical
Services meeting the following conditions: 1) Activities which recipients would normally
Services
perform themselves if they did not have functional limitations, 2) Activities which, due to the
recipient’s physical or mental condition, are necessary to maintain the recipient’s health, and
3) Activities which include the administration of medications, puncturing the skin, or inserting a
medical device into a body orifice, activities requiring sterile procedures, or requiring judgment
based on training given by a licensed health care professional. MPP 30-757.19
SOC 2271 (11/15)
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Form Soc 2285 - In-home Supportive Services Program Notice To Recipient Upholding Provider's Fourth Violation (one-year Period Of Ineligibility) For Exceeding Workweek And/or Travel Time Limits Form Soc 2285 - In-home Supportive Services Program Notice To Recipient Upholding Provider's Fourth Violation (one-year Period Of Ineligibility) For Exceeding Workweek And/or Travel Time Limits Legal
Form Soc 2283 - In-home Supportive Services Program Notice To Recipient Upholding Provider's Third Violation (90-day Suspension Of Eligibility) For Exceeding Workweek And/or Travel Time Limits Form Soc 2283 - In-home Supportive Services Program Notice To Recipient Upholding Provider's Third Violation (90-day Suspension Of Eligibility) For Exceeding Workweek And/or Travel Time Limits Legal
Form Soc 2272b - In-home Supportive Services Program Notice To Recipient Acknowledgement Of Provider's Request For County Violation Review For Exceeding Workweek And/or Travel Time Limits Form Soc 2272b - In-home Supportive Services Program Notice To Recipient Acknowledgement Of Provider's Request For County Violation Review For Exceeding Workweek And/or Travel Time Limits Legal
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