Existing law provides for the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with specified services in order to permit them to remain in their own homes and avoid institutionalization. Existing law defines supportive services for purposes of the IHSS program to include those necessary paramedical services that are ordered by a licensed health care professional, which persons could provide for themselves, but for their functional limitations. Existing law requires an applicant for, or recipient of, in-home supportive services, as a condition of receiving these services, to obtain a certification from a licensed health care professional declaring that the applicant or recipient is unable to perform some activities of daily living independently, and that without services to assist the applicant or recipient with activities of daily living, the applicant or recipient is at risk of placement in out-of-home care, and defines a licensed health care professional for this purpose to mean an individual licensed in California by the appropriate California regulatory agency, acting within the scope of their license or certificate as defined in the Business and Professions Code.

This bill would use the above-described definition of licensed health care professional for purposes of the provisions relating to paramedical services, and would, for purposes of the certification requirement, add to the above-described definition of licensed health care professional that the licensed individual has primary responsibilities to diagnose or provide treatment and care for physical or mental impairments that cause or contribute to an individuals functional limitations, and would use the same definition of licensed health care professional for purposes of the provisions relating to paramedical services. limitations.

Existing law provides for the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with specified services in order to permit them to remain in their own homes and avoid institutionalization. Existing law defines supportive services for purposes of the IHSS program to include those necessary paramedical services that are ordered by a licensed health care professional, which persons could provide for themselves, but for their functional limitations. Existing law requires an applicant for, or recipient of, in-home supportive services, as a condition of receiving these services, to obtain a certification from a licensed health care professional declaring that the applicant or recipient is unable to perform some activities of daily living independently, and that without services to assist the applicant or recipient with activities of daily living, the applicant or recipient is at risk of placement in out-of-home care, and defines a licensed health care professional for this purpose to mean an individual licensed in California by the appropriate California regulatory agency, acting within the scope of their license or certificate as defined in the Business and Professions Code.

Existing law provides for the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with specified services in order to permit them to remain in their own homes and avoid institutionalization. Existing law defines supportive services for purposes of the IHSS program to include those necessary paramedical services that are ordered by a licensed health care professional, which persons could provide for themselves, but for their functional limitations. Existing law requires an applicant for, or recipient of, in-home supportive services, as a condition of receiving these services, to obtain a certification from a licensed health care professional declaring that the applicant or recipient is unable to perform some activities of daily living independently, and that without services to assist the applicant or recipient with activities of daily living, the applicant or recipient is at risk of placement in out-of-home care, and defines a licensed health care professional to mean an individual licensed in California by the appropriate California regulatory agency, acting within the scope of their license or certificate as defined in the Business and Professions Code.

This bill would instead define licensed health care professional for those purposes to mean any person who engages in acts that are the subject of licensure or regulation under specified provisions of the Business and Professions Code or under any initiative act referred to in those specified provisions. The bill would also clarify that as a condition of receiving paramedical services, an applicant or recipient is required to obtain a certification from a licensed health care professional, as specified.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2025 - 2026 Regular Session

AB 346 (Nguyen) - In-home supportive services: licensed health care professional certification

Bill Summary:

AB 346 would revise the definition of “licensed health care professional” for purposes of authorizing services in the In-Home Supportive Services (IHSS) program.

Fiscal Impact:

Unknown ongoing costs (General Fund and federal funds), due to a potential increase in authorized IHSS services.

Background:

The IHSS program provides personal care services to eligible low-income individuals who are blind, are at least 65 years old or older, or have disabilities. Personal care services include feeding, bathing, bowel and bladder care, meal preparation and clean-up, laundry, and paramedical care. These services help program recipients avoid or delay more expensive and institutional care settings. The California Department of Social Services (CDSS) oversees the IHSS program, but counties administer the program locally. County social workers determine IHSS eligibility and perform case management after conducting a standardized in-home assessment of an individual’s ability to perform activities of daily living.

As a condition of receiving IHSS services, an applicant must obtain a certification from a licensed health care professional, declaring that the applicant or recipient is unable to perform some activities of daily living independently, and that without services to assist the applicant or recipient with activities of daily living, the applicant or recipient is at risk of placement in out-of-home care. For purposes of providing the certification, current law defines a licensed health care professional as an individual licensed in California by the appropriate California regulatory agency, acting within the scope of their license or certificate as defined in the Business and Professions Code. Current law also specifies that the licensed health care professional, includes, but is not limited to, a physician, physician assistant, regional center clinician or clinician supervisor, occupational therapist, physical therapist, psychiatrist, psychologist, optometrist, ophthalmologist, or public health nurse. The health care professional’s certification must include, at a minimum, both of the following:

• A statement by the professional that the individual is unable to independently perform one or more activities of daily living, and that one or more of the services available under the IHSS program is recommended for the applicant or recipient, in order to prevent the need for out-of-home care.
• A description of any condition or functional limitation that has resulted in, or contributed to, the applicant’s or recipient’s need for assistance.

Current law states that IHSS services include those necessary paramedical services that are ordered by a licensed health care professional who is lawfully authorized to do so, which persons could provide for themselves but for their functional limitations. Paramedical services include the administration of medications, puncturing the skin or inserting a medical device into a body orifice, activities requiring sterile procedures, or other activities requiring judgment based on training given by a licensed health care professional. These paramedical services must be rendered by a provider under the direction of a licensed health care professional, subject to the informed consent of the recipient obtained as a part of the order for service. The law does not specifically define “licensed health care professional” for purposes of ordering IHSS paramedical services.

Proposed Law:

Specific provisions of the bill would:

• Provide that for purposes of ordering IHSS paramedical services, a “licensed health care professional” means an individual licensed in California by the appropriate California regulatory agency, acting within the scope of their license or certificate, as defined in the Business and Professions Code, including a physician or surgeon, physician assistant, podiatrist, dentist, or nurse practitioner.
• Revise the definition of a “licensed health care professional” for purposes of IHSS certification, to mean an individual licensed in California by the appropriate California regulatory agency, acting within the scope of their license or certificate as defined in the Business and Professions Code, and whose primary responsibilities are to diagnose or provide treatment and care for physical or mental impairments that cause or contribute to an individual’s functional limitations. 
• Delete the existing provision that specifies that the licensed health care professional for purposes of IHSS certification, includes, but is not limited to, a physician, physician assistant, regional center clinician or clinician supervisor, occupational therapist, physical therapist, psychiatrist, psychologist, optometrist, ophthalmologist, or public health nurse.

Related Legislation:

SB 1245 (Ochoa Bogh, 2024) was similar to this bill. SB 1245 was held on the suspense file in this committee.

-- END --

SENATE COMMITTEE ON HUMAN SERVICES

Senator Arreguín, Chair

2025 - 2026 Regular

Subject: In-home supportive services: licensed health care professional certification

SUMMARY

This bill creates a single definition of health care professionals who can sign the two forms necessary for in-home support services (IHSS).

ABSTRACT

Existing Law:

1. Defines, for purposes of healing arts licensure, “health care practitioner” as any person who engages in acts that are the subject of licensure or regulation, as specified. (Business and Professions Code 680(c))
2. Establishes the IHSS program to provide supportive services to individuals who are aged, blind, or living with disabilities, and who are unable to perform the services themselves or remain safely in their homes without receiving these services. (Welfare and Institutions Code (WIC) 12300 et seq.)
3. Specifies that supportive services include: domestic services and services related to domestic services, heavy cleaning, personal care services, accompaniment by a provider when needed during necessary travel to health-related appointments or to alternative resource sites, yard hazard abatement, protective supervision, teaching and demonstration directed at reducing the need for other supportive services, and paramedical services which make it possible for the recipient to establish and maintain an independent living arrangement. Provides that personal care services mean all of the following:
   1. Assistance with ambulation
   2. Bathing, oral hygiene, and grooming
   3. Dressing
   4. Care and assistance with prosthetic devices
   5. Bowel, bladder, and menstrual care
   6. Repositioning, skin care, range of motion exercises, and transfers
   7. Feeding and assurance of adequate fluid intake
   8. Respiration
   9. Assistance with self-administration of medications. (WIC 12300(b))
4. Requires the California Department of Social Services (CDSS) to adopt regulations establishing a uniform range of services available to all eligible IHSS recipients based on individual needs. (WIC 12301.1 (a))
5. Requires a county welfare department to assess each IHSS recipient’s continuing monthly need for IHSS at varying intervals as necessary, but at least once every 12 months. Further, requires the results of the assessment to be divided by 4.33 to establish a recipient’s weekly authorized number of hours of IHSS, subject to certain limitations, as specified. (WIC 12301.1(b))
6. Authorizes counties to choose to contract with a nonprofit consortium or establish a public authority for the provision of IHSS services. Requires nonprofit consortia and public authorities to, among other things, establish a registry to assist recipients in locating IHSS providers, and to investigate the background and qualifications of potential providers, as specified. (WIC 12301.6)
7. Maintains an IHSS recipient’s right to hire, fire, and supervise the work of any IHSS provider, regardless of the employer responsibilities of a public authority or nonprofit consortium, as specified. (WIC 12301.6 (c))
8. Requires, as a condition of receiving IHSS, an applicant for, or recipient of services to obtain a certification from a licensed health care professional, as specified, declaring that the applicant or recipient is unable to perform some activities of daily living (ADLs) independently, and that without services to assist the applicant or recipient with ADLs, the applicant or recipient is at risk of placement in out-of-home care. (WIC 12309.1)
9. Provides that a skilled nursing facility must develop and implement an effective discharge planning process that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care, and the reduction of factors leading to preventable readmissions. The facility’s discharge planning process must be consistent with the discharge rights set forth in federal law. (42 Code of Federal Regulations 483.21(c) (1))

This Bill:

1. For the purposes of IHSS certification, defines “licensed health care professional” as an individual licensed in California by the appropriate state regulatory agency, acting within the scope of their license or certificate, and whose primary responsibilities are to diagnose or provide treatment and care for physical or mental impairments that cause or contribute to an individual's functional limitations.
2. Defines “licensed health care professional” to include, but not be limited to, a physician, physician assistant, regional center clinician or clinician supervisor, occupational therapist, physical therapist, psychiatrist, psychologist, optometrist, ophthalmologist, public health nurse, or nurse practitioner.

FISCAL IMPACT

According to the Assembly Appropriations Committee analysis:

“CDSS anticipates ongoing General Fund costs of an unknown amount, but likely minor. CDSS indicates the bill will likely have no significant impact on the caseload beyond improved access to certification and no significant expansion of benefits beyond improved access to services for eligible individuals.”

BACKGROUND AND DISCUSSION

Purpose of the Bill:

According to the author, “In-Home Supportive Services (IHSS) is a vital support system for older adults, blind individuals, and people with disabilities in California, allowing them to live safely and independently at home. Paramedical services are a crucial part of IHSS, but inconsistent form-signing requirements have created unnecessary delays in accessing care.

“AB 346 streamlines this process by allowing the same expanded list of health care professionals to sign both IHSS forms, reducing delays and easing administrative burdens for applicants. This bill ensures that vulnerable Californians receive the critical care they need in a timely manner to stay safely in their homes.”

In-Home Supportive Services (IHSS) program

The IHSS program provides personal care services to over 500,000 qualified low-income individuals who are blind, are at least 65 years old or older, or have disabilities. Personal care services include feeding, bathing, bowel and bladder care, meal preparation, and clean-up, laundry, and paramedical care. These services help program recipients avoid or delay more expensive and less desirable institutional care settings. Eligibility for IHSS may be tied to Medi-Cal or SSI eligibility, and all IHSS applicants and recipients must:

• Be a California resident.
  
• Have a Medi-Cal eligibility determination.
  
• Live at home or an abode of their own choosing (general acute care hospital, long-term care facilities, and licensed community care facilities are not considered “own home”).
  
• Submit a completed Health Care Certification form (SOC 873 or its successor).

As of April 2025, there were 750,956 IHSS providers in California. Of those, 544,758 were relative providers, 38,299 were spouse providers and 156,298 were parent providers according to data provided by CDSS. Of the over 500,000 recipients of IHSS services, 14.1% are over 85, 20.5% are aged 75-84, 21.1% are aged 65-74, and 19.3% are aged 45-64. Recipients of IHSS select, hire, and manage their service providers.

IHSS Eligibility Determinations

CDSS oversees the IHSS program, but it is administered at the county level. County social workers determine IHSS eligibility and perform case management after conducting a standardized in-home assessment of an individual’s ability to perform ADLs. In general, most social workers annually reassess recipients’ need for services. Based on authorized hours and services, IHSS recipients are responsible for hiring, firing, and directing their IHSS provider(s). These responsibilities include some administrative duties, such as scheduling and signing timesheets; however, the state handles payroll. Providers also must complete an enrollment process that includes submitting fingerprint images for a criminal background check and participating in a provider orientation prior to receiving IHSS payments for services they provide.

In most cases, services through IHSS are not started unless the person is living in or returns to their home. Some applicants for IHSS, however, cannot be released from a medical facility to their home unless hazards or other issues are resolved in the home first, such as deep cleaning of the home to remove hazardous debris or dirt. A county social worker would then complete a preliminary IHSS assessment for the applicant in the institution to determine the individual’s needs before they return home. Once the hazards are resolved and the individual returns home, the social worker would then conduct a second assessment at the applicant’s home.

IHSS Forms

The “In-Home Supportive Services (IHSS) Program Health Care Certification Form,” or the SOC 873 form, requires an applicant to provide information, with a portion to be completed by a licensed health care professional indicating that the applicant is unable to independently perform one or more ADLs and one or more IHSS services are recommended in order to prevent the need for out-of-home care. According to the form, a “licensed health care professional” means “an individual licensed in California by the appropriate California regulatory agency, acting within the scope of his or her license or certificate as defined in the Business and Professions Code. These include, but are not limited to: physicians, physician assistants, regional center clinicians or clinician supervisors, occupational therapists, physical therapists, psychiatrist, psychologist, optometrists, ophthalmologist and public health nurses.”

To obtain IHSS, an applicant must first complete the “Request for Order and Consent – Paramedical Services” form, SOC 321, which requires a licensed professional to indicate what specific services are needed and what specific condition necessitates the services. Unlike form SOC 873, this form does not provide a definition of what constitutes a “licensed professional.”

The CDSS Manual contains regulations regarding paramedical services provided by IHSS workers. Regulation 30-757.192 states that paramedical services “shall be provided when ordered by a licensed health care professional who is lawfully authorized to do so.” Regulation 30-780 .1(e) states, in part, “paramedical services when included in the personal care plan of treatment must be ordered by a licensed health care professional.” For other sections of the regulations, “licensed health care professional” is defined.

For example, regulation 30-701 (l)(2) states: “A Licensed Health Care Professional for the purposes of signing the Health Care Certification (LHCP-HCC) is an individual licensed in the State of California by the appropriate regulatory agency, acting within the scope of his/her license or certificate as defined in the Business and Professions Code, and whose primary responsibilities are to diagnose and/or provide treatment and care for, physical or mental impairments which cause or contribute to an individual's functional limitations.” For purposes of this regulation, a licensed health care professional means a medical professional licensed in California by the appropriate California regulatory agency, acting within the scope of his or her license or certificate as defined in the California Business and Professions Code, and who has knowledge of the recipient's medical history. This bill seeks to streamline the process by having a single definition of licensed healthcare professional.

Related/Prior Legislation:

SB 1245 (Ochoa-Bogh, 2024) was substantially similar to this bill. SB 1245 was held in the Senate Appropriations Committee.

AB 426 (Maienschein, Chapter 424, Statutes of 2019) prohibits a licensed health care professional from charging a fee for the completion of the medical certification form required to be eligible for IHSS.

SB 72 (Senate Committee on Budget and Fiscal Review, Chapter 8, Statutes of 2011) adopted the requirement that applicants for, and recipients of, IHSS obtain certification from a licensed health care professional, as specified, declaring that the applicant or recipient is unable to perform one or more activities of daily living independently, and that without one or more IHSS services, the applicant or recipient is at risk of placement in out-of-home care, among other things.

COMMENTS

This bill creates a single definition of licensed health care professionals that can sign both the SOC 873 “In-Home Supportive Services (IHSS) Program Health Care Certification Form” and the SOC 321 “Request for Order and Consent – Paramedical Services” Form. This will streamline the process and allow qualified individuals to receive IHSS services more expeditiously.

PRIOR VOTES

POSITIONS

Support:

County Welfare Directors Association of California (Sponsor)
Association of Regional Center Agencies
County of Alameda

County of Kern
County of Ventura
Occupational Therapy Association of California (OTAC)

Oppose:

None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 346

Author:(Nguyen)

As Amended Ver:May 23, 2025

Majority vote

SUMMARY

Revises the definition of "licensed health care professional" for purposes of authorizing specified services in the In-Home Supportive Services (IHSS) program.

Major Provision

For the purposes of IHSS certification, defines "licensed health care professional" as an individual licensed in California by the appropriate California regulatory agency, acting within the scope of their license or certificate, and whose primary responsibilities are to diagnose or provide treatment and care for physical or mental impairments that cause or contribute to an individual's functional limitations. "Licensed health care professional" includes, but is not limited to, a physician, physician assistant, regional center clinician or clinician supervisor, occupational therapist, physical therapist, psychiatrist, psychologist, optometrist, ophthalmologist, public health nurse, or nurse practitioner.

COMMENTS

Background: IHSS offers personal care assistance to eligible low-income individuals who are blind, 65 years of age or older, or have disabilities. These services include help with feeding, bathing, bowel and bladder care, meal preparation and cleanup, laundry, and paramedical care. Qualified individuals can receive up to 283 hours per month in assistance with these tasks. The goal of the program is to help recipients remain safely in their homes and avoid or delay more costly institutional care.

The California Department of Social Services (CDSS) oversees IHSS at the state level, and local counties are responsible for administering the program. County social workers determine IHSS eligibility and perform case management after conducting a standardized in-home assessment of an individual's ability to perform activities of daily living (ADLs). In general, most social workers annually reassess recipients' need for services. Based on authorized hours and services, IHSS recipients are responsible for hiring, firing, and directing their IHSS provider(s). The average number of service hours that will be provided to an estimated 771,650 IHSS recipients is projected to be 123.7 hours per month in 2025-26.

To qualify for IHSS, applicants must obtain a certification from a licensed health care professional. This certification must confirm that the individual cannot perform certain ADLs without assistance and would be at risk of being placed in out-of-home care without these services. Under current law, a licensed health care professional is defined as someone licensed in California by the appropriate regulatory board, operating within their legal scope of practice as outlined in the Business and Professions Code. This includes, but is not limited to, physicians, physician assistants, regional center clinicians or supervisors, occupational and physical therapists, psychiatrists, psychologists, optometrists, ophthalmologists, and public health nurses.

The certification must include at least the following two elements:

1. A statement that the individual is unable to independently perform one or more ADLs and that one or more IHSS services are recommended to help prevent the need for institutional care.
2. A description of the condition or functional limitation that causes or contributes to the individual's need for assistance.

Additionally, IHSS covers certain paramedical services that a person could manage on their own if not for their functional limitations. These services must be prescribed by a licensed health care professional legally authorized to do so and include tasks such as medication administration, skin punctures or insertion of medical devices, procedures requiring sterile technique, and other activities requiring professional judgment. These paramedical services must be provided by a caregiver under the direction of the licensed health care professional and with the recipient's informed consent, as part of the prescribed care. However, the law does not specifically define "licensed health care professional" in the context of prescribing paramedical services under IHSS.

This bill uses the definition of health care professional for licensed health care professionals, which expands who can authorize necessary services. Thereby, making it more accessible for individuals to get approved for services.

Equity Implications: IHSS recipients are older adults or adults with disabilities who need assistance with their ADLs. IHSS helps recipients live independently and prevent unnecessary or premature admission to congregate care. By expanding who can sign off on confirming the appropriate hours needed to live an independent life, it will likely ease the administrative burden for recipients and applicants.

According to the Author

"In-Home Supportive Services (IHSS) is a vital support system for older adults, blind individuals, and people with disabilities in California, allowing them to live safely and independently at home. Paramedical services are a crucial part of IHSS, but inconsistent form-signing requirements have created unnecessary delays in accessing care.

"[This bill] streamlines this process by allowing the same expanded list of health care professionals to sign both IHSS forms, reducing delays and easing administrative burdens for applicants. This bill ensures that vulnerable Californians receive the critical care they need in a timely manner to stay safely in their homes."

Arguments in Support

The sponsors, County Welfare Directors Association of California, report, this bill would have to dedicate to the approval process, and even increase the opportunity of paramedical services to more individuals who struggle to obtain the necessary authorizations.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee on May 23, 2025, CDSS anticipates ongoing General Fund costs of an unknown amount, but likely minor. CDSS indicates the bill will likely have no significant impact on the caseload beyond improved access to certification and no significant expansion of benefits beyond improved access to services for eligible individuals.

VOTES

ASM HUMAN SERVICES: 7-0-0

YES: Lee, Castillo, Calderon, Elhawary, Jackson, Celeste Rodriguez, Tangipa

ASM APPROPRIATIONS: 11-0-4

YES: Wicks, Arambula, Calderon, Caloza, Elhawary, Fong, Mark González, Hart, Pacheco, Pellerin, Solache

ABS, ABST OR NV: Sanchez, Dixon, Ta, Tangipa

UPDATED

VERSION: May 23, 2025

CONSULTANT: Alexandria Smith / HUM. S. / (916) 319-2089 FN: 0000901

Date of Hearing: May 7, 2025

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 346

Author:(Nguyen) – As Introduced Ver:January 29, 2025

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill revises the definition of “licensed health care professional” for purposes of authorizing specified services in the In-Home Supportive Services (IHSS) program.

Specifically, this bill:

1. Specifies, for purposes of ordering IHSS paramedical services, “licensed health care professional” has the same definition as “health care practitioner,” as defined in Section 680 of the Business and Professions Code.
2. Specifies, for purposes of certifying the need for IHSS services, a licensed health care professional may also include a nurse or nurse practitioner who is working under the direction of the licensed health care professional, and revises the definition of “licensed health care professional” to mean a “health care practitioner,” as described in item 1, above.

FISCAL EFFECT:

CDSS estimates ongoing General Fund costs of an unknown amount, but likely in the tens of millions of dollars annually for increased service costs as well as the increased administrative workload for county staff to accommodate the increase in verified IHSS cases and the inclusion of paramedical services. Exact costs will depend on the number of new cases, which is unknown.

This bill requires counties to accept certification forms signed by an expanded list of professionals beyond the currently authorized licensed health care professionals. This could streamline the process for some applicants by allowing more providers to complete the necessary documentation, potentially reducing delays in IHSS approval and service authorization. However, because the bill expands the licensed health care professional definition to include professionals whose scope of practice does not include functional impairment assessments or paramedical service authorizations, counties may face challenges in ensuring consistency in eligibility determinations.

COMMENTS:

1. Purpose. This bill is sponsored by the County Welfare Directors Association of California (CWDA). According to the author:

IHSS is a vital support system for older adults, blind individuals, and people with disabilities in California, allowing them to live safely and independently at home. Paramedical services are a crucial part of IHSS, but inconsistent form-signing requirements have created unnecessary delays in accessing care. [This bill] streamlines this process by allowing the same expanded list of health care professionals to sign both IHSS forms, reducing delays and easing administrative burdens for applicants. This bill ensures that vulnerable Californians receive the critical care they need in a timely manner to stay safely in their homes.

1. Background. The IHSS program provides personal care services to eligible low-income individuals who are blind, are at least 65 years old or older, or have disabilities. Personal care services include assistance with feeding, bathing, toileting, meal preparation and clean-up, laundry, and paramedical care. Qualified individuals may receive up to 283 hours per month in assistance with these tasks. The goal of the program is to help recipients remain safely in their homes and avoid or delay more costly institutional care.

The California Department of Social Services (CDSS) oversees the IHSS program, but counties administer the program locally. County social workers determine IHSS eligibility and perform case management after conducting a standardized in-home assessment of an individual’s ability to perform activities of daily living.

As a condition of receiving IHSS services, an applicant must obtain a healthcare certification form from a licensed health care professional declaring the applicant is unable to perform some activities of daily living independently and, without assistance, would be at risk of placement in out-of-home care. Existing law allows any “licensed health care professional,” as defined in the Business and Professions Code, to provide this certification, including a physician, physician assistant, regional center clinician or clinician supervisor, occupational therapist, physical therapist, psychiatrist, psychologist, optometrist, ophthalmologist, or public health nurse, among others.

Additionally, IHSS covers certain paramedical services such as medication administration, wound care, or injections, among others. These services must be prescribed by a licensed health care professional legally authorized to do so and require an additional certification form. Existing regulations allow only physicians, surgeons, podiatrists and dentists to authorize these services.

This bill allows the same licensed health care professionals who currently sign the IHSS health care certification form to also sign the paramedical certification form. This bill also allows nurses and nurse practitioners working at the direction of the licensed health care practitioner to complete the forms.

CWDA asserts:

Current requirements for authorizations of both the health care certification and paramedical forms can prevent timely delivery of services essential for the client's health. Aligning which licensed health care professionals may sign the paramedical and health care certification forms will reduce administrative barriers. By broadening the types of health care providers who are authorized to sign these forms, IHSS clients can have both forms signed at the same time by the same provider, thereby reducing delays, improving health outcomes and better fulfilling the goals of the IHSS program.

1. Prior Legislation. SB 1245 (Ochoa Bogh), of the 2023-24 Legislative Session, was nearly identical to this bill. SB 1245 was held on the Senate Committee on Appropriations suspense file.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: April 29, 2025

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Alex Lee, Chair

ABPCA Bill Id:AB 346 (

Author:Nguyen) – As Introduced Ver:January 29, 2025

SUBJECT: In-home supportive services: licensed health care professional certification

SUMMARY: Revises the definition of “licensed health care professional” for purposes of authorizing specified services in the In-Home Supportive Services (IHSS) program. Specifically, this bill:

1. Specifies that for purposes of ordering IHSS paramedical services, “licensed health care professional” has the same definition as “health care practitioner,” as defined in existing law, as described in 1) below.
2. Specifies that for purposes of certifying the need for IHSS services, a licensed health care professional may also include a nurse or nurse practitioner who is working under the direction of the licensed health care professional; and revises the definition of “licensed health care professional” to mean a “health care practitioner,” as defined in existing law, as described in 1) below.

EXISTING LAW:

1. Defines, for purposes of healing arts licensure, “health care practitioner” as any person who engages in acts that are the subject of licensure or regulation under the Healing Arts division or under any initiative act referred to in this division. (Business and Professions Code § 680(c))
2. Establishes the IHSS program to provide supportive services to individuals who are aged, blind, or living with disabilities, and who are unable to perform the services themselves or remain safely in their homes without receiving these services. (Welfare and Institutions Code [WIC] § 12300 et seq.)
3. Specifies that supportive services include: domestic services and services related to domestic services, heavy cleaning, personal care services, accompaniment by a provider when needed during necessary travel to health-related appointments or to alternative resource sites, yard hazard abatement, protective supervision, teaching and demonstration directed at reducing the need for other supportive services, and paramedical services which make it possible for the recipient to establish and maintain an independent living arrangement. Provides that personal care services mean all of the following:
   1. Assistance with ambulation;
   2. Bathing, oral hygiene, and grooming;
   3. Dressing;
   4. Care and assistance with prosthetic devices;
   5. Bowel, bladder, and menstrual care;
   6. Repositioning, skin care, range of motion exercises, and transfers;
   7. Feeding and assurance of adequate fluid intake;
   8. Respiration; and,
   9. Assistance with self-administration of medications. (WIC § 12300(b))
4. Requires the California Department of Social Services (CDSS) to adopt regulations establishing a uniform range of services available to all eligible IHSS recipients based on individual needs. (WIC § 12301.1 (a))
5. Requires a county welfare department to assess each IHSS recipient’s continuing monthly need for IHSS at varying intervals as necessary, but at least once every 12 months. Further, requires the results of the assessment to be divided by 4.33 to establish a recipient’s weekly authorized number of hours of IHSS, subject to certain limitations, as specified. (WIC § 12301.1(b))
6. Authorizes counties to choose to contract with a nonprofit consortium or establish a public authority for the provision of IHSS services. Requires nonprofit consortia and public authorities to, among other things, establish a registry to assist recipients in locating IHSS providers, and to investigate the background and qualifications of potential providers, as specified. (WIC § 12301.6)
7. Maintains an IHSS recipient’s right to hire, fire, and supervise the work of any IHSS provider, regardless of the employer responsibilities of a public authority or nonprofit consortium, as specified. (WIC § 12301.6 (c))
8. Requires, as a condition of receiving IHSS, an applicant for, or recipient of, services to obtain a certification from a licensed health care professional, as specified, declaring that the applicant or recipient is unable to perform some activities of daily living (ADLs) independently, and that without services to assist the applicant or recipient with ADLs, the applicant or recipient is at risk of placement in out-of-home care. (WIC § 12309.1)
9. Provides that a skilled nursing facility must develop and implement an effective discharge planning process that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care, and the reduction of factors leading to preventable readmissions. The facility's discharge planning process must be consistent with the discharge rights set forth in federal law. (42 Code of Federal Regulations 483.21(c) (1))

FISCAL EFFECT: Unknown, this bill has not been analyzed by a fiscal committee.

COMMENTS:

Background: IHSS offers personal care assistance to eligible low-income individuals who are blind, 65 years of age or older, or have disabilities. These services include help with feeding, bathing, bowel and bladder care, meal preparation and cleanup, laundry, and paramedical care. Qualified individuals can receive up to 283 hours per month in assistance with these tasks. The goal of the program is to help recipients remain safely in their homes and avoid or delay more costly institutional care.

CDSS oversees IHSS at the state level, and local counties are responsible for administering the program. County social workers determine IHSS eligibility and perform case management after conducting a standardized in-home assessment of an individual’s ability to perform ADLs. In general, most social workers annually reassess recipients’ need for services. Based on authorized hours and services, IHSS recipients are responsible for hiring, firing, and directing their IHSS provider(s). The average number of service hours that will be provided to an estimated 771,650 IHSS recipients is projected to be 123.7 hours per month in 2025-26.

To qualify for IHSS, applicants must obtain a certification from a licensed health care professional. This certification must confirm that the individual cannot perform certain ADLs without assistance and would be at risk of being placed in out-of-home care without these services. Under current law, a licensed health care professional is defined as someone licensed in California by the appropriate regulatory board, operating within their legal scope of practice as outlined in the Business and Professions Code. This includes, but is not limited to, physicians, physician assistants, regional center clinicians or supervisors, occupational and physical therapists, psychiatrists, psychologists, optometrists, ophthalmologists, and public health nurses. The certification must include at least the following two elements:

• A statement that the individual is unable to independently perform one or more ADLs and that one or more IHSS services are recommended to help prevent the need for institutional care.
• A description of the condition or functional limitation that causes or contributes to the individual’s need for assistance.

Additionally, IHSS covers certain paramedical services that a person could manage on their own if not for their functional limitations. These services must be prescribed by a licensed health care professional legally authorized to do so and include tasks such as medication administration, skin punctures or insertion of medical devices, procedures requiring sterile technique, and other activities requiring professional judgment. These paramedical services must be provided by a caregiver under the direction of the licensed health care professional and with the recipient’s informed consent, as part of the prescribed care. However, the law does not specifically define "licensed health care professional" in the context of prescribing paramedical services under IHSS.

This bill uses the definition of health care professional for licensed health care professionals, which expands who can authorize necessary services. Thereby, making it more accessible for individuals to get approved for services.

Author’s Statement: According to the Author, “In-Home Supportive Services (IHSS) is a vital support system for older adults, blind individuals, and people with disabilities in California, allowing them to live safely and independently at home. Paramedical services are a crucial part of IHSS, but inconsistent form-signing requirements have created unnecessary delays in accessing care.

“[This bill] streamlines this process by allowing the same expanded list of health care professionals to sign both IHSS forms, reducing delays and easing administrative burdens for applicants. This bill ensures that vulnerable Californians receive the critical care they need in a timely manner to stay safely in their homes.”

Equity Implications: IHSS recipients are older adults or adults with disabilities who need assistance with their ADLs. IHSS helps recipients live independently and prevent unnecessary or premature admission to congregate care. By expanding who can sign off on confirming the appropriate hours needed to live an independent life, it will likely ease the administrative burden for recipients and applicants.

RELATED AND PRIOR LEGISLATION:

SB 1245 (Ochoa Bogh) of 2024, was identical to this bill. SB 1245 was held on the Senate Committee on Appropriations suspense file.

AB 426 (Maienschein), Chapter 424, Statutes of 2019, prohibited a licensed health care professional from charging a fee for the completion of the medical certification form required to be eligible for IHSS.

SB 72 (Committee on Budget and Fiscal Review), Chapter 8, Statutes of 2011, adopted the requirement that applicants for, and recipients of, IHSS obtain certification from a licensed health care professional, as specified, declaring that the applicant or recipient is unable to perform one or more ADLs independently, and that without one or more IHSS services, the applicant or recipient is at risk of placement in out-of-home care, among other things.

REGISTERED SUPPORT / OPPOSITION:

Support

County Welfare Directors Association of California (Sponsor)

Association of Regional Center Agencies

California Advocates for Nursing Home Reform

City and County of San Francisco

County of Humboldt

County of Kern

County of Los Angeles Board of Supervisors

County of Sacramento

County of San Bernardino

County of Yolo

Del Norte County Department of Health and Human Services

Mendocino County Department of Social Services

Monterey County Department of Social Services

Opposition

None on file.

Analysis Prepared by: Alexandria Smith / HUM. S. / (916) 319-2089