Health Care Certification

What is the Health Care Certification Form Requirement?

State law (Senate Bill SB 72) requires that all In-Home Supportive Services have an IHSS Program Health Care Certification Form SOC 873 completed by a licensed health care professional.

New Applicants

Services cannot be authorized prior to the receipt of a completed medical certification form.

• SOC 875 Notice to Recipient of Health Care Certification Requirement (PDF, 36 KB)
• SOC 873 IHSS Health Care Certification form (PDF, 68 KB)
• SOC 873 IHSS Health Care Certification form in Spanish (PDF, 48 KB)
• Applicants have 45 calendar days from the date the county requests the SOC 873, to provide the county with the form completed and signed.
• If the applicant is determined eligible for services, eligibility may be effective the date of the application.
• The application is denied if the SOC 873 or alternative documentation is not provided within the 45 calendar day time-frame.

Recipients

Yes, for services to continue a completed SOC 873 must be received by IHSS within 45 days of the date your IHSS Social Worker provided you with the form.

• SOC 875 Notice to Recipient of Health Care Certification Requirement (PDF, 36 KB)
• If the form SOC 873 or alternative documentation is not provided within the 45 day calendar time-frame, services must be terminated. 

Exception

Exception is for those recipients who can demonstrate both a substantial and compelling reason beyond the recipient's control and that good faith efforts where made to obtain the form or alternative documentation - the recipient may be granted a additional 45 days to provide the SOC 873 if he/she contacts his/her IHSS Social Worker before the 35th calendar day from the date you were provided the form by your IHSS Social Worker.

Alternate Documentation for Applicants and Recipients

In lieu of obtaining the SOC 873, both applicants and recipients may provide the county with documentation no earlier then 60 calendar days prior to submission, that includes the following elements:

1. Statement and description indicated inability to independently perform one or more activities of daily living.
2. Description of condition or functional limitation that has contributed to the need for assistance.
3. Signature from a licensed health care professional.

Where can I get this form?

You can contact your IHSS Social Worker or use this link to open the SOC 873 IHSS Program Health Care Certification Form (PDF, 68 KB) from the CDSS web site.