Violations & Dispute Process

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Each timesheet turned in for payment is evaluated to ensure that it meets the overtime rules.  If the timesheet does not meet the rules, the provider will receive a violation.

If you have questions about a violation, please call the Provider and Recipient Call Center (PARCC) at 1-559-600-5749, and ask to speak to the Violations Team.


Overtime Rules

The IHSS program has specific rules about the payment of overtime and will issue a violation to providers when:

  • The provider claims overtime that is not authorized for their recipient. 
  • The provider claims more overtime than authorized for their recipient.
  • The provider, when working for two or more recipients, claims more than 66 hours per work week.  Only providers that have been approved for an Exemption can work up to 90 hours per work week.
  • The provider submits a travel claim for more than 7 hours per work week.

Each timesheet submitted for payment is evaluated for possible violations. 


Violation Notification

IHSS representatives will call the provider when they are issued a violation to discuss the timesheet they turned in for processing to help providers learn what caused the violation.  Top reasons violations are issued are:

  • Not realizing the claimed hours in a partial work week still counts in total hours worked for the first work week in a new pay period.
  • Working and claiming more than 66 hours per work week when working for two or more recipients.
  • Claiming more than 7 hours a work week for travel.
  • Working or claiming hours in a way that creates unauthorized or more than authorized overtime without prior approval.

After talking with the provider, or if unable to reach the provider, IHSS will send a notice to the provider and the recipient(s) that the provider works for about the violation.

It's important that the provider reads the violation notice because there are actions that the provider can take to dispute the violation or reduce the violation count.


Violation Levels

There are consequences when a provider receives violations that can negatively effect their ability to work as an IHSS provider:

 VIOLATION LEVELS
1st  Serves as a warning
 2nd  Can be removed if provider reviews, signs and turns in the Self-Training Certification*
3rd  Results in a 90 day suspension as an IHSS provider
4th   Results in a one-year termination as an IHSS provider

 

*Self-Training Certification packets are sent to providers that receive a 2nd violation.  Providers that decide to dispute the 2nd violation do not have to return the Self-Training until the outcome of the dispute is final, because the violation may be overridden and the Self-Training would not be necessary.


County Dispute Timeframes (All 4 Violation Levels)

  • Provider's have the ability to dispute any violation received, but must send in the dispute form within 10 calendar days from the date of the violation on the notice. 
  • Late, incomplete, or unsigned dispute forms will not be accepted.
  • The County has 10 days to make a decision about the dispute.
  • The provider and recipient(s) will be notified of the outcome of the dispute.
  • Suspension (3rd violation) or terminations (4th violation) will not start until 20 days after the date of the dispute outcome notice (when disputed by the provider).

State Dispute Timeframes (3rd & 4th Levels Only)

  • When a provider is unsatisfied with the outcome of a dispute for a 3rd or 4th violation, they can submit a State Administrative Review (SAR) form for further consideration. 
  • The County will send the SAR form with the dispute outcome notice for all 3rd and 4th violations. 
  • The provider must dispute at the County level first and then follow up at the State level, when needed. 
  • Suspension (3rd violation) or terminations (4th violation) will not start until 20 days after the date of the SAR outcome notice.

Violation Reduction

  • The provider's violation count will reduce by one each year, as long as the provider has not received another violation in the year following the last violation issued.
  • The Self-Training Certification is only available for when the provider receives their first 2nd violation and their violation count will return to 1 if it is returned within 14 calendar days after the 2nd violation notice is received. 
  • If the provider disputes the 2nd violation and the County decides to uphold it, the Self-Training Certification will be applied after the County makes their decision.
  • The Self-Training Certification reduction cannot be used again or for 3rd & 4th violations.