What is home care nursing?

Home care nursing means ongoing, physician-ordered, hourly nursing services provided by a registered nurse or licensed practical nurse. These services are to maintain or restore a person’s health. For more information, see Minn. Stat. §256B.0654 and Minnesota Nurse Practice Act sections 148.171 to 148.285. 

CDCS participants can incorporate home care nursing into their CDCS community support plans, as described in CBSM – Home care nursing (HCN) and CDCS – Purchasing home care services under CDCS. The costs of any state plan home care services selected by the participant must be included under his/her individual CDCS budget. 

Participants or their representatives are responsible to track nursing expenditures billed directly to DHS or the managed-care organization.

A CDCS participant plans to incorporate home care nursing services into his/her CDCS community support plan. How does he/she hire a nurse?

When a CDCS participant needs home care nursing, regardless of waiver/program or employment model, he/she will use one of the following options (note: he or she may choose only one option): 

1. Use nurses from a licensed home care agency. The costs of any state plan home care services selected by the participant must be included under his/her individual CDCS budget and itemized in the CDCS Community Support Plan (CSP). State plan home care services are provided by a licensed home care agency and authorized on the CDCS Service Agreement using state plan home care codes. The home care agency will bill DHS or the managed care organization directly. 
2. Use independent nurses. The participant or FMS provider does not hire the nurses directly. Instead, the participant/FMS provider pays the nurses as independent contractors, not as employees. The FMS provider must check the excluded provider list to ensure the independent nurse can be a paid provider. The participant must verify the independent nurses’ qualifications/license and should obtain copies of verification of licenses, liability coverage and any other requirement for each nurse. The participant must provide copies of this documentation to the FMS provider and lead agency case manager upon request. Although not required, the FMS provider can choose to conduct its own verification of independent contractor qualifications as part of its standard business practices. 
3. Use independent home care nurses who are enrolled as Minnesota Health Care Program (MHCP) providers. The participant or FMS provider does not hire the independent home care nurses directly. As part of MHCP enrollment requirements, DHS verifies the qualifications of the independent home care nurses. Services are authorized on the CDCS Service Agreement using state plan home care codes and the MHCP provider number. The enrolled independent home care nurse will bill DHS or the managed care organization directly.

How does the FMS provider handle billing when a participant chooses nurses who are independent contractors?

If a participant uses a nurse who is an independent contractor and not an MHCP-enrolled provider, the FMS provider handles the billing as it would for other non-MHCP enrolled independent contractors. Because the FMS provider is not a licensed home care agency, the FMS provider cannot hire nurses directly.

How does the lead agency authorize nursing services when a participant chooses nurses who are independent contractors?

When a participant selects a nurse who is an independent contractor, the lead agency authorizes this service as T2028. The FMS provider bills it under the CDCS Treatment and Training service category (T2028 U2).

How does a participant include nursing services on his/her CDCS Community Support Plan?

When a participant selects a nurse who is an independent contractor, the participant is responsible to include nursing services on his/her CDCS community support plan as an allocation under the Treatment and Training section and identify the provider. 

When a participant uses home care services provided by a home care agency (or MHCP-enrolled independent home care nurse), the participant adds home care services into the MA Home Care Services section of his/her CDCS community support plan.

What is the difference between a nurse who is an independent contractor and an Independent LPN/RN?

“Independent LPN or Independent LPN or RN” is a provider type listed in the MHCP Provider Manual. This is different than classifying someone as an independent contractor. If an LPN or RN who is an independent contractor choses to be an enrolled provider, he/she must meet all requirements listed in MHCP Provider Manual – Home Care Nursing (HCN) Services.

What is the difference between a nurse who is an independent contractor and an Independent LPN/RN?

“Independent LPN or Independent LPN or RN” is a provider type listed in the MHCP Provider Manual. This is different than classifying someone as an independent contractor. If an LPN or RN who is an independent contractor choses to be an enrolled provider, he/she must meet all requirements listed in MHCP Provider Manual – Home Care Nursing (HCN) Services.

Are LPN or RN services through an independent contractor subject to Medicaid reimbursable rates for RN, or can a participant pay whatever they want within the parameters of their CDCS budget?

A CDCS participant may negotiate payment rates for a nurse who is an independent contractor, but that rate cannot exceed any state-established service rates.

Do LPNs and RNs who are independent contractors need to have a comprehensive home care license from the Minnesota Department of Health?

No. LPNs and RNs who provide home care services independently (i.e., not through any contractual or employment relationship with a home care provider or other organization) do not have to have a comprehensive home care license. For information about who must hold a home care license, see Minn. Stat. §144A.471.

Does a nurse who is an independent contractor need to obtain physician’s orders to provide home care nursing services?

Yes, the nurse is required to receive orders and implement interventions that are delegated, ordered or prescribed by a licensed health care provider. The nurse must maintain signed physician’s orders for a participant in his/her files. For more information, see Minn. Stat. § 148.171, subd. 14 and subd. 15.

Can a parent of a minor or a spouse be paid to provide nursing services?

No. CDCS only allows payment to parents of minors and spouses under the service category of Personal Assistance.

Can a legal guardian (parent or other guardian) of a CDCS adult participant be paid to provide nursing services?

No. To receive payment for nursing services, the legal guardian would need to apply for the Home Care Nursing Hardship Waiver. However, the Home Care Nursing Hardship Waiver is not available when a person is using CDCS.

Can a parent of a minor or a spouse be paid to provide nursing services?

No. CDCS only allows payment to parents of minors and spouses under the service category of Personal Assistance.

Can a legal guardian (parent or other guardian) of a CDCS adult participant be paid to provide nursing services?

No. To receive payment for nursing services, the legal guardian would need to apply for the Home Care Nursing Hardship Waiver. However, the Home Care Nursing Hardship Waiver is not available when a person is using CDCS.

Can CDCS support workers be paid to administer medication or perform other nursing tasks?

No. Providers must meet the certification or licensing requirements in state law related to the service the participant wishes to include in his/her plan. If the participant needs nursing services as part of his/her CDCS community support plan, the person providing it must be a nurse.

When tasks require professional clinical judgment or assessment, analysis of clinical data and/or sterile techniques (i.e. deep suctioning), a nurse is the only person who may be paid to perform these tasks.

Examples of nursing tasks include, but are not limited to, the following:

• Initiate and administer both routine and complex medications
• Assess, monitor and revise the nursing plan of care
• Perform sterile tracheostomy care
• Check nasogastric (through the nose) tube patency (i.e. check for obstruction) and confirmation of placement
• Perform intermittent suctioning when assessed to be needed
• Insert a urinary catheter
• Give injections (including insulin)
• Perform PEG/PEJ tube-feeding (when it requires assessment/confirmation of placement before administration of nutrition).

If a family member (or other worker) performs nursing tasks because of a lack of available nursing services, they must perform those tasks as an unpaid family member/worker. CDCS workers cannot be paid to provide nursing tasks. The person or managing party/legal representative cannot delegate or assign a CDCS worker to perform any of the nursing tasks described above.

CDCS workers may be paid to perform tasks that do not involve clinical judgement or assessment, if the person or their managing party/legal representative provides the training, guidance and direction. These tasks must be specifically described in the worker’s job description and included in the person’s CDCS community support plan.

When reviewing the person’s plan, the lead agency is responsible to consult with medical professionals and/or other members of their long-term care consultation team to ensure the person has a safe and effective plan.

The person or managing party/legal representative may delegate or assign a CDCS worker to perform a non-nursing task, but is responsible to assess the task in relation to the needs of the person (i.e. stability, absence of risk of complications, predictability of change in condition).

This means that tasks a CDCS worker has been assigned to perform may no longer be appropriate because of a change in the person’s current condition or stability. For example, it may no longer be safe for a CDCS worker to tube-feed the person because of the person’s current illness, recent discharge from the hospital, change in the their condition, new physician orders or medication changes, overall health status, etc.

Examples of tasks that CDCS workers might be paid to provide include, but are not limited to, the following:

• Medication assistance for prescribed or over-the-counter medication (at the direction of the person or the person’s representative). Tasks may include, but are not limited to:
  • Reminders to take medication
  • Bringing and/or giving medication to the person that has been set up/pre-packaged by the person, their representative, the pharmacy or the nurse (i.e. pill boxes, medication envelopes, bubble packs/blister pack)
  • Assistance with opening medication bottles
  • Bringing and/or giving PRN (when necessary) or over-the-counter medication to the person upon request of the person or their representative. (CDCS workers cannot determine the dose of a medication or that a PRN medication is needed)
• Taking and recording vital signs and weights
• Monitoring intake and output, following the direction of the plan of care developed by a health care provider (RN or physician, APRN, PA) or under the direction of the family member
• Non-clinical assistance with tube-feeding (i.e. following the prescribed feeding schedule, amount of formula, etc.)