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.
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):
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.
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).
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.
“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.
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.
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.
Yes. For more information about the requirement of ongoing direction and supervision of LPNs, see Minn. Stat. § 148.171, subd. 14.
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.
No. CDCS only allows payment to parents of minors and spouses under the service category of Personal Assistance.
Yes, a parent who is not the legal guardian of an adult CDCS participant can provide home care nursing services. Relatives of adults may be paid to provide home care nursing when all of the following is true:
A licensed home care agency must hire the parent of the adult CDCS participant, or the parent (who is not the legal guardian) must enroll as an Independent home care nurse with MHCP, or the parent must be an independent contractor (see options 1, 2 or 3 in general questions section about how to hire a nurse).
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.
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:
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:
The participant can give an incentive/bonus to nurses as long as he/she outlines the specific criteria for the bonus in his/her CDCS community support plan. If the person pays a bonus to his or her nurse or other paid support workers, the person should work with his/her FMS provider, which will be responsible to issue checks and submit all required paperwork.