Home care nursing (HCN) services are nursing services that a physician orders for a member whose illness, injury, physical or mental condition requires more individual and continuous care by a registered nurse (RN) or licensed practical nurse (LPN) than can be provided in a single or twice-daily skilled nurse visit and that requires greater skill than a Home Health Aide (HHA) or Personal Care Assistant (PCA) can provide.
Individual RN’s and LPN’s must have an active nursing license. If an enrolling individual LPN cannot attest to all statements on the Home Care Nurse – Individual LPN or RN Applicant Assurance Statement (DHS-7099) (PDF), the LPN must obtain a comprehensive homecare license.
The HCN Relative Hardship Waiver allows certain relatives to receive reimbursement for providing services to an MA member. The relative must be currently licensed in the State of Minnesota as an RN or LPN and must be one of the following:
To qualify for a HCN Relative Hardship Waiver, at least one of the following criteria must be met:
In the case of a HCN Relative Hardship Waiver, the provider agency is responsible for:
For a member who is enrolled in a managed care organization (MCO), the MCO is responsible for reviewing and approving or denying the HCN Hardship Waiver Application.
Paid services and review under the hardship waiver
Members must be eligible under one of the following programs:
Home care nursing is based on an assessment of the member’s medical or health care needs. This service includes ongoing professional nursing observation, monitoring, intervention, and evaluation. This level of care provides continuity, intensity, and the length of time required to maintain or restore optimal health. Professional nursing is defined in the MN Nurse Practice Act.
To request HCN services, complete the MA Home Care Nursing Assessment (DHS-4071A) (PDF) form following the process described in the updated MA Home Care Nursing Assessment Instructions (DHS-4071B) (PDF) and the HCN Service Decision Tree (DHS-4071C) (PDF).
HCN services can be classified regular or complex.
Regular HCN is provided to a member who requires more individual and continuous care than can be provided during a skilled nurse visit or whose cares are outside of the scope of services than can be provided by a home health aide or personal care assistant.
Complex HCN is provided to members who meet the criteria for regular home care nursing and require life-sustaining interventions to reduce the risk of long-term injury or death.
The following are not covered under HCN:
A complex care reimbursement rate is only available when the member is receiving one-to-one (1:1) HCN services. A complex care rate is not available when the member is receiving shared (1:2) HCN services. This means members can share HCN services if they are authorized complex care, but the agency will only receive the complex rate during the hours the member is receiving the 1:1 services.
This option allows two members to share HCN services in the same setting at the same time from the same private duty nurse. All regulations pertaining to home care nursing services also apply to the shared care option. A setting includes:
Shared HCN cannot be provided to two members in separate apartments in the same building. HCN cannot replace or supplement required staff at a licensed facility.
Include a copy of each of the following in the member’s chart when service is shared HCN:
Changing or discontinuing shared HCN
The member or legal representative must notify the provider in writing if the member chooses to make a change in his or her shared care. Changes include:
The written revocation or change must be maintained in the member’s file. For more information, refer to the Quick Reference Tool.
Plan of care - PCA: See Service Plan.
Home care nursing agency: An agency holding a comprehensive home care license and that is enrolled with the Department of Human Services to provide home care nursing services.
Service plan – PCA: (Also called PCA plan of care.) A written description of the services needed by the member based on an assessment. The service plan must include a description of the home care services, the frequency and duration of services, member’s functional level, medications, and treatments, and the expected outcomes and goals.
42 CFR 440.80 (Home Care Nursing Services)
Minnesota Statutes 256B.0625 subd 7 (Home Care Nursing)
Minnesota Statutes 256B.0651 (Home care services)
Minnesota Statutes 256B.0654 (Home Care Nursing)
Minnesota Rules 9505.0360 (Home Care Nursing Services)