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Home Care Nursing (HCN) Services

Revised: 10-05-2018

  • Eligible Providers
  • Eligible Recipients
  • Authorization Requirements
  • Covered Services
  • Noncovered Services
  • Billing
  • Definitions
  • Legal References
  • 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.

    Eligible Providers

  • • Medicare-certified home health agency with a comprehensive homecare licensed
  • • Independent registered nurse (RN
  • • Independent licensed practical nurse (LPN)
  • 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.

    HCN Relative Hardship Waiver

    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:

  • • The parent of a member
  • • The spouse of a member
  • • Legal guardian or conservator
  • • Family foster parent of a minor child
  • To qualify for a HCN Relative Hardship Waiver, at least one of the following criteria must be met:

  • • The relative resigns from a full-time or part-time job to provide HCN for the member
  • • The relative goes from a full-time to a part-time job with less compensation to provide HCN for the member
  • • The relative takes a leave of absence without pay to provide HCN for the member
  • • Because of labor conditions, intermittent hours of care needed, or special language needs, the relative is needed in order to provide an adequate number of qualified HCNs to meet the member’s needs
  • In the case of a HCN Relative Hardship Waiver, the provider agency is responsible for:

  • • Receiving the request from the member or responsible party
  • • Obtaining the relative’s signature
  • • Completing the HCN Hardship Waiver Application (DHS-4109) (PDF)
  • • Ensuring the accuracy of the information
  • • Submitting the DHS-4109 along with supporting documentation to Disability Services Division (DSD) to the number on the form.
  • • Criminal background check
  • 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

  • • Provision of paid service does not preclude the parent, spouse or guardian from his or her obligations for nonreimbursed family responsibilities of emergency backup caregiver and primary caregiver. The parent, spouse or legal guardian are not legally required to provide these services. Services provided by a parent, spouse or guardian cannot be used in lieu of nursing services covered and available under liable third-party payers including Medicare.
  • • Paid hours of service provided by the parent, spouse or guardian must be included in the member’s service plan. Hours authorized for the parent, spouse or guardian may not exceed 50 percent of the total approved nursing hours or 8 hours per day, whichever is less, up to a maximum of 40 hours per week.
  • • A parent or spouse may not be paid to provide HCN if they fail to pass a criminal background check or if the home health agency, waiver case manager or physician determine that the care the parent, spouse or guardian provides is unsafe.
  • • The review process is 30 days. Written notice will be issued upon a decision. The provider must keep this notice in the member’s file. The hardship waiver will be approved from the date received forward. If the hardship waiver is denied an explanation will be provided.
  • Eligible Recipients

    Members must be eligible under one of the following programs:

  • Medical Assistance (MA)
  • MinnesotaCare: Expanded benefit set (pregnant women and children under age 21)
  • Waiver and Alternative Care
  • Authorization Requirements

    Assessment Requirements

    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).

  • • All HCN services require prior authorization. HCN services require a physician order prior to initiating service.
  • • The member’s physician must review and approve the service plan every 60 days.
  • Covered Services

    HCN services can be classified regular or complex.

    Regular Home Care Nursing

    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.

    Services must:

  • • Be provided according to the member’s plan of care
  • • Be approved by the member’s physician
  • • Be provided in the member’s home, or outside the home if normal life activities take them outside the home (must be in the care plan)
  • Complex Home Care Nursing

    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.

    Noncovered Services

    The following are not covered under HCN:

  • • Visits for the sole purpose of providing household tasks, transportation, companionship, or socialization
  • • Services that are not medically necessary
  • • Services that are not ordered by a physician
  • • Services provided in a hospital, nursing facility (NF), or intermediate care facility (ICF)
  • Billing

    Complex Reimbursement Rates

    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.

    Shared HCN Option

    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:

  • • The home or licensed foster care home of one of the members
  • • Outside the home or foster care home when normal life activities take members outside the home
  • • A child care program licensed under Minnesota Statutes 245A, or operated by a local school district or private school
  • • An adult day care service licensed under Minnesota Statutes 245A
  • 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.

    Required documentation
    Include a copy of each of the following in the member’s chart when service is shared HCN:

  • • A signed consent form by each member or legal representative of the member
  • • Permission for the agency to schedule shared care up to the maximum hours chosen by the member
  • • Any use of services outside the member’s home
  • • Permission to place the member’s name in the chart of the other shared member
  • • How the needs of both members are appropriately and safely being met
  • • Where the shared services will be provided
  • • Ongoing monitoring and evaluation of the shared services by the HCN
  • • Emergency response back up plans to the member’s illness or absence or the HCN’s illness or absence
  • • Additional training, if needed, for the HCN to provide care to two members
  • • The names of each member receiving shared HCN services
  • • The starting and ending times the members received shared HCN
  • • Routine nursing documentation such as changes in the member’s condition or any problems due to sharing services
  • 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 number of authorized units the member wishes to share
  • • Discontinuing participation in shared care
  • • Changing providers
  • The written revocation or change must be maintained in the member’s file. For more information, refer to the Quick Reference Tool.

    Definitions

    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.

    Legal References

    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)

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