Page reviewed: 1/15/26

Legal authority

Federally approved BI, CAC, CADI, DD and EW waiver plans, Minn. Stat. §256B.0625, subd. 6a, Minn. Stat. §256B.0651, Minn. Stat. §256B.0653 Minn. Stat. §256B.0913, 42 CFR 484.30, 42 CFR 440.70

Definitions

Skilled nursing visit (SNV): Visit conducted by a registered nurse (RN) or licensed practical nurse (LPN) that:

Medical review agent: Entity contracted with DHS to determine a person’s eligibility for SNV based on clinical documentation.

Face-to-face visit requirement

All SNVs must comply with the face-to-face visit requirement. For information about this requirement, refer to the face-to-face requirement section on CBSM – Home health agency services.

Exception

The face-to-face requirement does not apply when an SNV is provided for a one-time perinatal visit.

Covered services

SNVs can include any of the following tasks:

All SNVs must be:

Non-covered services

SNVs are not covered:

SNVs also are not covered for the sole purpose to:

ICF/DD exception

DHS may prior authorize SNVs for up to 90 days for a person in an ICF/DD to prevent admission to a hospital or a nursing facility. Home health agencies must request prior authorization using the process for a person not on a waiver/AC. SNV payments cannot duplicate ICF/DD payments.

Process and procedure

For process and procedural information, refer to the specific sections:

Provider standards and qualifications

Only Medicare-certified home health agencies may provide SNVs. The nurse must be employed by a home health agency.

Access

To access SNVs, anyone may make a referral directly to a Medicare-certified home health agency.

Assessment

An RN or appropriate therapist from an enrolled Medicare-certified home health agency completes an assessment to document the person’s need for service and keeps it in the person’s record. This assessment:

1. Identifies the person’s needs.

2. Includes an individualized care or service plan.

3. Requests authorization for the number of:

Note: The home health agency can request a change mid-authorization to the ratio of LPN SNV and RN SNV units using MA Home Care Technical Change Request, DHS-4074.

Authorization

All SNV services require prior authorization. There are two options for the home health agency to submit the request:

The medical review agent reviews the materials submitted for completeness, need for service and number of visits. The medical review agent may request documentation of the required face-to-face visit.

Length of authorization

If approved, the medical review agent provides one of the following authorizations:

Timelines

The medical review agent must receive the request for authorization within 20 working days of the start of service.

Access

The county/tribal nation uses the MnCHOICES assessment to determine the person’s need for service. To initiate service, a certified assessor, case manager or care coordinator may make a referral to a Medicare-certified home health agency.

Assessment

An RN or appropriate therapist from an enrolled Medicare-certified home health agency completes an assessment to document the person’s need for service and keeps it in the person’s record. This assessment:

1. Identifies the person’s needs.

2. Includes an individualized care or service plan.

3. Requests authorization for the number of:

Authorization

All SNVs need prior authorization from the county/tribal nation. The home health agency collaborates with the county/tribal nation for authorization.

The county/tribal nation:

1. Enters an authorization into the MMIS service agreement using the rates and codes list for RN and LPN skilled nurse visits in Long-Term Services and Supports Service Rate Limits, DHS-3945 (PDF).

2. Bases the length of the authorization on the person’s needs and/or the length of the current service agreement.

Services through an MCO

BI, CAC, CADI and DD

For people on BI, CAC, CADI and DD who are enrolled in managed care, the county/tribal nation must use placeholder code X5609 in MMIS to authorize services for which the MCO is responsible for payment. When using this code, the case manager must indicate all the following:

For more information, refer to Instructions for completing and entering the LTCC screening document and service agreement into MMIS, DHS-4625 (PDF).

The case manager and MCO staff members can use MCO, County Agency and Tribal Nation Communication Form – Recommendation for Home Care Services, DHS-5841 to initiate home care recommendations. The form includes detailed instructions for use. Then, the MCO follows its procedure to authorize the service.

EW

For people on EW who are enrolled in managed care, the care coordinator follows the MCO’s procedure to authorize the service, unless the person receives case management through a tribal nation. In this arrangement, services may be authorized by the tribal nation through MMIS and also by the MCO through its billing system. Contact the case manager at the tribal nation for more information.