Home Care Nursing (HCN) Services

Revised: July 26, 2023

· Overview

· Eligible Providers

· Eligible Members

· Authorization Requirements

· Covered Services

· Noncovered Services

· Billing

· Definitions

· Legal References

Overview

Home care nursing (HCN) services are nursing services that a physician, advanced practice registered nurse, or physician assistant 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 home care license

· Home care agency with a comprehensive home care license

· Independent registered nurse (RN)

· Independent licensed practical nurse (LPN)

Individual RNs and LPNs must have an active nursing license and must be able to attest to all statements on the Home Care Nurse – Individual LPN or RN Applicant Assurance Statement (DHS-7099) (PDF).

HCN Relative Hardship Waiver

The HCN Relative Hardship Waiver allows certain relatives to receive reimbursement for providing services to an Medical Assistance (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 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 fax 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.

For a member who is on a waiver, the HCN Hardship Waiver is only available if the member is using traditional waiver services and not receiving services through Consumer Directed Community Supports (CDCS).

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 care agency, waiver case manager or ordering practitioner determines 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 Members

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, advanced practice registered nurse, or physician assistant's order before initiating service. Refer to Home Care Authorization Requests in the Authorization section of the Minnesota Health Care Programs Provider Manual.

· The member’s ordering practitioner must review and approve the service plan every 60 days.

Covered Services

HCN services can be classified as 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 ordering practitioner

· 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 qualifying practitioner

· 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 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.

Rates

Providers can use the Minnesota DHS Home Care Nursing Calculator to determine if a particular combination of services is within the limits of unit and dollar caps. The calculator is for planning purposes only. The DHS contractor makes the final determination based on a specific person’s needs.

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.

Definitions

Home care nursing agency: An agency holding a comprehensive home care license and that is enrolled with the Minnesota Department of Human Services (DHS) to provide home care nursing services.

Medicare-certified home health agency: An agency holding a Medicare-certification and a comprehensive home care license that is enrolled with DHS to provide home care nursing services.

Plan of care: Refer to Service Plan.

Service plan: 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

Minnesota Statutes 256B.0625, subdivision 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)
Code of Federal Regulations, title 42, section 440.80 (Private Duty Nursing Services – Federal name for Home Care Nursing Services)