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Supporting Minnesotans Where
They Live: A Home Care Update
Jeanine Wilson
Diane Benjamin
Disabilities Services Division
Medical Assistance

States that participate in Medical Assistance (MA)
are required to provide certain services

States may also add optional services

States must submit to the Center for Medicaid
Services (CMS) a plan that details services provided,
how they will be provided and what they will pay for
the services

If services are included in the state plan, they are
considered an entitlement service
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MA Home Care Services

Home Health Agency Services – Required by CMS
include:

Skilled Nurse Visit

Home Health Aide

Durable Medical Equipment (DME)
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MA Home Care Services

Home Health Agency Services – Optional services
include:

Private Duty Nursing (PDN)

Personal Care Assistance (PCA)

Home therapies
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MA Home Health Agency Services

Must be provided by a Medicare Certified Agency

Providers are held to the Medicare standards and
conditions of participation

There are differences between Medicare and
Medicaid standards of coverage
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Medicaid

Medicaid (Medical Assistance) coverage guidelines

Person is NOT required to be home bound

Chronic ongoing care to maintain a person’s
health
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Skilled Nurse Visit - MA Policy


Skilled nurse visits must be:

Ordered by a doctor

Documented in a plan of care

Medically necessary

Authorized by DHS
MN Statute 256B.0653
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Skilled Nurse Visit - MA Policy

Covered services include:

Observation, assessment and evaluation of the
physical and/or mental status of a person

Completion of procedures requiring specialized
skill i.e. sterile procedures

Consumer teaching and education/training
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Skilled Nurse Visit - MA Policy

Authorization guidelines:

Up to two skilled nurse visits per day

Up to nine visits without prior authorization

Request for authorization must be received within
20 working days of the start of service
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Home Health Aide Visit - MA Policy


Home health aide visits must be:

Ordered by a doctor
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Documented in a plan of care
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Supervised by a registered nurse or a therapist if
appropriate

All visits must be authorized by DHS

One visit per day
MN Statute 256B.0653
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Home Health Aide Visit - MA Policy

Covered services include:

Hands-on personal care

Simple procedures as an extension of therapy or
nursing services

Assist in instrumental activities of daily living
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Private Duty Nursing - MA Policy


Private duty nursing (PDN) must be:

Ordered by a doctor

Documented in a plan of care

Assessed to be medically necessary

Authorized by DHS
MN Statute 256B.0654
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Private Duty Nursing - MA Policy

Covered services include:

Professional nursing services when recipient
requires more care than can be provided in a
skilled nursing visit

Used only when care is outside scope of home
health aide or personal care assistant

Shared service is allowed in certain
circumstances

Family members of recipients that are nurses may
provide services in certain circumstances
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Personal Care Assistance - MA Policy


Personal Care Assistance (PCA) services must be:

Assessed for the need and appropriateness of
PCA services by a Public Health Nurse (PHN)

Provided by a PCA provider agency enrolled with
DHS with supervision of PCAs by Qualified
Professionals

Documented in a written plan of care
MN Statute 256B.0659
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PCA Services - MA Policy

Covered services include assistance with:
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Activities of daily living
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Health-related procedures and tasks
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Observation and redirection of behaviors
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Instrumental activities of daily living
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PCA Services - MA Policy

Authorization guidelines:
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Temporary start of services must be authorized within
five days of beginning services
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Face-to-face assessments used to authorize services
for up to one year

Telephone assessments may be used to authorize
temporary start of services or temporary increase of
services

Shared care service allowed in certain circumstances

Two service delivery models – Traditional agency
model and PCA Choice Model
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Home Therapies - MA Policy


Home therapies include:

Physical therapy

Occupational therapy

Speech-language pathology services

Respiratory therapy
MN Statute 256B.0653
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Home Therapies - MA Policy


Home therapies must be:

Ordered by a doctor

Documented in a plan of care

Medically necessary
Home therapies are not prior authorized by DHS
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Coming Soon –
MnCHOICES Assessment

Combines assessment with service planning
process



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Determines eligibility for programs and services
Used for all ages and disability types
Completed by a certified assessor using web-based
application
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Coming Soon –
MnCHOICES Assessment



o
o
Replaces four assessments
1. Developmental Disability Screening (DD)
2. Long Term Care Consultation (LTCC)
3. Personal Care Assistant (PCA)
4. Private Duty Nursing (PDN) – Future
Uses person-centered approach to tailor services to
individual’s strengths, goals, and assessed needs
Changes who conducts assessments
Only certified assessors
County of location responsible for conducting all
assessments
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Coming Soon –
MnCHOICES Assessment

Certified Assessors Qualifications and Experience:
o
A minimum of a bachelor’s degree in social work,
nursing with a public health certificate, or other
closely-related field and at least one year of homeand community-based experience, or
o A two-year registered nursing degree with at
least two years of home- and community-based
experience
o
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Become certified with MnCHOICES Certified
Assessor Training (MnCAT)
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Questions ?

For more information –
 DHS Web Site - http://mn.gov/dhs/

Community Supports Program Manual

MN Health Care Programs Provider Manual (MHCP)
Thank you!
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