Subdivision 1. Definitions. (a) "Complex home care nursing" means home care nursing services provided to recipients who meet the criteria for regular home care nursing and require life-sustaining interventions to reduce the risk of long-term injury or death.
(b) "Home care nursing" means ongoing hourly nursing ordered by a physician, advanced practice registered nurse, or physician assistant and services performed by a registered nurse or licensed practical nurse within the scope of practice as defined by the Minnesota Nurse Practice Act under sections 148.171 to 148.285, in order to maintain or restore a person's health.
(c) "Home care nursing agency" means a medical assistance enrolled provider licensed under chapter 144A to provide home care nursing services.
(d) "Regular home care nursing" means home care nursing provided because:
(1) the recipient requires more individual and continuous care than can be provided during a skilled nurse visit; or
(2) the cares are outside of the scope of services that can be provided by a home health aide or personal care assistant.
(e) "Shared home care nursing" means the provision of home care nursing services by a home care nurse to two recipients at the same time and in the same setting.
Subd. 2. MS 2008 [Renumbered 256B.0652, subd 5]
Subd. 2a. Home care nursing services. (a) Home care nursing services must be used:
(1) in the recipient's home or outside the home when normal life activities require;
(2) when the recipient requires more individual and continuous care than can be provided during a skilled nurse visit; and
(3) when the care required is outside of the scope of services that can be provided by a home health aide or personal care assistant.
(b) Home care nursing services must be:
(1) assessed by a registered nurse on a form approved by the commissioner;
(2) ordered by a physician, advanced practice registered nurse, or physician assistant and documented in a plan of care that is reviewed by the ordering practitioner at least once every 60 days; and
(3) authorized by the commissioner under section 256B.0652.
Subd. 2b. Noncovered home care nursing services. Home care nursing services do not cover the following:
(1) nursing services by a nurse who is the family foster care provider of a person who has not reached 18 years of age unless allowed under subdivision 4;
(2) nursing services to more than two persons receiving shared home care nursing services from a home care nurse in a single setting; and
(3) nursing services provided by a registered nurse or licensed practical nurse who is the recipient's legal guardian or related to the recipient as spouse, parent, or family foster parent whether by blood, marriage, or adoption except as specified in subdivision 4.
Subd. 3. Shared home care nursing option. (a) Medical assistance payments for shared home care nursing services by a home care nurse shall be limited according to this subdivision. Unless otherwise provided in this subdivision, all other statutory and regulatory provisions relating to home care nursing services apply to shared home care nursing services. Nothing in this subdivision shall be construed to reduce the total number of home care nursing hours authorized for an individual recipient.
(b) Shared home care nursing is the provision of nursing services by a home care nurse to two medical assistance eligible recipients at the same time and in the same setting. This subdivision does not apply when a home care nurse is caring for multiple recipients in more than one setting.
(c) For the purposes of this subdivision, "setting" means:
(1) the home residence or foster care home of one of the individual recipients as defined in section 256B.0651;
(2) a child care program licensed under chapter 245A or operated by a local school district or private school;
(3) an adult day care service licensed under chapter 245A; or
(4) outside the home residence or foster care home of one of the recipients when normal life activities take the recipients outside the home.
(d) The home care nursing agency must offer the recipient the option of shared or one-on-one home care nursing services. The recipient may withdraw from participating in a shared service arrangement at any time.
(e) The recipient or the recipient's legal representative, and the recipient's physician, advanced practice registered nurse, or physician assistant, in conjunction with the home care nursing agency, shall determine:
(1) whether shared home care nursing care is an appropriate option based on the individual needs and preferences of the recipient; and
(2) the amount of shared home care nursing services authorized as part of the overall authorization of nursing services.
(f) The recipient or the recipient's legal representative, in conjunction with the home care nursing agency, shall approve the setting, grouping, and arrangement of shared home care nursing care based on the individual needs and preferences of the recipients. Decisions on the selection of recipients to share services must be based on the ages of the recipients, compatibility, and coordination of their care needs.
(g) The following items must be considered by the recipient or the recipient's legal representative and the home care nursing agency, and documented in the recipient's health service record:
(1) the additional training needed by the home care nurse to provide care to two recipients in the same setting and to ensure that the needs of the recipients are met appropriately and safely;
(2) the setting in which the shared home care nursing care will be provided;
(3) the ongoing monitoring and evaluation of the effectiveness and appropriateness of the service and process used to make changes in service or setting;
(4) a contingency plan which accounts for absence of the recipient in a shared home care nursing setting due to illness or other circumstances;
(5) staffing backup contingencies in the event of employee illness or absence; and
(6) arrangements for additional assistance to respond to urgent or emergency care needs of the recipients.
(h) The documentation for shared home care nursing must be on a form approved by the commissioner for each individual recipient sharing home care nursing. The documentation must be part of the recipient's health service record and include:
(1) permission by the recipient or the recipient's legal representative for the maximum number of shared nursing hours per week chosen by the recipient and permission for shared home care nursing services provided in and outside the recipient's home residence;
(2) revocation by the recipient or the recipient's legal representative for the shared home care nursing permission, or services provided to others in and outside the recipient's residence; and
(3) daily documentation of the shared home care nursing services provided by each identified home care nurse, including:
(i) the names of each recipient receiving shared home care nursing services;
(ii) the setting for the shared services, including the starting and ending times that the recipient received shared home care nursing care; and
(iii) notes by the home care nurse regarding changes in the recipient's condition, problems that may arise from the sharing of home care nursing services, and scheduling and care issues.
(i) The commissioner shall provide a rate methodology for shared home care nursing. For two persons sharing nursing care, the rate paid to a provider must not exceed 1.5 times the regular home care nursing rates paid for serving a single individual by a registered nurse or licensed practical nurse. These rates apply only to situations in which both recipients are present and receive shared home care nursing care on the date for which the service is billed.
Subd. 4. Hardship criteria; home care nursing. (a) Payment is allowed for extraordinary services that require specialized nursing skills and are provided by parents of minor children, family foster parents, spouses, and legal guardians who are providing home care nursing care under the following conditions:
(1) the provision of these services is not legally required of the parents, spouses, or legal guardians;
(2) the services are necessary to prevent hospitalization of the recipient; and
(3) the recipient is eligible for state plan home care or a home and community-based waiver and one of the following hardship criteria are met:
(i) the parent, spouse, or legal guardian resigns from a part-time or full-time job to provide nursing care for the recipient;
(ii) the parent, spouse, or legal guardian goes from a full-time to a part-time job with less compensation to provide nursing care for the recipient;
(iii) the parent, spouse, or legal guardian takes a leave of absence without pay to provide nursing care for the recipient; or
(iv) because of labor conditions, special language needs, or intermittent hours of care needed, the parent, spouse, or legal guardian is needed in order to provide adequate home care nursing services to meet the medical needs of the recipient.
(b) Home care nursing may be provided by a parent, spouse, family foster parent, or legal guardian who is a nurse licensed in Minnesota. Home care nursing services provided by a parent, spouse, family foster parent, or legal guardian cannot be used in lieu of nursing services covered and available under liable third-party payors, including Medicare. The home care nursing provided by a parent, spouse, family foster parent, or legal guardian must be included in the service agreement. Authorized nursing services for a single recipient or recipients with the same residence and provided by the parent, spouse, family foster parent, or legal guardian may not exceed 50 percent of the total approved nursing hours, or eight hours per day, whichever is less, up to a maximum of 40 hours per week. A parent or parents, spouse, family foster parent, or legal guardian shall not provide more than 40 hours of services in a seven-day period. For parents, family foster parents, and legal guardians, 40 hours is the total amount allowed regardless of the number of children or adults who receive services. Nothing in this subdivision precludes the parent's, spouse's, or legal guardian's obligation of assuming the nonreimbursed family responsibilities of emergency backup caregiver and primary caregiver.
(c) A parent, family foster parent, or a spouse may not be paid to provide home care nursing care if:
(1) the parent or spouse fails to pass a criminal background check according to chapter 245C;
(2) it has been determined by the home care nursing agency, the case manager, or the physician, advanced practice registered nurse, or physician assistant that the home care nursing provided by the parent, family foster parent, spouse, or legal guardian is unsafe; or
(3) the parent, family foster parent, spouse, or legal guardian does not follow physician, advanced practice registered nurse, or physician assistant orders.
(d) For purposes of this section, "assessment" means a review and evaluation of a recipient's need for home care services conducted in person. Assessments for home care nursing must be conducted by a registered nurse.
Subd. 5. Payment rates for home care nursing services. The commissioner shall annually adjust payments for home care nursing services to reflect the change in the federal Centers for Medicare and Medicaid Services Home Health Agency Market Basket. The commissioner shall use the indices as forecasted for the midpoint of the prior rate year to the midpoint of the current rate year.
1986 c 444; 1990 c 568 art 3 s 51; 1991 c 292 art 7 s 12,25; 1992 c 391 s 3-6; 1992 c 464 art 2 s 1; 1992 c 513 art 7 s 50; 1Sp1993 c 1 art 5 s 51-53; 1995 c 207 art 6 s 52-55; 1996 c 451 art 5 s 17-20; 1997 c 203 art 4 s 28,29; 3Sp1997 c 3 s 9; 1998 c 407 art 4 s 29-31; 1999 c 245 art 4 s 50-58; 2000 c 474 s 8-11; 1Sp2001 c 9 art 3 s 29-41; 2002 c 375 art 2 s 17; 2002 c 379 art 1 s 113; 2003 c 15 art 1 s 33; 1Sp2003 c 14 art 3 s 26-28; 2005 c 10 art 1 s 49,50; 2005 c 56 s 1; 1Sp2005 c 4 art 7 s 15-19; 2009 c 79 art 8 s 26,85; 2014 c 291 art 9 s 2,5; 2015 c 21 art 1 s 56; 2020 c 115 art 4 s 121-124; 1Sp2020 c 2 art 2 s 17-20; 1Sp2021 c 7 art 13 s 12
Structure Minnesota Statutes
Chapters 245 - 267 — Public Welfare And Related Activities
Chapter 256B — Medical Assistance For Needy Persons
Section 256B.011 — Policy For Childbirth And Abortion Funding.
Section 256B.02 — Definitions.
Section 256B.021 — Medical Assistance Reform Waiver.
Section 256B.03 — Payments To Vendors.
Section 256B.035 — Managed Care.
Section 256B.037 — Prospective Payment Of Dental Services.
Section 256B.0371 — Performance Benchmarks For Dental Access; Contingent Dental Administrator.
Section 256B.038 — Provider Rate Increases After June 30, 1999.
Section 256B.04 — Duties Of State Agency.
Section 256B.041 — Centralized Disbursement Of Medical Assistance Payments.
Section 256B.042 — Third-party Liability.
Section 256B.043 — Cost-containment Efforts.
Section 256B.05 — Administration By County Agencies.
Section 256B.051 — Housing Stabilization Services.
Section 256B.055 — Eligibility Categories.
Section 256B.056 — Eligibility Requirements For Medical Assistance.
Section 256B.0561 — Periodic Data Matching To Evaluate Continued Eligibility.
Section 256B.057 — Eligibility Requirements For Special Categories.
Section 256B.0571 — Long-term Care Partnership Program.
Section 256B.0575 — Availability Of Income For Institutionalized Persons.
Section 256B.058 — Treatment Of Income Of Institutionalized Spouse.
Section 256B.059 — Treatment Of Assets When A Spouse Is Institutionalized.
Section 256B.0594 — Payment Of Benefits From An Annuity.
Section 256B.0595 — Prohibitions On Transfer; Exceptions.
Section 256B.06 — Eligibility; Migrant Workers; Citizenship.
Section 256B.061 — Eligibility; Retroactive Effect; Restrictions.
Section 256B.0615 — Mental Health Certified Peer Specialist.
Section 256B.0616 — Mental Health Certified Family Peer Specialist.
Section 256B.0621 — Covered Services: Targeted Case Management Services.
Section 256B.0622 — Assertive Community Treatment And Intensive Residential Treatment Services.
Section 256B.0623 — Adult Rehabilitative Mental Health Services Covered.
Section 256B.0624 — Crisis Response Services Covered.
Section 256B.0625 — Covered Services.
Section 256B.0626 — Estimation Of 50th Percentile Of Prevailing Charges.
Section 256B.063 — Cost Sharing.
Section 256B.0631 — Medical Assistance Co-payments.
Section 256B.0635 — Continued Eligibility In Special Circumstances.
Section 256B.0636 — Controlled Substance Prescriptions; Abuse Prevention.
Section 256B.0637 — Presumptive Eligibility; Treatment For Breast Or Cervical Cancer.
Section 256B.0638 — Opioid Prescribing Improvement Program.
Section 256B.064 — Sanctions; Monetary Recovery.
Section 256B.0641 — Recovery Of Overpayments.
Section 256B.0642 — Federal Financial Participation.
Section 256B.0643 — Vendor Request For Contested Case Proceeding.
Section 256B.0644 — Reimbursement Under Other State Health Care Programs.
Section 256B.0646 — Minnesota Restricted Recipient Program; Personal Care Assistance Services.
Section 256B.065 — Social Security Amendments.
Section 256B.0651 — Home Care Services.
Section 256B.0652 — Authorization And Review Of Home Care Services.
Section 256B.0653 — Home Health Agency Services.
Section 256B.0654 — Home Care Nursing.
Section 256B.0658 — Housing Access Grants.
Section 256B.0659 — Personal Care Assistance Program.
Section 256B.0671 — Covered Mental Health Services.
Section 256B.0711 — Quality Self-directed Services Workforce.
Section 256B.072 — Performance Reporting And Quality Improvement System.
Section 256B.073 — Electronic Visit Verification.
Section 256B.075 — Disease Management Programs.
Section 256B.0751 — Health Care Homes.
Section 256B.0753 — Payment Restructuring; Care Coordination Payments.
Section 256B.0754 — Payment Reform.
Section 256B.0755 — Integrated Health Partnership Demonstration Project.
Section 256B.0756 — Hennepin And Ramsey Counties Pilot Program.
Section 256B.0757 — Coordinated Care Through A Health Home.
Section 256B.0758 — Health Care Delivery Pilot Program.
Section 256B.0759 — Substance Use Disorder Demonstration Project.
Section 256B.076 — Case Management Services.
Section 256B.08 — Application.
Section 256B.09 — Investigations.
Section 256B.0911 — Long-term Care Consultation Services.
Section 256B.0913 — Alternative Care Program.
Section 256B.0914 — Conflicts Of Interest Related To Medicaid Expenditures.
Section 256B.0916 — Expansion Of Home And Community-based Services.
Section 256B.0917 — Home And Community-based Services For Older Adults.
Section 256B.0918 — Employee Scholarship Costs.
Section 256B.0919 — Adult Foster Care And Family Adult Day Care.
Section 256B.092 — Services For Persons With Developmental Disabilities.
Section 256B.0921 — Home And Community-based Services Innovation Pool.
Section 256B.0922 — Essential Community Supports.
Section 256B.0924 — Targeted Case Management Services.
Section 256B.0926 — Admission Review Team; Intermediate Care Facilities.
Section 256B.093 — Services For Persons With Traumatic Brain Injuries.
Section 256B.094 — Child Welfare Targeted Case Management Services.
Section 256B.0943 — Children's Therapeutic Services And Supports.
Section 256B.0945 — Services For Children With Severe Emotional Disturbance.
Section 256B.0946 — Children's Intensive Behavioral Health Services.
Section 256B.0947 — Intensive Rehabilitative Mental Health Services.
Section 256B.0948 — Foster Care Rate Limits.
Section 256B.0949 — Early Intensive Developmental And Behavioral Intervention Benefit.
Section 256B.095 — Quality Assurance System Established.
Section 256B.0951 — Quality Assurance Commission.
Section 256B.0952 — County Duties; Quality Assurance Teams.
Section 256B.0953 — Quality Assurance Process.
Section 256B.0954 — Certain Persons Defined As Mandated Reporters.
Section 256B.0955 — Duties Of The Commissioner Of Human Services.
Section 256B.097 — Regional And Systems Improvement For Minnesotans Who Have Disabilities.
Section 256B.12 — Legal Representation.
Section 256B.121 — Treble Damages.
Section 256B.14 — Relative's Responsibility.
Section 256B.15 — Claims Against Estates.
Section 256B.17 — Transfers Of Property.
Section 256B.18 — Methods Of Administration.
Section 256B.19 — Division Of Cost.
Section 256B.194 — Federal Payments.
Section 256B.196 — Intergovernmental Transfers; Hospital And Physician Payments.
Section 256B.197 — Intergovernmental Transfers; Inpatient Hospital Payments.
Section 256B.1973 — Directed Payment Arrangements.
Section 256B.198 — Payments For Non-hospital-based Governmental Health Centers.
Section 256B.199 — Payments Reported By Governmental Entities.
Section 256B.20 — County Appropriations.
Section 256B.21 — Change Of Residence.
Section 256B.22 — Compliance With Social Security Act.
Section 256B.23 — Use Of Federal Funds.
Section 256B.24 — Prohibitions.
Section 256B.25 — Payments To Certified Facilities.
Section 256B.26 — Agreements With Other State Departments.
Section 256B.27 — Medical Assistance; Cost Reports.
Section 256B.30 — Health Care Facility Report.
Section 256B.32 — Facility Fee Payment.
Section 256B.35 — Personal Needs Allowance; Persons In Certain Facilities.
Section 256B.36 — Special Personal Allowance For Certain Individuals.
Section 256B.37 — Private Insurance Policies, Causes Of Action.
Section 256B.39 — Avoidance Of Duplicate Payments.
Section 256B.40 — Subsidy For Abortions Prohibited.
Section 256B.421 — Definitions.
Section 256B.431 — Rate Determination.
Section 256B.434 — Payment Rates And Procedures; Contracts And Agreements.
Section 256B.439 — Long-term Care Quality Profiles.
Section 256B.48 — Conditions For Participation.
Section 256B.49 — Home And Community-based Service Waivers For Persons With Disabilities.
Section 256B.4905 — Home And Community-based Services Policy Statement.
Section 256B.4911 — Consumer-directed Community Supports.
Section 256B.4912 — Home And Community-based Waivers; Providers And Payment.
Section 256B.4914 — Home And Community-based Services Waivers; Rate Setting.
Section 256B.492 — Home And Community-based Settings For People With Disabilities.
Section 256B.493 — Adult Foster Care Planned Closure.
Section 256B.501 — Rates For Community-based Services For Persons With Disabilities.
Section 256B.5011 — Icf/dd Reimbursement System Effective October 1, 2000.
Section 256B.5012 — Icf/dd Payment System Implementation.
Section 256B.5013 — Payment Rate Adjustments.
Section 256B.5014 — Reporting Requirements.
Section 256B.5015 — Pass-through Of Other Services Costs.
Section 256B.51 — Nursing Homes; Cost Of Home Care.
Section 256B.69 — Prepaid Health Plans.
Section 256B.6903 — Ombudsperson For Managed Care.
Section 256B.691 — Risk-based Transportation Payments.
Section 256B.692 — County-based Purchasing.
Section 256B.6925 — Enrollee Information.
Section 256B.6926 — State Monitoring.
Section 256B.6927 — Quality Assessment And Performance.
Section 256B.6928 — Managed Care Rates And Payments.
Section 256B.693 — State-operated Services; Managed Care.
Section 256B.694 — Sole-source Or Single-plan Managed Care Contract.
Section 256B.70 — Demonstration Project Waiver.
Section 256B.71 — Social Health Maintenance Organization Demonstration.
Section 256B.72 — Commissioner's Recovery Of Overpayments.
Section 256B.73 — Demonstration Project For Uninsured Low-income Persons.
Section 256B.74 — Special Payments.
Section 256B.75 — Hospital Outpatient Reimbursement.
Section 256B.756 — Reimbursement Rates For Births.
Section 256B.758 — Reimbursement For Doula Services.
Section 256B.76 — Physician And Dental Reimbursement.
Section 256B.761 — Reimbursement For Mental Health Services.
Section 256B.762 — Reimbursement For Health Care Services.
Section 256B.763 — Critical Access Mental Health Rate Increase.
Section 256B.7635 — Reimbursement For Evidence-based Public Health Nurse Home Visits.
Section 256B.764 — Reimbursement For Family Planning Services.
Section 256B.765 — Provider Rate Increases.
Section 256B.766 — Reimbursement For Basic Care Services.
Section 256B.767 — Medicare Payment Limit.
Section 256B.77 — Coordinated Service Delivery System For Persons With Disabilities.
Section 256B.771 — Complementary And Alternative Medicine Demonstration Project.
Section 256B.78 — Demonstration Project For Family Planning Services.
Section 256B.79 — Integrated Care For High-risk Pregnant Women.
Section 256B.795 — Maternal And Infant Health Report.
Section 256B.81 — Mental Health Provider Appeal Process.
Section 256B.82 — Prepaid Plans And Mental Health Rehabilitative Services.
Section 256B.84 — American Indian Contracting Provisions.
Section 256B.85 — Community First Services And Supports.
Section 256B.851 — Community First Services And Supports; Payment Rates.