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 6/10/20162

3 Home Health Agency Services – Required by CMS include: Skilled Nurse Visit Home Health Aide Durable Medical Equipment (DME) MA Home Care Services

6/10/20164 MA Home Care Services Home Health Agency Services – Optional services include: Private Duty Nursing (PDN) Personal Care Assistance (PCA) Home therapies

6/10/20165 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

6/10/20166 Medicaid Medicaid (Medical Assistance) coverage guidelines Person is NOT required to be home bound Chronic ongoing care to maintain a person’s health

6/10/20167 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

6/10/20168 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

6/10/20169 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

6/10/ Home Health Aide Visit - MA Policy Home health aide visits must be: Ordered by a doctor Documented in a plan of care 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

6/10/ 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

6/10/ 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

6/10/ 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

6/10/ 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

6/10/ PCA Services - MA Policy Covered services include assistance with: Activities of daily living Health-related procedures and tasks Observation and redirection of behaviors Instrumental activities of daily living

6/10/ PCA Services - MA Policy Authorization guidelines: Temporary start of services must be authorized within five days of beginning services 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

6/10/ Home Therapies - MA Policy Home therapies include: Physical therapy Occupational therapy Speech-language pathology services Respiratory therapy MN Statute 256B.0653

6/10/ 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

6/10/ Coming Soon – MnCHOICES Assessment Combines assessment with service planning process Determines eligibility for programs and services Used for all ages and disability types Completed by a certified assessor using web-based application

6/10/ Coming Soon – MnCHOICES Assessment 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 o Only certified assessors o County of location responsible for conducting all assessments

6/10/ 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 home- and community-based experience, or o A two-year registered nursing degree with at least two years of home- and community-based experience o Become certified with MnCHOICES Certified Assessor Training (MnCAT)

6/10/ Questions ? For more information – DHS Web Site - Community Supports Program Manual MN Health Care Programs Provider Manual (MHCP) Thank you!