Supporting Minnesotans Where They Live: A Home Care Update

1. Supporting Minnesotans Where They Live: A Home Care Update Jeanine WilsonDiane BenjaminDisabilities Services Division

2. 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

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

4. MA Home Care Services • Home Health Agency Services – Optional services include: • Private Duty Nursing (PDN) • Personal Care Assistance (PCA) • Home therapies

5. 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. Medicaid • Medicaid (Medical Assistance) coverage guidelines • Person is NOT required to be home bound • Chronic ongoing care to maintain a person’s health

7. 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

8. 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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

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

18. 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

19. 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

20. 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 • Only certified assessors • County of location responsible for conducting all assessments

21. Coming Soon – MnCHOICES Assessment • Certified Assessors Qualifications and Experience: • 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 • A two-year registered nursing degree with at least two years of home- and community-based experience • Become certified with MnCHOICES Certified Assessor Training (MnCAT)

22. Questions ? • For more information – • DHS Web Site - http://mn.gov/dhs/ • Community Supports Program Manual • MN Health Care Programs Provider Manual (MHCP) Thank you!