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Home Care Nursing (HCN) Services

Revised: 07-28-2014

  • Eligible Providers
  • Eligible Recipients
  • Authorization Requirements
  • Covered Services
  • Noncovered Services
  • Billing
  • Definitions
  • Legal References
  • Home Care Nursing (HCN) Services are nursing services ordered by a physician, for a recipient whose illness, injury, physical or mental condition requires more individual and continuous care by a Registered (RN) or Licensed Practical Nurse (LPN) than can be provided in a single or twice daily skilled nurse visit and requires greater skill than a Home Health Aide (HHA) or Personal Care Assistant (PCA) can provide.

    HCN services:

  • • Are for recipients who need more individual and continuous skilled nursing care than provided in a skilled nurse visit
  • • Are for care outside the scope of services provided by a Home Health Aide/PCA
  • • Are provided under a plan of care or service plan approved by the physician
  • • Specify the level of care the nurse is qualified to provide
  • • Are ordered by the recipient’s physician
  • • May be used outside of the recipient’s home during hours when normal life activities take them outside of their home
  • • Must be provided by an RN or LPN
  • • May be provided by an RN or LPN with a hardship waiver who is one of the following: parent of a minor child, spouse of the recipient, legal guardian or conservator, or family foster parent of a minor child.
  • Eligible Providers

  • • Medicare Certified Home Health Agency
  • • Class A licensed Home Care Agency
  • • Independent Registered Nurse (RN)
  • • Independent Licensed Practical Nurse (LPN) with a class A license from MDH
  • HCN Relative Hardship Waiver
    TheHCN Relative Hardship Waiver allows certain relatives to receive reimbursement for providing services to an MA recipient. The relative must be currently licensed in the State of Minnesota as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) employed by a Class A or Medicare Certified Home Care Nursing Agency enrolled with MHCP and is:

  • • The parent of a recipient
  • • The spouse of a recipient
  • • Legal guardian or conservator
  • • Family foster parent of a minor child
  • In order 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 recipient
  • • The relative goes from a full-time to a part-time job with less compensation to provide HCN for the recipient
  • • The relative takes a leave of absence without pay to provide HCN for the recipient
  • • Because of labor conditions, intermittent hours of care needed, or special language needs, the relative is needed in order to provide an adequate number of qualified HCNs to meet the recipient’s needs
  • In the case of a HCN Relative Hardship Waiver, the provider agency is responsible for:

  • • Receiving the request from the recipient/responsible party
  • • Obtaining the relative’s signature
  • • Completing the HCN Hardship Waiver Application request form (DHS-4109)
  • • Ensuring the accuracy of the information
  • • Submitting the HCN Hardship Waiver Application (DHS-4109) form along with supporting documentation to Disability Services Division (DSD)
  • • Criminal background check
  • • For a recipient who is enrolled in a managed care organization (MCO), the MCO is responsible for reviewing and approving or denying the HCN Hardship Waiver Application.
  • Please note:

  • • Provision of paid service does not preclude the parent, spouse or guardian from his/her obligations for non-reimbursed family responsibilities of emergency backup caregiver and primary caregiver. The provision of these services is not legally required of the parent, spouse or legal guardian. 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 recipient’s service plan. Hours authorized for the parent, spouse or guardian may not exceed 50% 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 health agency, the waiver case manager or the physician, determine that the care provided by the parent, spouse or guardian is unsafe.
  • • The review process is 30 days. Written notice will be issued upon a decision. The provider must keep this notice in the recipient’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 Recipients

    Recipients 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 recipient’s medical/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) form following the process described in the updated MA Home Care Nursing Assessment Instructions (DHS-4071B) and the HCN Decision Tree (DHS-4071C).

  • • All HCN services require prior authorization. HCN services require a physician order prior to initiating service
  • • Review/approval of the service plan by the recipient’s physician every 60 days
  • Covered Services

    HCN services can be classified regular or complex.

    Regular Home Care Nursing

    Regular HCN is provided to a recipient 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 outside the scope of services that can be provided by a Home Health Aide or PCA
  • • Be provided according to the recipient’s plan of care
  • • Be approved by the recipient’s physician
  • • Be provided in the recipient’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 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.

    Noncovered Services

  • • 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 physician
  • • 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 recipient is receiving 1:1 HCN services. A complex care rate is not available when the recipient is receiving shared (1:2) HCN services. This means a recipient can share HCN services if they are authorized complex care, but the agency will only receive the complex rate during the hours the recipient is receiving the 1:1 services.

    Shared HCN Option

    This option allows two recipients to share HCN services in the same setting at the same time from the same private duty nurse. All regulations pertaining to home care nursing services also apply to the Shared Care Option. A setting includes:

  • • The home/licensed foster care home of one of the recipients
  • • Outside the home/foster care home when normal life activities take recipients outside the home
  • • A child care program licensed under MS 245A, or operated by a local school district/private school
  • • An adult day care service licensed under MS 245A
  • Shared HCN cannot be provided to two recipients in separate apartments in the same building. HCN cannot replace or supplement required staff at a licensed facility.

    Required Documentation
    Include a copy of each of the following in the recipient’s chart when service is shared HCN:

  • • A signed consent form by each recipient/legal representative
  • • Permission for the agency to schedule shared care up to the maximum hours chosen by the recipient
  • • Any use of services outside the recipient’s home
  • • Permission to place the recipient’s name in the chart of the other shared recipient
  • • How the needs of both recipients 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 recipient’s illness/absence or HCN’s illness/absence
  • • Additional training, if needed, for the HCN to provide care to two recipients
  • • The names of each recipient receiving shared HCN services
  • • The starting and ending times the recipients received shared HCN
  • • Routine nursing documentation such as changes in the recipient’s condition/any problems due to sharing services
  • Changing or Discontinuing Shared HCN
    The recipient or legal representative must notify the provider in writing if the recipient chooses to make a change in their shared care. Changes include:

  • • The number of authorized units the recipient wishes to share
  • • Discontinuing participation in shared care
  • • Changing providers
  • The written revocation or change must be maintained in the recipient’s file. For additional information, refer to the Quick Reference Tool.


    Plan of Care - PCA: See Service Plan.

    Home Care Nursing Agency: An agency holding a Class A Home Care license and is enrolled with the Department of Human Services to provide home care nursing services.

    Service Plan – PCA: (Also called PCA plan of care.)A written description of the services needed by the recipient based on the assessment. The service plan must include a description of the home care services, the frequency and duration of services, recipient’s functional level, medications, treatments and the expected outcomes and goals.

    Legal References

    42 CFR 440.80 (Home Care Nursing Services)
    MS 256B.0625
    subd 7 (Home Care Nursing)
    MS 256B.0651
    (Home care services)
    MS 256B.0654
    (Home Care Nursing)
    MN Rule 9505.0360
    (Home Care Nursing Services)

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