1.1                          A bill for an act 
  1.2             relating to health; allowing reimbursement for 
  1.3             supplemental private duty nursing services provided by 
  1.4             spouses of recipients under the community alternative 
  1.5             care home and community-based waivered services 
  1.6             program; amending Minnesota Statutes 1998, section 
  1.7             256B.49, by adding a subdivision. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 1998, section 256B.49, is 
  1.10  amended by adding a subdivision to read: 
  1.11     Subd. 10.  [PRIVATE DUTY NURSING SERVICES PROVIDED BY A 
  1.12  SPOUSE.] The commissioner shall seek to amend the community 
  1.13  alternative care home and community-based waivered services 
  1.14  program to include payment for spouses providing private duty 
  1.15  nursing care to a recipient who can direct his or her own care.  
  1.16  For purposes of this subdivision, a recipient can direct his or 
  1.17  her own care if the recipient can communicate: 
  1.18     (1) orientation to person, place, and time; 
  1.19     (2) an understanding of the recipient's plan of care, 
  1.20  including medications and medication schedule; 
  1.21     (3) needs; and 
  1.22     (4) an understanding of safety issues, including how to 
  1.23  access emergency assistance. 
  1.24  Private duty nursing may be provided by a spouse who is a 
  1.25  licensed nurse employed by a Medicare certified home health 
  1.26  agency, in cases where there is a lack of a sufficient number of 
  2.1   qualified providers or private duty nurses and to prevent the 
  2.2   hospitalization of the recipient.  Private duty nursing services 
  2.3   provided by a spouse cannot be used in lieu of nursing services 
  2.4   covered and available under liable third-party payers including 
  2.5   Medicare and medical assistance not paid by the waiver.  The 
  2.6   private duty nursing provided by a spouse must be included in 
  2.7   the plan of care and must be scheduled by the home health 
  2.8   agency, and may be covered for up to 24 hours per week.  In no 
  2.9   case shall the authorization of these services provided by the 
  2.10  spouse exceed 50 percent of the total approved nursing hours or 
  2.11  eight hours per day, whichever is less.  Nothing in this 
  2.12  subdivision precludes the spouse's obligation of assuming the 
  2.13  nonreimbursed family responsibilities of emergency backup 
  2.14  caregiver and primary caregiver.  The waiver interdisciplinary 
  2.15  team shall recommend to the commissioner whether the provision 
  2.16  of private duty nursing care by a spouse is appropriate.  In no 
  2.17  case shall a spouse be paid to provide private duty nursing care 
  2.18  if the spouse fails to pass a criminal background check 
  2.19  according to section 245A.04, or if it has been determined by 
  2.20  the home health agency or the waiver case manager that the 
  2.21  private duty nursing care provided by the spouse is unsafe.  
  2.22  This subdivision is effective upon the date of federal approval.