1997 Minnesota Statutes

     256B.0627 Covered service; home care services. 

    Subdivision 1.    Definition.  (a) "Assessment" means a 
 review and evaluation of a recipient's need for home care 
 services conducted in person.  Assessments for private duty 
 nursing shall be conducted by a private duty nurse.  Assessments 
 for home health agency services shall be conducted by a home 
 health agency nurse.  Assessments for personal care services 
 shall be conducted by the county public health nurse or a 
 certified public health nurse under contract with the county.  
 An initial assessment for personal care services is conducted on 
 individuals who are requesting personal care services or for 
 those consumers who have never had a public health nurse 
 assessment.  The initial assessment must include:  a 
 face-to-face health status assessment and determination of 
 baseline need, collection of initial case data, identification 
 of appropriate services and service plan development, 
 coordination of initial services, referrals and follow-up to 
 appropriate payers and community resources, completion of 
 required reports, obtaining service authorization, and consumer 
 education.  A reassessment visit for personal care services is 
 conducted at least annually or when there is a significant 
 change in consumer condition and need for services.  The 
 reassessment visit includes a review of initial baseline data, 
 evaluation of service outcomes, redetermination of service need, 
 modification of service plan and appropriate referrals, update 
 of initial forms, obtaining service authorization, and on going 
 consumer education.  Assessments for medical assistance home 
 care services for mental retardation or related conditions and 
 alternative care services for developmentally disabled home and 
 community-based waivered recipients may be conducted by the 
 county public health nurse to ensure coordination and avoid 
 duplication.  Assessments must be completed on forms provided by 
 the commissioner within 30 days of a request for home care 
 services by a recipient or responsible party. 

    (b) "Care plan" means a written description of personal 
 care assistant services developed by the agency nurse with the 
 recipient or responsible party to be used by the personal care 
 assistant with a copy provided to the recipient or responsible 
 party. 

    (c) "Home care services" means a health service, determined 
 by the commissioner as medically necessary, that is ordered by a 
 physician and documented in a service plan that is reviewed by 
 the physician at least once every 60 days for the provision of 
 home health services, or private duty nursing, or at least once 
 every 365 days for personal care.  Home care services are 
 provided to the recipient at the recipient's residence that is a 
 place other than a hospital or long-term care facility or as 
 specified in section 256B.0625.  

    (d) "Medically necessary" has the meaning given in 
 Minnesota Rules, parts 9505.0170 to 9505.0475.  

    (e) "Personal care assistant" means a person who:  (1) is 
 at least 18 years old, except for persons 16 to 18 years of age 
 who participated in a related school-based job training program 
 or have completed a certified home health aide competency 
 evaluation; (2) is able to effectively communicate with the 
 recipient and personal care provider organization; (3) effective 
 July 1, 1996, has completed one of the training requirements as 
 specified in Minnesota Rules, part 9505.0335, subpart 3, items A 
 to D; (4) has the ability to, and provides covered personal care 
 services according to the recipient's care plan, responds 
 appropriately to recipient needs, and reports changes in the 
 recipient's condition to the supervising registered nurse; (5) 
 is not a consumer of personal care services; and (6) is subject 
 to criminal background checks.  An individual who has been 
 convicted of a crime specified in Minnesota Rules, part 
 4668.0020, subpart 14, or a comparable crime in another 
 jurisdiction is disqualified from being a personal care 
 assistant, unless the individual meets the rehabilitation 
 criteria specified in Minnesota Rules, part 4668.0020, subpart 
 15. 

    (f) "Personal care provider organization" means an 
 organization enrolled to provide personal care services under 
 the medical assistance program that complies with the 
 following:  (1) owners who have a five percent interest or more, 
 and managerial officials are subject to a background study as 
 provided in section 245A.04.  This applies to currently enrolled 
 personal care provider organizations and those agencies seeking 
 enrollment as a personal care provider organization.  An 
 organization will be barred from enrollment if an owner or 
 managerial official of the organization has been convicted of a 
 crime specified in section 245A.04, or a comparable crime in 
 another jurisdiction, unless the owner or managerial official 
 meets the reconsideration criteria specified in section 245A.04; 
 (2) the organization must maintain a surety bond and liability 
 insurance throughout the duration of enrollment and provides 
 proof thereof.  The insurer must notify the department of human 
 services of the cancellation or lapse of policy; and (3) the 
 organization must maintain documentation of services as 
 specified in Minnesota Rules, part 9505.2175, subpart 7, as well 
 as evidence of compliance with personal care assistant training 
 requirements. 

    (g) "Responsible party" means an individual residing with a 
 recipient of personal care services who is capable of providing 
 the supportive care necessary to assist the recipient to live in 
 the community, is at least 18 years old, and is not a personal 
 care assistant.  Responsible parties who are parents of minors 
 or guardians of minors or incapacitated persons may delegate the 
 responsibility to another adult during a temporary absence of at 
 least 24 hours but not more than six months.  The person 
 delegated as a responsible party must be able to meet the 
 definition of responsible party, except that the delegated 
 responsible party is required to reside with the recipient only 
 while serving as the responsible party.  Foster care license 
 holders may be designated the responsible party for residents of 
 the foster care home if case management is provided as required 
 in section 256B.0625, subdivision 19a.  For persons who, as of 
 April 1, 1992, are sharing personal care services in order to 
 obtain the availability of 24-hour coverage, an employee of the 
 personal care provider organization may be designated as the 
 responsible party if case management is provided as required in 
 section 256B.0625, subdivision 19a. 

    (h) "Service plan" means a written description of the 
 services needed based on the assessment developed by the nurse 
 who conducts the assessment together with the recipient or 
 responsible party.  The service plan shall include a description 
 of the covered home care services, frequency and duration of 
 services, and expected outcomes and goals.  The recipient and 
 the provider chosen by the recipient or responsible party must 
 be given a copy of the completed service plan within 30 calendar 
 days of the request for home care services by the recipient or 
 responsible party. 

    (i) "Skilled nurse visits" are provided in a recipient's 
 residence under a plan of care or service plan that specifies a 
 level of care which the nurse is qualified to provide.  These 
 services are: 

    (1) nursing services according to the written plan of care 
 or service plan and accepted standards of medical and nursing 
 practice in accordance with chapter 148; 

    (2) services which due to the recipient's medical condition 
 may only be safely and effectively provided by a registered 
 nurse or a licensed practical nurse; 

    (3) assessments performed only by a registered nurse; and 

    (4) teaching and training the recipient, the recipient's 
 family, or other caregivers requiring the skills of a registered 
 nurse or licensed practical nurse.  

    Subd. 2.    Services covered.  Home care services 
 covered under this section include:  

    (1) nursing services under section 256B.0625, subdivision 
 6a; 

    (2) private duty nursing services under section 256B.0625, 
 subdivision 7; 

    (3) home health aide services under section 256B.0625, 
 subdivision 6a; 

    (4) personal care services under section 256B.0625, 
 subdivision 19a; 

    (5) nursing supervision of personal care services under 
 section 256B.0625, subdivision 19a; and 

    (6) assessments by county public health nurses for services 
 under section 256B.0625, subdivision 19a. 

    Subd. 3. Repealed, 1991 c 292 art 7 s 26 

    Subd. 4.    Personal care services.  (a) The personal 
 care services that are eligible for payment are the following:  

    (1) bowel and bladder care; 

    (2) skin care to maintain the health of the skin; 

    (3) repetitive maintenance range of motion, muscle 
 strengthening exercises, and other tasks specific to maintaining 
 a recipient's optimal level of function; 

    (4) respiratory assistance; 

    (5) transfers and ambulation; 

    (6) bathing, grooming, and hairwashing necessary for 
 personal hygiene; 

    (7) turning and positioning; 

    (8) assistance with furnishing medication that is 
 self-administered; 

    (9) application and maintenance of prosthetics and 
 orthotics; 

    (10) cleaning medical equipment; 

    (11) dressing or undressing; 

    (12) assistance with eating and meal preparation and 
 necessary grocery shopping; 

    (13) accompanying a recipient to obtain medical diagnosis 
 or treatment; 

    (14) assisting, monitoring, or prompting the recipient to 
 complete the services in clauses (1) to (13); 

    (15) redirection, monitoring, and observation that are 
 medically necessary and an integral part of completing the 
 personal care services described in clauses (1) to (14); 

    (16) redirection and intervention for behavior, including 
 observation and monitoring; 

    (17) interventions for seizure disorders, including 
 monitoring and observation if the recipient has had a seizure 
 that requires intervention within the past three months; and 

    (18) incidental household services that are an integral 
 part of a personal care service described in clauses (1) to (17).

 For purposes of this subdivision, monitoring and observation 
 means watching for outward visible signs that are likely to 
 occur and for which there is a covered personal care service or 
 an appropriate personal care intervention. 

    (b) The personal care services that are not eligible for 
 payment are the following:  

    (1) services not ordered by the physician; 

    (2) assessments by personal care provider organizations or 
 by independently enrolled registered nurses; 

    (3) services that are not in the service plan; 

    (4) services provided by the recipient's spouse, legal 
 guardian for an adult or child recipient, or parent of a 
 recipient under age 18; 

    (5) services provided by a foster care provider of a 
 recipient who cannot direct the recipient's own care, unless 
 monitored by a county or state case manager under section 
 256B.0625, subdivision 19a; 

    (6) services provided by the residential or program license 
 holder in a residence for more than four persons; 

    (7) services that are the responsibility of a residential 
 or program license holder under the terms of a service agreement 
 and administrative rules; 

    (8) sterile procedures; 

    (9) injections of fluids into veins, muscles, or skin; 

    (10) services provided by parents of adult recipients, 
 adult children or adult siblings of the recipient, unless these 
 relatives meet one of the following hardship criteria and the 
 commissioner waives this requirement: 

    (i) the relative resigns from a part-time or full-time job 
 to provide personal care for the recipient; 

    (ii) the relative goes from a full-time to a part-time job 
 with less compensation to provide personal care for the 
 recipient; 

    (iii) the relative takes a leave of absence without pay to 
 provide personal care for the recipient; 

    (iv) the relative incurs substantial expenses by providing 
 personal care for the recipient; or 

    (v) because of labor conditions or intermittent hours of 
 care needed, the relative is needed in order to provide an 
 adequate number of qualified personal care assistants to meet 
 the medical needs of the recipient; 

    (11) homemaker services that are not an integral part of a 
 personal care services; 

    (12) home maintenance, or chore services; 

    (13) services not specified under paragraph (a); and 

    (14) services not authorized by the commissioner or the 
 commissioner's designee. 

    Subd. 5.    Limitation on payments.  Medical assistance 
 payments for home care services shall be limited according to 
 this subdivision.  

    (a)    Limits on services without prior authorization.  
 A recipient may receive the following home care services during 
 a calendar year: 

    (1) any initial assessment; 

    (2) up to two reassessments per year done to determine a 
 recipient's need for personal care services; and 

    (3) up to five skilled nurse visits.  

    (b)    Prior authorization; exceptions.  All home care 
 services above the limits in paragraph (a) must receive the 
 commissioner's prior authorization, except when: 

    (1) the home care services were required to treat an 
 emergency medical condition that if not immediately treated 
 could cause a recipient serious physical or mental disability, 
 continuation of severe pain, or death.  The provider must 
 request retroactive authorization no later than five working 
 days after giving the initial service.  The provider must be 
 able to substantiate the emergency by documentation such as 
 reports, notes, and admission or discharge histories; 

    (2) the home care services were provided on or after the 
 date on which the recipient's eligibility began, but before the 
 date on which the recipient was notified that the case was 
 opened.  Authorization will be considered if the request is 
 submitted by the provider within 20 working days of the date the 
 recipient was notified that the case was opened; 

    (3) a third-party payor for home care services has denied 
 or adjusted a payment.  Authorization requests must be submitted 
 by the provider within 20 working days of the notice of denial 
 or adjustment.  A copy of the notice must be included with the 
 request; 

    (4) the commissioner has determined that a county or state 
 human services agency has made an error; or 

    (5) the professional nurse determines an immediate need for 
 up to 40 skilled nursing or home health aide visits per calendar 
 year and submits a request for authorization within 20 working 
 days of the initial service date, and medical assistance is 
 determined to be the appropriate payer. 

    (c)    Retroactive authorization.  A request for 
 retroactive authorization will be evaluated according to the 
 same criteria applied to prior authorization requests.  

    (d)    Assessment and service plan.  Assessments under 
 section 256B.0627, subdivision 1, paragraph (a), shall be 
 conducted initially, and at least annually thereafter, in person 
 with the recipient and result in a completed service plan using 
 forms specified by the commissioner.  Within 30 days of 
 recipient or responsible party request for home care services, 
 the assessment, the service plan, and other information 
 necessary to determine medical necessity such as diagnostic or 
 testing information, social or medical histories, and hospital 
 or facility discharge summaries shall be submitted to the 
 commissioner.  For personal care services: 

    (1) The amount and type of service authorized based upon 
 the assessment and service plan will follow the recipient if the 
 recipient chooses to change providers.  

    (2) If the recipient's medical need changes, the 
 recipient's provider may assess the need for a change in service 
 authorization and request the change from the county public 
 health nurse.  Within 30 days of the request, the public health 
 nurse will determine whether to request the change in services 
 based upon the provider assessment, or conduct a home visit to 
 assess the need and determine whether the change is appropriate. 

    (3) To continue to receive personal care services when the 
 recipient displays no significant change, the county public 
 health nurse has the option to review with the commissioner, or 
 the commissioner's designee, the service plan on record and 
 receive authorization for up to an additional 12 months at a 
 time for up to three years. 

    (e)    Prior authorization.  The commissioner, or the 
 commissioner's designee, shall review the assessment, the 
 service plan, and any additional information that is submitted.  
 The commissioner shall, within 30 days after receiving a 
 complete request, assessment, and service plan, authorize home 
 care services as follows:  

    (1)    Home health services.  All home health services 
 provided by a licensed nurse or a home health aide must be prior 
 authorized by the commissioner or the commissioner's designee.  
 Prior authorization must be based on medical necessity and 
 cost-effectiveness when compared with other care options.  When 
 home health services are used in combination with personal care 
 and private duty nursing, the cost of all home care services 
 shall be considered for cost-effectiveness.  The commissioner 
 shall limit nurse and home health aide visits to no more than 
 one visit each per day. 

    (2)    Personal care services.  (i) All personal care 
 services and registered nurse supervision must be prior 
 authorized by the commissioner or the commissioner's designee 
 except for the assessments established in paragraph (a).  The 
 amount of personal care services authorized must be based on the 
 recipient's home care rating.  A child may not be found to be 
 dependent in an activity of daily living if because of the 
 child's age an adult would either perform the activity for the 
 child or assist the child with the activity and the amount of 
 assistance needed is similar to the assistance appropriate for a 
 typical child of the same age.  Based on medical necessity, the 
 commissioner may authorize: 

    (A) up to two times the average number of direct care hours 
 provided in nursing facilities for the recipient's comparable 
 case mix level; or 

    (B) up to three times the average number of direct care 
 hours provided in nursing facilities for recipients who have 
 complex medical needs or are dependent in at least seven 
 activities of daily living and need physical assistance with 
 eating or have a neurological diagnosis; or 

    (C) up to 60 percent of the average reimbursement rate, as 
 of July 1, 1991, for care provided in a regional treatment 
 center for recipients who have Level I behavior, plus any 
 inflation adjustment as provided by the legislature for personal 
 care service; or 

    (D) up to the amount the commissioner would pay, as of July 
 1, 1991, plus any inflation adjustment provided for home care 
 services, for care provided in a regional treatment center for 
 recipients referred to the commissioner by a regional treatment 
 center preadmission evaluation team.  For purposes of this 
 clause, home care services means all services provided in the 
 home or community that would be included in the payment to a 
 regional treatment center; or 

    (E) up to the amount medical assistance would reimburse for 
 facility care for recipients referred to the commissioner by a 
 preadmission screening team established under section 256B.0911 
 or 256B.092; and 

    (F) a reasonable amount of time for the provision of 
 nursing supervision of personal care services.  

    (ii) The number of direct care hours shall be determined 
 according to the annual cost report submitted to the department 
 by nursing facilities.  The average number of direct care hours, 
 as established by May 1, 1992, shall be calculated and 
 incorporated into the home care limits on July 1, 1992.  These 
 limits shall be calculated to the nearest quarter hour. 

    (iii) The home care rating shall be determined by the 
 commissioner or the commissioner's designee based on information 
 submitted to the commissioner by the county public health nurse 
 on forms specified by the commissioner.  The home care rating 
 shall be a combination of current assessment tools developed 
 under sections 256B.0911 and 256B.501 with an addition for 
 seizure activity that will assess the frequency and severity of 
 seizure activity and with adjustments, additions, and 
 clarifications that are necessary to reflect the needs and 
 conditions of recipients who need home care including children 
 and adults under 65 years of age.  The commissioner shall 
 establish these forms and protocols under this section and shall 
 use an advisory group, including representatives of recipients, 
 providers, and counties, for consultation in establishing and 
 revising the forms and protocols. 

    (iv) A recipient shall qualify as having complex medical 
 needs if the care required is difficult to perform and because 
 of recipient's medical condition requires more time than 
 community-based standards allow or requires more skill than 
 would ordinarily be required and the recipient needs or has one 
 or more of the following: 

    (A) daily tube feedings; 

    (B) daily parenteral therapy; 

    (C) wound or decubiti care; 

    (D) postural drainage, percussion, nebulizer treatments, 
 suctioning, tracheotomy care, oxygen, mechanical ventilation; 

    (E) catheterization; 

    (F) ostomy care; 

    (G) quadriplegia; or 

    (H) other comparable medical conditions or treatments the 
 commissioner determines would otherwise require institutional 
 care.  

    (v) A recipient shall qualify as having Level I behavior if 
 there is reasonable supporting evidence that the recipient 
 exhibits, or that without supervision, observation, or 
 redirection would exhibit, one or more of the following 
 behaviors that cause, or have the potential to cause: 

    (A) injury to the recipient's own body; 

    (B) physical injury to other people; or 

    (C) destruction of property. 

    (vi) Time authorized for personal care relating to Level I 
 behavior in subclause (v), items (A) to (C), shall be based on 
 the predictability, frequency, and amount of intervention 
 required. 

    (vii) A recipient shall qualify as having Level II behavior 
 if the recipient exhibits on a daily basis one or more of the 
 following behaviors that interfere with the completion of 
 personal care services under subdivision 4, paragraph (a): 

    (A) unusual or repetitive habits; 

    (B) withdrawn behavior; or 

    (C) offensive behavior. 

    (viii) A recipient with a home care rating of Level II 
 behavior in subclause (vii), items (A) to (C), shall be rated as 
 comparable to a recipient with complex medical needs under 
 subclause (iv).  If a recipient has both complex medical needs 
 and Level II behavior, the home care rating shall be the next 
 complex category up to the maximum rating under subclause (i), 
 item (B). 

    (3)    Private duty nursing services.  All private duty 
 nursing services shall be prior authorized by the commissioner 
 or the commissioner's designee.  Prior authorization for private 
 duty nursing services shall be based on medical necessity and 
 cost-effectiveness when compared with alternative care options.  
 The commissioner may authorize medically necessary private duty 
 nursing services in quarter-hour units when: 

    (i) the recipient requires more individual and continuous 
 care than can be provided during a nurse visit; or 

    (ii) the cares are outside of the scope of services that 
 can be provided by a home health aide or personal care assistant.

    The commissioner may authorize: 

    (A) up to two times the average amount of direct care hours 
 provided in nursing facilities statewide for case mix 
 classification "K" as established by the annual cost report 
 submitted to the department by nursing facilities in May 1992; 

    (B) private duty nursing in combination with other home 
 care services up to the total cost allowed under clause (2); 

    (C) up to 16 hours per day if the recipient requires more 
 nursing than the maximum number of direct care hours as 
 established in item (A) and the recipient meets the hospital 
 admission criteria established under Minnesota Rules, parts 
 9505.0500 to 9505.0540.  

    The commissioner may authorize up to 16 hours per day of 
 medically necessary private duty nursing services or up to 24 
 hours per day of medically necessary private duty nursing 
 services until such time as the commissioner is able to make a 
 determination of eligibility for recipients who are 
 cooperatively applying for home care services under the 
 community alternative care program developed under section 
 256B.49, or until it is determined by the appropriate regulatory 
 agency that a health benefit plan is or is not required to pay 
 for appropriate medically necessary health care services.  
 Recipients or their representatives must cooperatively assist 
 the commissioner in obtaining this determination.  Recipients 
 who are eligible for the community alternative care program may 
 not receive more hours of nursing under this section than would 
 otherwise be authorized under section 256B.49. 

    (4)    Ventilator-dependent recipients.  If the 
 recipient is ventilator-dependent, the monthly medical 
 assistance authorization for home care services shall not exceed 
 what the commissioner would pay for care at the highest cost 
 hospital designated as a long-term hospital under the Medicare 
 program.  For purposes of this clause, home care services means 
 all services provided in the home that would be included in the 
 payment for care at the long-term hospital.  
 "Ventilator-dependent" means an individual who receives 
 mechanical ventilation for life support at least six hours per 
 day and is expected to be or has been dependent for at least 30 
 consecutive days.  

    (f)    Prior authorization; time limits.  The 
 commissioner or the commissioner's designee shall determine the 
 time period for which a prior authorization shall be effective.  
 If the recipient continues to require home care services beyond 
 the duration of the prior authorization, the home care provider 
 must request a new prior authorization.  Under no circumstances, 
 other than the exceptions in paragraph (b), shall a prior 
 authorization be valid prior to the date the commissioner 
 receives the request or for more than 12 months.  A recipient 
 who appeals a reduction in previously authorized home care 
 services may continue previously authorized services, other than 
 temporary services under paragraph (h), pending an appeal under 
 section 256.045.  The commissioner must provide a detailed 
 explanation of why the authorized services are reduced in amount 
 from those requested by the home care provider.  

    (g)    Approval of home care services.  The commissioner 
 or the commissioner's designee shall determine the medical 
 necessity of home care services, the level of caregiver 
 according to subdivision 2, and the institutional comparison 
 according to this subdivision, the cost-effectiveness of 
 services, and the amount, scope, and duration of home care 
 services reimbursable by medical assistance, based on the 
 assessment, primary payer coverage determination information as 
 required, the service plan, the recipient's age, the cost of 
 services, the recipient's medical condition, and diagnosis or 
 disability.  The commissioner may publish additional criteria 
 for determining medical necessity according to section 256B.04. 

    (h)    Prior authorization requests; temporary services. 
  The agency nurse, the independently enrolled private duty 
 nurse, or county public health nurse may request a temporary 
 authorization for home care services by telephone.  The 
 commissioner may approve a temporary level of home care services 
 based on the assessment, and service or care plan information, 
 and primary payer coverage determination information as required.
 Authorization for a temporary level of home care services 
 including nurse supervision is limited to the time specified by 
 the commissioner, but shall not exceed 45 days, unless extended 
 because the county public health nurse has not completed the 
 required assessment and service plan, or the commissioner's 
 determination has not been made.  The level of services 
 authorized under this provision shall have no bearing on a 
 future prior authorization. 

    (i)    Prior authorization required in foster care 
 setting.  Home care services provided in an adult or child 
 foster care setting must receive prior authorization by the 
 department according to the limits established in paragraph (a). 

    The commissioner may not authorize: 

    (1) home care services that are the responsibility of the 
 foster care provider under the terms of the foster care 
 placement agreement and administrative rules.  Requests for home 
 care services for recipients residing in a foster care setting 
 must include the foster care placement agreement and 
 determination of difficulty of care; 

    (2) personal care services when the foster care license 
 holder is also the personal care provider or personal care 
 assistant unless the recipient can direct the recipient's own 
 care, or case management is provided as required in section 
 256B.0625, subdivision 19a; 

    (3) personal care services when the responsible party is an 
 employee of, or under contract with, or has any direct or 
 indirect financial relationship with the personal care provider 
 or personal care assistant, unless case management is provided 
 as required in section 256B.0625, subdivision 19a; 

    (4) home care services when the number of foster care 
 residents is greater than four unless the county responsible for 
 the recipient's foster placement made the placement prior to 
 April 1, 1992, requests that home care services be provided, and 
 case management is provided as required in section 256B.0625, 
 subdivision 19a; or 

    (5) home care services when combined with foster care 
 payments, other than room and board payments that exceed the 
 total amount that public funds would pay for the recipient's 
 care in a medical institution. 

    Subd. 6.    Recovery of excessive payments.  The 
 commissioner shall seek monetary recovery from providers of 
 payments made for services which exceed the limits established 
 in this section.  This subdivision does not apply to services 
 provided to a recipient at the previously authorized level 
 pending an appeal under section 256.045, subdivision 10. 

    Subd. 7.    Noncovered home care services.  The 
 following home care services are not eligible for payment under 
 medical assistance:  

    (1) skilled nurse visits for the sole purpose of 
 supervision of the home health aide; 

    (2) a skilled nursing visit: 

    (i) only for the purpose of monitoring medication 
 compliance with an established medication program for a 
 recipient; or 

    (ii) to administer or assist with medication 
 administration, including injections, prefilling syringes for 
 injections, or oral medication set-up of an adult recipient, 
 when as determined and documented by the registered nurse, the 
 need can be met by an available pharmacy or the recipient is 
 physically and mentally able to self-administer or prefill a 
 medication; 

    (3) home care services to a recipient who is eligible for 
 covered services including hospice, if elected by the recipient, 
 under the Medicare program or any other insurance held by the 
 recipient; 

    (4) services to other members of the recipient's household; 

    (5) a visit made by a skilled nurse solely to train other 
 home health agency workers; 

    (6) any home care service included in the daily rate of the 
 community-based residential facility where the recipient is 
 residing; 

    (7) nursing and rehabilitation therapy services that are 
 reasonably accessible to a recipient outside the recipient's 
 place of residence, excluding the assessment, counseling and 
 education, and personal care; 

    (8) any home health agency service, excluding personal care 
 assistant services and private duty nursing services, which are 
 performed in a place other than the recipient's residence; and 

    (9) Medicare evaluation or administrative nursing visits on 
 dual-eligible recipients that do not qualify for Medicare visit 
 billing. 

    Subd. 8.    Personal care assistant services.  
 Recipients of personal care assistant services may share staff 
 and the commissioner shall provide a rate system for shared 
 personal care assistant services.  The rate system shall not 
 exceed 1-1/2 the amount paid for providing services to one 
 person, and shall increase incrementally by one-half the cost of 
 serving a single person, for each person served.  A personal 
 care assistant may not serve more than three children in a 
 single setting. 

    Nothing in this subdivision shall be construed to reduce 
 the total number of hours authorized for an individual recipient.

    HIST: 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