MA Reimbursement Rates For Independent Private Duty Nursing Increase
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1 # Bulletin June 6, 2001 Minnesota Department of Human s 444 Lafayette Rd. St. Paul, MN OF INTEREST TO! County Directors! Administrative Contacts: CAC, CADI, TBI, PAS, MR/RC, EW, AC! Private Duty Nurses! Home Health Agencies! County Public Health! Health Care Plans ACTION Please read this bulletin and implement as specified. EFFECTIVE DATE June 15, 2001 MA Reimbursement s For Independent Private Duty Nursing Increase TOPIC Private duty nurses (PDNs) who are independent (self-employed) will receive the same rates as PDNs who are employees of agencies beginning with dates of service June 15, 2001 and later. PURPOSE Inform counties of the changes of codes and rates for PDNs who are independent. Inform PDNs of the increased rates for independent PDN services. CONTACT CSMD Resource Center (651) or 1 (800) FAX (651) Provider Help Desk (651) , (800) FAX (651) For TTY, contact Minnesota Relay at 1 (800) Minnesota Department of Human s Community Supports for Minnesotans with Disabilities (CSMD) 444 Lafayette Road North St. Paul, Minnesota SIGNED MARIA R. GÓMEZ Assistant Commissioner
2 Page 2 BACKGROUND Minnesota has a strong commitment to providing home and community-based support options for people with disabilities and special health care needs. Our state s experience over the past two decades demonstrates that most individuals currently institutionalized can be appropriately served in home and community-based settings at a cost reasonable to the state. Additionally, the 1999 ed States Supreme Court Olmstead decision affirmed that states have an obligation to ensure that people with disabilities are not forced to move to or remain in segregated or institutional settings. This bulletin is the first in a series designed to introduce program and administrative changes that will result in increased access to community services and supports for Minnesotans with disabilities and special health care needs as well as strengthen the capacity of Minnesota s communities to respond to their needs. The first administrative change is increasing the Medical Assistance (MA) rate for independent (selfemployed) private duty nurses (PDNs). This step is intended to help increase the availability of this service and provider choice for consumers with disabilities and special health care needs. PDN PROCEDURE CODE AND RATE CHANGES Medical Assistance offers a menu of home care services that includes private duty nursing by either registered nurses (RNs) or licensed practical nurses (LPNs). Currently, independent (self-employed) PDNs receive a lower rate than nurses employed by agencies. To increase the availability of this service to consumers, rates for independent PDNs are being increased to the same rate provided to PDNs employed by agencies. To bill for PDN services, separate procedures codes have been used to distinguish between independent and agency PDNs. The separate codes applied to both MA home care services and to extended services available through the Community Alternatives Care (CAC) waiver. Other waivers, Elderly Waiver (EW), Community Alternatives for Disabled Individuals (CADI) and the Traumatic Brain Injury Waiver (TBIW), also provide extended services but do not distinguish between independent and agency employed PDNs. Nursing agencies, independent PDNs and county case managers are to begin using the same procedure codes and rates for independent PDNs that are used for PDNs employed by agencies. This change will take effect for dates of service June 15, 2001 and later. The current PDN - Independent and PDN - Independent codes will be eliminated on that date. The procedure codes and rates to use for MA and CAC are listed below. For EW, CADI, and TBIW, use the existing codes for extended services for independent PDNs.
3 Page 3 Active s - MA/MinnesotaCare Home Care s LPN - Private Duty X minutes $5.17 LPN - Private Duty 1:2 X Y 15 minutes $3.88 LPN - Private Duty (Vent Dependent) X minutes $6.01 RN - Private Duty X minutes $6.73 RN - Private Duty 1:2 X Y 15 minutes $5.05 RN - Private Duty (Vent Dependent) X minutes $7.60 Discontinued s for MA/Minnesota Care Home Care LPN - Independent LPN - Independent 1:2 RN - Independent RN - Independent 1:2 X5642 X5642 X5641 X5641 CAC Program s Active s LPN - Home Health, X minutes $10.31 LPN - Home Health, 1:2 LPN - ICU - Home Health, LPN - Vent. Dep.-Home Health, X Y 30 minutes $7.74 X minutes $13.15 X minutes $12.02 RN - Home Health, X minutes $13.48 RN - Home Health, 1:2 X Y 30 minutes $10.11 RN - ICU - Home Health, X minutes $17.53
4 Page 4 CAC Program s Active s RN - Supervision of Independent PDN RN - Vent. Dep.- Home Health, X minutes $7.29 X minutes $15.19 Discontinued s for CAC LPN - Independent Home Health, LPN - Independent Home Health, 1:2 RN - Independent Home Health, RN - Independent Home Health, X5267 X5267 X5266 X5266 Home care agencies, nurses and county case managers should watch for a future bulletin with provider rate increases effective upon legislative approval. NOTICE TO INTERESTED NURSES Independent (self-employed) PDNs must enroll as providers of MA services with the Department of Human s (DHS). RNs and LPNs interested in providing private duty nursing without being an employee of a home care agency are encouraged to contact the DHS Provider Enrollment Division at (651) or 1 (800) to request enrollment materials. Independent private duty nurses should also contact county social service agencies to inform waiver case managers of their availability to provide PDN services. LPNs providing independent private duty nursing are required to hold a Class A home care license through the Minnesota Department of Health. RNs are exempt from this requirement. For information, call Mary Mather at (651)
5 Page 5 LEGAL AUTHORITY Minnesota Statutes, sections 256B.0625 and 256B.0627 Minnesota Statutes, chapter 144A RESOURCES ON THE INTERNET Minnesota Statutes and Rules: DHS bulletins from1999 on: ALTERNATIVE FORMATS This information is available in other forms to persons with disabilities by calling (651) , or contact us through the Minnesota Relay at 1 (800) (TTY) or 1 (877) (speech-to-speech relay service).
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