Home Care Licensing Changes FAQs
During the 2013 Session, the Legislature passed new law that changes the way MDH licenses home care providers (see July 2013 Notice: Important notice to MDH licensed home care providers (PDF: 186KB/3 pages)). The current “Classes” of licenses (i.e. Class A,B,C,F) will be replaced by two types of home care licenses: either Basic or Comprehensive. While new home care licensees will begin to comply with the new law beginning January 1, 2014, there will be a transition period for existing providers.
We are establishing an area of frequently asked questions with responses so that we may continue to communicate information about these changes. Below is a brief overview of next steps for current and new providers, as well as a growing list of FAQ’s. This document will continue to be updated as new questions come in - if you do not find the answer to your question
below, please submit your question to: Health.firstname.lastname@example.org
On this page:
Basic vs. Comprehensive License
Bill of Rights UPDATED
Changes of Ownership
Convert to Basic/Comprehensive Provider
Do I Need a Home Care License?
Medication Management UPDATED
Nurse Practice Act
Posting of License
Statement of Home Care Services
Uniform Consumer Information Guide
I am a current home care provider. What do I need to do?
Starting July 1, 2014, all home care providers licensed by MDH prior to January 1, 2014 will transition to the new set of requirements upon their regular license renewal date (any renewals occurring prior to July 1, 2014 will renew based on your existing license classification). You should therefore continue to operate under your existing license and current law until the date of your renewal occurring between July 1, 2014 and June 30, 2015. More information will be provided to you about how to convert to the new license classification as we near July 1, 2014.
I would like to become a new home care provider. What set of laws do I follow?
Through the end of 2013, new license applications should be submitted based on the current law and using the current license applications. Beginning January 1, 2014, MDH will begin to accept applications for new licenses under the new law. MDH is working on creating new application
forms, which will be available on our website later this year. See Minn. Stat. Sec. 144A.473 for more information about temporary licenses.
Note – All responses should be reviewed in conjunction with applicable home care licensing regulations.
Is a LPN permitted to conduct the required 90-day Comprehensive Home Care monitoring and reassessment every-other-time under the direction of a registered nurse (meaning LPN/RN/LPN/RN etc.)?
A registered nurse (RN) may elect to assign to a Licensed Practical Nurse (LPN) the nursing task of the ongoing client monitoring and reassessment that is required by Minn. Stat. Sec. 144A.4791, subd. 8(c). This is because Minn. Stat. Sec. 148.171, subd. 14 states that it is within a LPN’s scope of practice to conduct focused assessments; however, this same statute requires an LPN to report any changes in the condition or needs of a client to a RN. The RN scope of practice includes providing a comprehensive assessment and evaluating responses to interventions and the effectiveness of the plan of care. Therefore, an RN should conduct reassessments triggered by changes in a client’s condition.
Refer to the Minnesota Board on Nursing (MBN) and/or Minn. Stat. Sec. 148.171, subd.’s 14 & 15 for the scope of practice or an LPN and RN respectively. You may also refer to the document by the MBN that provides scope statements shown in a side‐by‐side format (PDF) to assist in comparing and contrasting the respective scopes of practice.
Please note that according to Minn. Stat. Sec. 144A.4791, subd. 8(a), the individualized initial assessment must be completed by a registered nurse. (10/31/13)
I am not sure which category I am in: Basic or Comprehensive.
The determination of the new license-type will be based on whether you provide basic or comprehensive home care services. Home care services that may be provided with a Basic Home Care license are delineated in Minn. Stat. Sec. 144A.471, subd. 6. Home care services that may be provided with a Comprehensive Home Care license include any of the basic home care services, as well as at least one of the services listed in Minn. Stat. Sec. 144A.471, subd. 7. (9/9/13)
The new home care bill of rights differs from the current (2007) version. Will home care providers be required to provide (and obtain proof of such) the “new” version to home care clients that came in under the 2007 BOR version? If so, how long do providers have to make this transition?
Changes made to the home care bill of rights were mainly clarifying language; the intent of the bill of rights has not changed. All existing providers will be asked to convert to either the Comprehensive Home Care license or the Basic Home Care license based on their existing license renewal dates, starting July 1, 2014. Upon their renewal date (and conversion to the new license), providers are expected to be in compliance with all requirements set forth in the new laws, including home care provider’s responsibility to provide the client written notice of the home care bill of rights. This means that every existing licensee has until at least July 1, 2014, to meet the new requirements.
For new home care providers, MDH will begin to accept applications for new licenses under the new law beginning January 1, 2014. Therefore, anyone submitting an application that will be received on or after January 1, 2014, will be subject to the new licensing structure and will need to comply with the new requirements upon application. The new home care bill of rights will be made available on our website when the new license applications are also available later this year.
Please note that the new laws contain several effective dates and these have caused some confusion about when MDH will be implementing the new requirements (including the changes to the home care bill of rights). Please refer to the information above for the correct effective dates of the new home care bill of rights, as well as to our document providing clarification on the effective dates of the new home care provider laws (PDF). See Minn. Stat. Sec. 144A.44 for the changes made to the home care bill of rights. (9/9/13; UPDATED 10/31/13)
I note that this change of ownership (CHOW) language does not require the newly licensed owner to abide by the new licensing laws (Basic or Comprehensive) or state the new license will be a temporary license – is that the case? Is the October 1, 2013 CHOW date based on WHEN MDH issues the new license (in other words, CHOWs currently being submitted), or only for CHOW applications being submitted after September 30, 2013? Put another way, how will CHOW applications dated September 30, 2013 be handled and charged?
Will CHOWs processed beginning October 1, 2013 be issued a temporary comprehensive or basic license?
The new law requires that all change of ownership (CHOW) applications received in our office on or after October 1, 2013, will be required to pay a fee in the amount of either $4,200 or $2,100. The amount of the CHOW fee will be based on services the new owner intends to provide; providers who provide nursing, delegated nursing, or professional health care services
must submit a CHOW fee of $4,200. All other providers must submit $2,100 fee with their CHOW application. A temporary license will not be issued to new owners due to a change of ownership.
It is also true that CHOW applicants will be issued their new license for one year, and based on the current licensure law. So while a higher fee applies to applications received as of October 1, 2013, these applications will be made using the current license applications. After July 1, 2014, existing providers will be required to convert to the new licensing structure upon their renewal – any CHOW’s made after a home care provider has converted will need to be submitted according to the new law. See Minn. Stat. Sec. 144A.481 subd. 1(d). (9/9/13)
Can a current provider “opt in” to the new regulations prior to their post July 2014 renewal date?
No; existing providers must follow the effective dates of their current home care license. Existing home care providers will be required to convert to either the Comprehensive Home Care license or the Basic Home Care license based on their existing license renewal dates, starting July 1, 2014. (9/9/13)
Can you please advise whether under the revised home care provider licensing laws, an individual nursing assistant in the state of Minnesota would be required to obtain a home care provider license when the individual is providing home care services on a full time basis and being paid for the care? The individual would be working independently and would not associated with any licensed home care provider.
A home care license is required for an individual nursing assistant or other unlicensed person, if the individual is regularly engaged in the delivery of at least one home care service, directly in a client's home for a fee and is was not otherwise exempted or excluded from licensure.
You may also refer to:
Minn. Stat. Sec. 144A.43, Subd. 4 for the definition of a home care provider.
Minn. Stat. Sec. 144A.43, Subd.3 for the definition of a home care service.
Minn. Stat. Sec. 144A.471, Subd. 3 for the determination of “regularly engaged.”
Minn. Stat. Sec. 144A.471, Subd. 1 for the requirement of a home care license for home care providers.
Minn. Stat. Sec. 144A.471, Subdivisions 8 & 9 for exemptions and exclusions from home care licensure respectively.
It is our understanding that MDH will not be processing any home care license applications in the month of December 2013. In order not to be affected by the moratorium, is there a deadline for submission of a Class A home care license application so it can be processed and approved before then? Also, how long does it take to process a Class A home care license application for a new provider?
There is no moratorium on any license at any point. MDH will begin to accept applications for temporary licenses on January 1, 2014. Through the end of 2013, initial applications may be submitted based on the current law and using the current license applications. The license issued will be based on when the application was received, since it is the date received that determines which license application (and set of laws) applies.
No change has been made to the current law that allows MDH up to 90 days to process an initial license application from the date MDH has a complete application. Refer to Minn. Stat. Sec. 144A.481, subd. 1. (9/9/13)
What is Integrated Licensing and how can I find out more information about it?
Minnesota Statutes 144A.43-144A.47 requires providers of home care services to be licensed by MDH. Effective July 1, 2013 legislation passed (Ch 108, art 11, sec 31 (page 511) (PDF)) and requires MDH and DHS to develop and recommend to the legislature in 2014 an integrated licensing system for those agencies that provide both home care services under 144A and Home and Community Based Services (HCBS) required to be licensed under Minn. Stat. Sec. 245D.
The law also creates an interim process whereby providers currently licensed by MDH as a Class
A, Class B, Class C, or Class F home care provider under Minnesota Statute 144A may also
provide HCBS services subject to licensure under Minnesota Statute 245D, without obtaining a
245D license. MDH licensed home care providers who provide HCBS subject to licensure under 245D must enroll with DHS Provider Enrollment and must comply with all other requirements under 245D.
There are exceptions in which a home care provider may be required to obtain a 245D license. For example, a 144A licensed home care provider that provides “foster care services” defined
under one of the disability waivers (EW is excluded) in a corporate adult foster care (AFC) home
where ALL residents of the home receive ‘foster care services” or supported living services licensed under 245D MUST convert the AFC license to a 245D-Community Residential Setting (CRS) license. In order to hold a 245D-CRS license the provider must also hold a 245D-Home and Community based Services (HCBS) program license. So, these subset of providers otherwise NOT required to obtain a 245D license, must obtain a 245D-HCBS license and have their AFC license convert to a 245D0-CRS license.
Housing with Services establishments and Home Management providers registered by MDH are not licensed home care providers and are not included in the integrated licensing.
More information will be available soon to providers regarding the interim integrated licensing requirements. (9/9/13)
Can unlicensed personnel “draw up” insulin when delegated by a nurse and with prescriber orders? What other injections can unlicensed personnel administer when delegated by a nurse?
According to Minn. Stat. Sec. 144A.4795, subd. 4, a “registered nurse or licensed health professional may delegate tasks only to staff that are competent and possess the knowledge and skills consistent with the complexity of the tasks and according to the appropriate Minnesota Practice Act.” This means that under a Comprehensive Home Care license, a registered nurse may delegate nursing tasks to properly trained and competent unlicensed personnel. For each client, the decision to delegate a nursing task should take into consideration the competency of the unlicensed personnel performing the delegated task, the complexity of the task, the condition and/or stability of the client, and the degree of supervision needed to ensure safe performance of the delegated task. The decision to delegate any task must also be in accordance with the home care provider’s policies and procedures. Examples of nursing tasks that may be delegated to properly trained and competent unlicensed personnel include dialing up and drawing up of insulin, administration of insulin pens, and other injectables.
Please note that there is not a standard for all situations; the decision to delegate is a discretionary choice, and the registered nurse is expected to exercise professional judgment on a case-by-case or situation-specific basis. Please refer to the Minnesota Nurse Practice Act Toolkit for the definitions of professional and practical nursing, and their respective scopes of practice.
Refer to Minn. Stat. Sec. 144A.4795 for training requirements, training content and competency evaluations of unlicensed personnel completing delegated tasks, the delegation of home care tasks, and requirements for instructors and competency evaluators. Regarding the delegation of medication administration specifically, refer to Minn. Stat. Sec. 144A.4792, subd. 7. (10/31/13)
Does the medication assessment only include medications that are set up or does it also include dispensing medications from a prescription bottle?
Every client’s medication assessment should include all medications the client is known to be taking. Minn. Stat. Sec. 144A.4792, subd. 2 states that for each client who requires medication management services, the comprehensive home care provider must conduct an assessment to determine what medication management services will be provided and how the services will be provided. This assessment must also identify and review all medications the client is known to be taking, including prescriptions, over-the-counter drugs and dietary supplements. (10/31/13)
Is it correct that the concept of “Central Storage of Medications” no longer exists, rather it is replaced by the definition of “Medication Management” (which includes “storing and securing medications”)?
It is correct that the new home care law does not include a separate section regarding “Central
Storage of Medications”. The requirements for medication storage are now located in a section
called “Medication Management”. According to Minn. Stat. Sec. 144A.4792, subd. 1(c), controlling and storing of medications are among the items that must be addressed in the
Comprehensive Home Care provider’s written medication management policies and procedures.
Additionally, each individualized medication management plan must include a description of
storage of medications, along with any other related information (See Minn. Stat. Sec. 144A.4792, subd. 5 Individualized medication management plan). (9/9/13)
Which registered nurse is considered “in charge” as noted in 144A.4792, subd. 16 - the nurse in charge of the agency or in charge of the client?
Minn. Stat. Sec. 144A.4792, subd. 16 states that “when a written or electronic prescription is received, it must be communicated to the registered nurse in charge and recorded or placed in the client’s record”. This registered nurse may be either the nurse in charge of the agency or the nurse in charge of the client’s services. (9/9/13)
Can you provide clarification on the changes to Nurse Practice Act?
The Minnesota Nurse Practice Act was recently amended to revise the definitions of professional
and practical nursing. The Minnesota Board on Nursing (MBN) has posted a document to their
website that goes over the changes to the definitions of the terms used within the scope of
nursing practice (PDF). The document also provides scope statements shown in a side‐by‐side format to assist in comparing and contrasting the respective scopes of practice. Changes to the Minnesota Nurse Practice Act were effective August 1, 2013.
Please contact the MBN and/or their Nurse Practice Act Toolkit for more information about the changes to the laws and rules that govern nursing practice in Minnesota. (9/9/13)
Is it correct that when comprehensive home care is not provided in a registered Housing with Services setting (most likely in a private home or apartment), a copy of the home care license does not need to be posted in the home or apartment where services are being delivered?
Yes, it is true that a home care license does not have to be posted in every location where the services are being provided. Just as in current law, the current license should be displayed in the home care provider’s principal business office (this may or may not be the same address as a registered Housing With Services establishment). Any branch offices would require copies of the original current license be posted. Refer to Minn. Stat. Sec. 144A.479, subd. 1 Display of License. (9/9/13)
Can you clarify what my fee would be for my current license?
Beginning July 1, 2014, all home care providers licensed by MDH prior to January 1, 2014 will be required to convert to the new license classification upon their regular license renewal date (any renewals occurring prior to July 1, 2014 will renew based on your existing license classification). The license renewal fees for both the Comprehensive and the Basic licenses will be based on your annual revenue derived from the provision of home care services. The new home care license renewal fees are located in Minn. Stat. Sec. 144A.472, subd.7(c).
However, the new home care legislation also sets forth a two-year phase-in period of new renewal fees for current licensees. Minn. Stat. Sec. 144A.481. subd. 3(b) states “The fees charged for licenses renewed between July 1, 2014, and June 30, 2016, shall be the lesser of 200 percent or $1,000, except where the 200 percent or $1,000 increase exceeds the actual renewal fee charged, with a maximum renewal fee of $6,625”.
In other words, renewal fees during this two-year phase-in period will reflect either a $1,000
increase, or double the current fee if the doubled amount is less than $1,000. Just as it exists
now, a guide to the renewal fee amounts will be provided in the new license applications to assist
in determining the appropriate fee. For information about the transition period for current
licensees, refer to Minn. Stat. Sec. 144A.481, subd. 3. (9/9/13)
Is the “service plan” and the “service agreement” now one document?
All home care providers (both Comprehensive and Basic) will be required to maintain a service
plan – a service agreement is no longer a requirement under the new law. For the contents of the
service plan required for Comprehensive and Basic licenses, please refer to Minn. Stat. Sec.
144A.4791, subd. 9. (9/9/13).
Does MDH plan to provide a statement of home care services for providers to use so that there is consistency in this notification to clients/representative?
A home care provider must provide to the client or the client’s representative a written statement which identifies if the provider has a basic or comprehensive home care license, the services the provider is authorized to provide, and which services the provider cannot provide under the scope of the provider’s license. MDH does plan to provide a Statement of Home Care Services form for Comprehensive and Basic home care providers to use to ensure consistency. The Statement of Home Care Services form will be made available on our website when the new license applications are available later this year. See Minn. Stat. Sec. 144A.4791, Subd. 3 for information about the Statement of Home Care Services. (10/14/13)
Are providers who are issued a temporary home care license required to have an initial MDH survey within 12 months or within 14 months?
Pursuant to Minn. Stat. Sec. 144A.473, subd. 2(b), the new law states that MDH will complete a survey within one year of issuing the temporary license. The survey will occur after MDH has been notified that the temporary licensee is providing home care services. Under limited circumstances MDH is allowed an extra two months to conduct the survey because of language in Minn. Stat. Sec. 144A.473, subd. 2(e).
If the temporary licensee does not have clients until 45 days before their temporary license expires, MDH can extend the temporary license for up to 60 days in order to allow MDH the time to conduct and complete the survey. (9/9/13)
Under the new system of requirements, would MDH require all providers to re-do the training and competency testing for all their employees?
Upon conversion to the new licensing-type, current providers will just need to document the training they already provided to all staff providing home care services for all of the topics that remained the same from the previous to the new licensing-structure. For those topics of training that are new, providers will need to make sure to train (and provide competency evaluations, when applicable) on those topics, and then document the training of those topics in the employee’s record. Refer to Minn. Stat. Sec. 144A.4795 for the new requirements relating to the training and competency requirements of all staff providing home care services. (12/4/13)
What level of detail is expected for the annual staff training requirement to review the provider’s policies and procedures relating to the provision of home care services and how to implement those policies and procedures? It would certainly take up more than the entire eight annual hours of training to review all agency specific home care policies and procedures!
Minn. Stat. Sec. 144A.4796, subd. 1 states that “all staff providing and supervising direct home care services must complete an orientation to home care licensing requirements and regulations before providing home care services to clients”. Part of the required orientation content listed in subdivision 2 includes an “introduction and review of all the provider’s policies and procedures related to the provision of home care services”.
One of the purposes of the annual training (required by Minn. Stat. Sec. 144A.4796, subd. 6) is to ensure continued staff awareness and comprehension of these policies; it should therefore serve as a reminder or “refresher” of policies and procedures staff should already be aware of and performing. If a provider is experiencing agency-wide issues with implementing a policy for example, more than the required eight hours may be necessary to maintain compliance in that area. (9/9/13)
Comprehensive home care staff orientation includes some topics that were not required for orientation training under Class F or Class A. Will a Comprehensive Home Care provider be required to retroactively go back and train previously hired staff on the additional requirements, or will they be “grandfathered” in, or if required, how long do providers have to make this transition?
Minn. Stat. Sec. 144A.4796, subd. 1 states that “all staff providing and supervising direct home care services must complete an orientation to home care licensing requirements and regulations before providing home care services to clients. The orientation may be incorporated into the training required under subdivision 6”.
Existing providers will be required to convert to either the Comprehensive Home Care license or the Basic Home Care license based on their existing license renewal dates, starting July 1, 2014. There will not be any “grandfathering” of current staff regarding the home care orientation requirements. Upon conversion to the new license, providers are expected to be in compliance with all requirements set forth in the new law, including the staff orientation to home care licensing requirements and regulations. This means that every existing licensee has until at least July 1, 2014 to meet the new requirements. (9/9/13)
Will you be updating the uniform consumer guide? How and when will this change?
No; the Uniform Consumer Information Guide (UCIG) may reflect a few updates, but no major change is planned for this form. However, please note that a 2013 update to Minn. Stat. Sec. 144D.08 now excludes Housing With Services (HWS) establishments that are serving the homeless from having to provide a UCIG to residents. Therefore, there were no changes to the information required in the UCIG, but who is required to comply with the UCIG requirement has been amended to exclude only HWS establishments that are serving the homeless. (10/14/13)
What will be the process for the pursuit of a waiver?
The new law only allows for innovation variances, which may be granted to allow a home care provider to offer home care services of a type or in a manner that is innovative. Applications may be made in writing at any time; the specific requirements to apply for an innovation variance are outlined in Minn. Stat. Sec. 144A.478, subd. 4. (9/9/13)