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Frequently Asked Questions for Providers of Home Care and Assisted Living ServicesExpand All Collapse All
Is an 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 Minnesota Statutes, section 144A.4791, subdivision 8 (c). This is because Minnesota Statutes, section 148.171, subdivision 14 states that it is within an 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 an 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 of Nursing (MBN) and/or Minnesota Statutes, section 148.171, subdivisions 14 & 15 for the scope of practice for 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 Minnesota Statutes, section 144A.4791, subdivision 8 (a), a registered nurse must complete the individualized initial assessment.
As a comprehensive licensee, do I need to follow the requirements under Minnesota Statutes, section 144A.4791, subdivision 8 Comprehensive assessment, monitoring and reassessment, for a client who receives only basic home care services? Should a comprehensive licensee obtain a separate basic license in order to avoid the comprehensive requirements for basic clients?
The initial assessment or review of a client will determine the services the client will receive. A comprehensive licensee who is providing basic level services to a client may follow the requirements of Minnesota Statutes, section 144A.4791, subdivision 7 Basic individualized client review and monitoring, when the only services provided are basic services. The provider does not need to obtain a basic license to use this method of client review and monitoring to serve clients receiving only basic services.
If a home care provider elects to become a comprehensive-licensed home care agency, but only wants to provide a very limited number of nursing or delegated services and all other services provided are permitted with a basic license, are the following statements correct?
Scenario: A client of a comprehensive-licensed home care agency only requires services that are allowed with a basic license. The comprehensive-licensed agency will be in compliance with comprehensive statutes if they are compliant with the following:
- Training of unlicensed personnel can be compliant with basic licensing requirements as specified in Minnesota Statutes, section 144A.4795, subdivisions 3 & 7.
- Individualized basic client review and monitoring can be compliant with basic licensing requirements (need not be done by an RN, initial review must be completed within 30 days, on-going client monitoring and review cannot exceed 90 days from the date of the last review). See Minnesota Statutes, section 144A.4791, subdivision 7.
- Supervision of staff can be compliant with the basic licensing requirements. See Minnesota Statutes, section 144A.4797, subdivision 2.
- The licensee must use the Statement of Home Care Services for the comprehensive license and check only those services that are offered by the licensed home care agency. See Minnesota Statutes, section 144A.4791, subdivision 3.
If the client, whether at the initial review or subsequently, needs services covered by a comprehensive license the provider must immediately follow comprehensive statutes for staff training, assessments and monitoring, and supervision of services.
Where can I find the correct version of the home care bill of rights to give to my clients?
The home care bill of rights (BOR) is available on the MDH website in several languages. The version of the BOR a provider uses is based on the following criteria:
- Whether the provider is state-licensed only or Medicare certified.
- Whether the client is receiving assisted living services in a housing with services establishment or not.
- Whether the provider is exempt from having a home care license (but still required to provide clients with the home care bill of rights).
Home care bill of rights
(1/21/2016; Updated 7/25/2017)
When is a change of ownership application required?
A home care license may not be transferred to another party. If you are considering purchasing a home care business, you must complete a change of ownership (CHOW) application before the sales transaction occurs. MDH has 60 days from the date a completed application is received to process the CHOW. Please review the application for information about what is required. See Minnesota Statutes, section 144A.472, subdivision 5 for more information.
(1/21/2016; Updated 7/25/2017)
Can you clarify what is considered a complex or specialty care?
Below is a partial list of the types of clients who may require complex or specialty care. It is not all-inclusive.
- Spinal cord injury
- Acquired brain injury
- Pediatric care
- Cerebral Palsy
- Muscular Dystrophy
- Multiple Sclerosis
- Huntington's Disease
- Locked-in Syndrome
- Motor Neuron Disease (such as ALS)
- Ventilated clients
The Minnesota Department of Health issues many correction orders for TB prevention and control. Can you tell us what is typically found on survey and what are the best resources for providers to use to get the most up to date information about TB prevention and control?
Minnesota Statutes, section 144A.4798 DISEASE PREVENTION AND INFECTION CONTROL, Subdivision 1. Tuberculosis (TB) infection control states:
(a) A home care provider must establish and maintain a comprehensive tuberculosis infection control program according to the most current tuberculosis infection control guidelines issued by the United States Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination, as published in the CDC's Morbidity and Mortality Weekly Report. This program must include a tuberculosis infection control plan that covers all paid and unpaid employees, contractors, students, and volunteers. The commissioner shall provide technical assistance regarding implementation of the guidelines.
(b) The home care provider must maintain written evidence of compliance with this subdivision.
MDH has issued correction orders for the following reasons; failure to:
- Complete the required facility TB risk assessment;
- Develop and implement written TB infection control procedures; and
- Educate health care workers on TB pathogenesis and transmission, signs and symptoms of active TB disease, and the provider’s infection control plan.
In addition, correction orders have been issued for failure to:
- Screen employees prior to working with clients and appropriately document the screening. Screening of employees must include:
- Assessing for current symptoms of active TB disease;
- Assessing TB history; and
- Testing for the presence of infection with Mycobacterium tuberculosis by administering either a two-step TST (tuberculin skin test) or a single IGRA (interferon gamma release assay).
Please note, if the first step of the two-step TST is negative the employee may begin working with clients (if the TST is dated within 90 days before hire) but must have the second TST test within 21 days after hire.Clarification of the two-step TST:
The first step of the two-step TST is to have an injection of tuberculin purified protein derivative (PPD) into the inner surface of the forearm, wait for 48 to 72 hours, and have the skin test reaction read. The second step of the two-step TST is to repeat this test seven to 21 days after the first TST is read. This two-step approach is used to reduce the likelihood that a boosted reaction to a subsequent TST will be misinterpreted as a recent infection. A diagram of the two-step TST can be viewed on the MDH website:
Providers can review Regulations for Tuberculosis Control in Minnesota Health Care Settings (PDF) for more information about tuberculosis infection control including the screening and training of employees and the requirements for documentation of screening.
What is the expectation of MDH regarding Minnesota Statutes, section 144A.479, subdivision 6 (b) for individual abuse prevention plans?
The statute requires that home care providers develop and implement individual abuse prevention plans for each vulnerable adult or minor for whom home care services are provided. In summary, that means:
- Every client must have a plan, minors included.
- The plan must include an individualized assessment of the client’s:
- susceptibility to abuse by other individuals, including other vulnerable adults or minors;
- risk of abusing other vulnerable adults or minors.
- It must include a statement of the specific measures to be taken to minimize the risk of abuse to that person and other vulnerable adults or minors.
- For the purposes of the abuse prevention plan, the term "abuse" includes self-abuse.
- The plan should be complete, accurate and updated with any changes. If it is noted in the client’s record that the client has behavioral issues this should be addressed in the individual abuse prevention plan. If, for example, the provider did a baseline assessment, and a year later the client's dementia has worsened and services have changed, the provider must update the abuse prevention plan to be in alignment with the client’s current condition.
Interventions should be individualized.
What is integrated licensing and how can I find out more information about it?
As of July 1, 2015, licensed home care providers that also provide basic support services that would otherwise require licensure under chapter 245D may apply for an integrated license: home and community-based services (HCBS) designation on their home care licenses. Providers that hold the integrated license do not need a 245D license to provide basic support services as defined in Minnesota Statutes 245D.03 (b).
A list of questions and answers about this topic can be found at:
(1/21/2016, updated 6/22/17)
What is the expectation for Minnesota Statutes, section 144A.4792, subdivision 2 Provision of medication management services?
(a) For each client who requests medication management services, the comprehensive home care provider shall, prior to providing medication management services, have a registered nurse, licensed health professional, or authorized prescriber conduct an assessment to determine what medication management services will be provided and how the services will be provided. This assessment must be conducted face-to-face with the client. The assessment must include an identification and review of all medications the client is known to be taking. The review and identification must include indications for medications, side effects, contraindications, allergic or adverse reactions, and actions to address these issues.
(b) The assessment must identify interventions needed in management of medications to prevent diversion of medication by the client or others who may have access to the medications. "Diversion of medications" means the misuse, theft, or illegal or improper disposition of medications.
MDH expects that the provider conduct a face-to-face assessment with the client to review all medications the client is known to be taking. The client’s record should contain documentation of the client’s individualized medication assessment, including the nurse or other health professional’s review and identification of indications for medications, side effects, contraindications, allergic or adverse reactions, and actions to address these issues. The provider is free to use their pharmacy, a drug reference book, or other appropriate professional resource to obtain the information required in the review of medications. The assessment documentation must also identify the provider’s interventions used to manage diversion of medications, including any individualized interventions necessary in respect to the client’s medications that may pose a risk of diversion.
Does the language in subdivision 11 (below) mean that a comprehensive home care provider can elect to NOT require or have on file prescriptions for medications it agrees to manage in the Service Plan?
[Minnesota Statutes, section 144A.4792, subdivision 11. Prescribed and non-prescribed medication. The comprehensive home care provider must determine whether the comprehensive home care provider shall require a prescription for all medications the provider manages. The comprehensive home care provider must inform the client or the client's representative whether the comprehensive home care provider requires a prescription for all over-the-counter and dietary supplements before the comprehensive home care provider agrees to manage those medications.]
The language indicates that a provider can choose to require a physician’s order for over-the-counter and dietary supplements. The provider’s choice to require a prescription should be shared with the client and client’s representative prior to providing medication management services. Whether the provider chooses to require a prescription or not, all of the client’s over-the-counter and dietary supplements managed by the provider should be included in the client’s individualized medication management plan.
Does the language in subdivision 13 (below) mean that a comprehensive home care provider must have on file prescriptions for medications it agrees to manage in the service plan?
[Minnesota Statutes, section 144A.4792 subdivision 13. Prescriptions. There must be a current written or electronically recorded prescription as defined in Minnesota Rules, part 6800.0100, subpart 11a, for all prescribed medications that the comprehensive home care provider is managing for the client.]
Please see Minnesota Statutes, section 144A.43, subdivision 22 for the definition of “Prescription”. This is the intended reference for the requirements related to prescriptions and this is what will be enforced for compliance with the home care regulations. The home care provider does not need to have the original signed paper prescription for all medications it manages, but it must, at a minimum, have a prescription drug order that meets the definition of “chart order” as outlined in Minnesota Statutes, section 151.01, Subdivision 16b The home care provider may use a faxed or copied version of a paper or electronic prescription provided by the filling pharmacy as long as the manual or electronic signature of the practitioner is affixed to the order. The prescription label on a medication does not serve as a prescription.
144A.43, subdivision 22. Prescription. "Prescription" has the meaning given in Minnesota Statutes, section 151.01, subdivision 16 .
(11/19/14, UPDATED 1/21/16)
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 Minnesota Statutes, section 144A.4795, subdivision 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 MBN website for the definitions of professional and practical nursing, and their respective scopes of practice.
Refer to Minnesota Statutes, section 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 Minnesota Statutes, section 144A.4792, subdivision 7.
(10/31/13, UPDATED 1/21/16, 7/24/18)
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. Minnesota Statutes, section 144A.4792, subdivision 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, UPDATED 1/21/16)
What policies are providers required to develop and implement if you offer the service of medication management?
Per Minnesota Statutes, section 144A.4792, Subdivision 1, providers and applicants for licensure must have policies in place that address the following topics:
- requesting and receiving prescriptions for medications;
- preparing and giving medications;
- verifying that prescription drugs are administered as prescribed;
- documenting medication management activities;
- controlling and storing medications;
- monitoring and evaluating medication use;
- resolving medication errors;
- communicating with the prescriber, pharmacist, and client and client representative about medications;
- disposing of unused medications; and
- educating clients and client representatives about medications.
When controlled substances are being managed, the policies and procedures must also identify how the provider will ensure security and accountability for the overall management, control, and disposition of those substances in compliance with state and federal regulations and with subdivision 22.
How is the medication management assessment done, by whom and what must be included?
Per Minnesota Statutes, section 144A.4792, subdivision 2, the medication management assessment must be conducted face-to-face with the client before providing medication management services. It can be completed by a registered nurse, licensed health professional, or authorized prescriber under section 151.37.
The assessment must include an identification and review of all medications the client is known to be taking, including indications for medications, side effects, contraindications, allergic or adverse reactions, and actions to address these issues.
The assessment also must identify interventions needed in management of medications to prevent diversion of medication by the client or others who may have access to the medications. "Diversion of medications" means the misuse, theft, or illegal or improper disposition of medications.
Can you provide clarification on the changes to Nurse Practice Act?
The Minnesota Nurse Practice Act was amended in 2013 to revise the definitions of professional and practical nursing. The Minnesota Board on Nursing (MBN) has posted a document to their website that illustrates the changes to the definitions of the terms used within the scope of nursing practice. The document also provides a side‐by‐side comparison (PDF) of the scopes of practice of RNs and LPNs. Changes to the Minnesota Nurse Practice Act were effective August 1, 2013.
More information can be found on the MBN website.
(9/9/13, UPDATED 1/21/16, 7/24/18)
Is it correct that when home care services are provided in someone’s private home or apartment (as opposed to a registered housing with services establishment), 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 correct that a home care license does not have to be posted in every location where services are provided. 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). Branch offices must post copies of the current license. Refer to Minnesota Statutes, section 144A.479, subdivision 1 Display of License.
(9/9/13, UPDATED 1/21/16, 6/22/17)
Can a provider renew a license without having provided home care services within the last 12 months?
Minnesota Statutes, section 144A.472, subdivision 3(a) states that “except as provided in section 144A.475, a license may be renewed for a period of one year if the licensee satisfies the following: (1) submits an application for renewal in the format provided by the commissioner at least 30 days before expiration of the license; (2) submits the renewal fee in the amount specified in subdivision 7; (3) has provided home care services within the past 12 months; (4) complies with sections 144A.43 to 144A.4798; (5) provides information sufficient to show that the applicant meets the requirements of licensure, including items required under subdivision 1; (6) provides verification that all policies under subdivision 1 are current; and (7) provides any other information deemed necessary by the commissioner.”
Therefore, if a provider has not provided home care services within 12 months of the license expiration date, MDH will not renew the license.
(6/12/14, UPDATED 1/21/16)
Do services such as laundry, housekeeping, meal preparation and shopping qualify as providing home care services?
Assistance with laundry, housekeeping, meal preparation, shopping, or other household chores and services must be provided in conjunction with at least one of the activities in clauses (1) to (5) to be considered as providing home care services.
- assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing;
- providing standby assistance;
- providing verbal or visual reminders to the client to take regularly scheduled medication, which includes bringing the client previously set-up medication, medication in original containers, or liquid or food to accompany the medication;
- providing verbal or visual reminders to the client to perform regularly scheduled treatments and exercises;
- preparing modified diets ordered by a licensed health professional.
A basic or comprehensive provider (including temporary licensees) must provide home care services within the license year, or the license will expire at the end of the year and the applicant must apply for a new temporary license.
Are personal care assistant services (PCA) considered licensed home care services?
If the PCA services are provided by an enrolled PCA agency to eligible Medical Assistance recipients and billed to the Department of Human Services using billing codes T1019 or QP T1019 the services are not considered home care services.
If the services are provided to private pay clients or to clients who are not enrolled with Medical Assistance and eligible to receive PCA services, they may be considered home care services.
Can you clarify what the fee will be to renew my license?
License renewal fees are based on revenue received from providing licensed home care services. . See the fee schedule at Minnesota Statute, section 144A.472, Subd. 7. Refer to the Home Care Revenue Worksheet (PDF) on the website for additional information on how to calculate your license renewal fee.
Does an email confirmation from a client/responsible party accepting a change to the service plan meet the requirements of statute? What documentation must we keep?
Email confirmation of modifications to the service plan are acceptable. The email must be printed, attached to the plan and placed in the client’s record.
Do providers need to complete a Statement of Home Care Services for all clients?
Yes, providers are required to complete a Statement of Home Care Services for ALL clients. You can use your own form or use MDH’s forms to meet this requirement. Statement of Home Care Services - Comprehensive (PDF) or Statement of Home Care Services - Basic (PDF).
(2/12/15, UPDATED 1/21/16, 6/22/17)
Are providers who are issued a temporary home care license required to have an initial MDH survey within 12 months or within 14 months?
Minnesota Statutes, section 144A.473, subdivision 2(b) 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 licensed home care services. Under limited circumstances, MDH is allowed an extra two months to conduct the survey (Minnesota Statutes, section 144A.473, subdivision 2(e).)
If the temporary licensee does not have clients until within 45 days of the temporary license expiration, 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, UPDATED 1/21/16, 6/22/17)
Can the registered nurse (RN) delegate teaching of unlicensed staff to a licensed practical nurse (LPN)? Please clarify Minnesota Statutes, section 144A.4795 Subdivision 7. (2).
An RN can delegate portions of the training of unlicensed personnel (ULP) to the LPN. The Minnesota Nurse Practice Act indicates it would be the role of the RN to identify the content of the training and the method of training. The RN can delegate the task of training to the LPN. The LPN should contact the RN if questions come up during the training that are out of the scope of the training content, if any learners have learning challenges, and for resources as needed.
Competency testing of ULP can be completed by the LPN if the competency can be objectively determined (right/wrong, pass/fail). If competency testing requires a subjective determination, the RN should complete that task. See the MBN website for further information.
(5/22/15, UPDATED 6/22/17)
Does an unlicensed staff person who is on the nursing assistant registry need to be competency tested by the home care RN on the training/competency requirements in Minnesota Statutes, section 144A.4795, subdivision 7, (b) and (c)?
Staff who meet the requirements of Minnesota Statutes, section 144A.4795, subdivision 3 (b) (2) “satisfy the current requirements of Medicare for training or competency of home health aides or nursing assistants, as provided by Code of Federal Regulations, title 42, section 483 or 484.36” do not need to be competency tested by the home care RN on the training/competency requirements in Minnesota Statutes, section 144A.4795, Subdivision 7 (b) and (c).
Please note: Subdivision 4, Delegation of home care tasks. “A registered nurse or licensed health professional may delegate tasks only to staff who are competent and possess the knowledge and skills consistent with the complexity of the tasks and according to the appropriate Minnesota practice act.” This indicates that even for staff who meet the requirements at 144A.4795 Subdivision 3 (b) (2), the registered nurse or other health professional would need to ensure appropriate delegation of tasks to meet the client’s individual needs and preferences.
Does an unlicensed staff person need to be re-trained in a delegated task that they have not performed recently?
The registered nurse or licensed health professional must ensure that, prior to the delegation of tasks, the unlicensed personnel is trained in the proper methods to perform the tasks or procedures for each client. If an unlicensed personnel has not regularly performed the delegated home care task for a period of 24 consecutive months, the unlicensed personnel must demonstrate competency in the task.
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!
Minnesota Statutes, section 144A.4796, subdivision 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 Minnesota Statutes, section 144A.4796, subdivision 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, more than the required eight hours may be necessary to maintain compliance in that area.
(9/9/13, UPDATED 1/21/16)
Will MDH issue waivers (meaning exemption from compliance with a requirement of the chapter)?
No, under the new statutes, waivers are no longer allowed. 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 by utilizing the Innovation Variance Request Form on our website. The specific requirements to apply for an innovation variance are outlined in Minnesota Statutes, section 144A.478, subdivision 4.