Home Care

Definitions

Activities of Daily Living (ADL): Routine self-care functions such as eating, toileting, grooming, dressing, bathing, transferring, mobility, and positioning.

Care Plan – PCA: A written description of how the member’s needs identified during the assessment process will be met. This is developed by the QP or the member/responsible party with the assistance of the member’s physician. This is a requirement of the PCA program.

Community First Services and Supports (CFSS): Flexible options to meet the unique needs of PrimeWest Health members with disabilities. CFSS allows members greater independence in their homes and communities. This includes the elderly and others with special health care needs. CFSS services are provided in members’ homes or in the community when normal life activities take members outside the home. CFSS replaced personal care assistance (PCA) and the Consumer Support Grant (CSG) on October 1, 2024. PCA and CSG will be phased out over time. Review the Minnesota Department Human Services (DHS) CFSS Policy Manual for CFSS policy information.

Consultation Services Provider: A Minnesota Health Care Programs (MHCP) provider that supports people receiving CFSS. Consultation services providers do the following:

Provide education to help people make informed decisions about how to meet their needs using CFSS
Help people write their service delivery plans, if desired
Review service delivery plans
Provide people with ongoing support, as needed

Financial Management Services (FMS): Services that provide help with financial tasks, billing, and employer-related responsibilities for people who self-direct their services through Consumer Directed Community Supports (CDCS), the Consumer Support Grant (CSG), and Community First Services and Supports (CFSS). These services are provided by financial management services (FMS) providers.

Fiscal Agent Option: See PCA Choice provider.

Flexible Use Service Option: Planned and approved use of authorized PCA service hours/units in a six-month flexible schedule to more effectively meet the needs of the person. PrimeWest Health follows Minnesota Health Care Programs (MHCP) guidelines in establishing two six-month periods for the PCA Flexible Use Service Option. The Flexible Use Service Option allows authorized PCA units to vary from day to day to meet the needs and schedules as specified in the PCA assessment. Flexible Use does not increase the total amount of authorized PCA units. Units may not be transferred from one six-month period to another.

Home Care Agency: Home health care agencies are entities that offer a broad level of care given by skilled medical professionals and require a license from the Minnesota Department of Health (MDH). Home care services are provided in a variety of settings including the following:

Individuals’ private homes
Residential homes where there may be multiple members*
Larger multi-unit establishments, often with communal dining and other shared spaces*

*These settings are called “housing with services establishments.” They may be required to register with MDH or they may hold an optional registration.

Home Care Nursing Agency: An agency holding a comprehensive home care license and that is enrolled with the Minnesota Department of Human Services (DHS) to provide home care nursing services.

Home Care Rating: Cost limits that establish a rating system based on the common assessed needs of individuals.

Home Health Agency: A home health agency delivers health services specified in MN Rules part 9505.0295, MN Stat. sec. 256B.0651, and MN Stat. sec. 256B.0653. These services are delivered at home to recovering, disabled, and chronically or terminally ill members. They may have medical, nursing, social, therapeutic, and treatment needs and/or assistance with essential ADL. Home health care may be provided in a place or residence including, but not limited to, the following: single family home, apartment, assisted living, adult foster home, adult day care, a relative’s home, or congregate housing residence. Home health care is not usually provided in an institutional setting such as a long-term care facility (LTCF) or hospital, unless an arrangement has been made for PDN (see Combination PCA Hospice and Other Home Care Services section) by the member or family. Home health care providers in the State of Minnesota must be licensed by MDH as at least one of the following in order to provide services. Only those providing home management tasks (driving, shopping) are registered rather than licensed.

Basic licensure. Each application for a home care provider license must include information sufficient to show that the applicant meets the requirements of licensure, including the following:
1. The applicant's name, email address, physical address, and mailing address, including the name of the county in which the applicant resides and has a principal place of business
2. The initial license fee in the amount specified in subdivision 7
3. The email address, physical address, mailing address, and telephone number of the principal administrative office
4. The email address, physical address, mailing address, and telephone number of each branch office, if any
5. The names, email and mailing addresses, and telephone numbers of all owners and managerial officials
6. Documentation of compliance with the background study requirements of section 144A.476 for all persons involved in the management, operation, or control of the home care provider
7. Documentation of a background study as required by section 144.057 for any individual seeking employment, paid or volunteer, with the home care provider
8. Evidence of workers' compensation coverage as required by sections 176.181 and 176.182
9. Documentation of liability coverage, if the provider has it
10. Identification of the license level the provider is seeking
11. Documentation that identifies the managerial official who is in charge of day-to-day operations and attestation that the person has reviewed and understands the home care provider regulations
12. Documentation that the applicant has designated one or more owners, managerial officials, or employees as an agent or agents, which shall not affect the legal responsibility of any other owner or managerial official under this chapter
13. The signature of the officer or managing agent on behalf of an entity, corporation, association, or unit of government
14. Verification that the applicant has the following policies and procedures in place so that if a license is issued, the applicant will implement the policies and procedures and keep them current:
  1. Requirements in sections 626.556, reporting of maltreatment of minors, and 626.557, reporting of maltreatment of vulnerable adults
  2. Conducting and handling background studies on employees
  3. Orientation, training, and competency evaluations of home care staff, and a process for evaluating staff performance
  4. Handling complaints from clients, family members, or client representatives regarding staff or services provided by staff
  5. Conducting initial evaluation of clients' needs and the providers' ability to provide those services
  6. Conducting initial and ongoing client evaluations and assessments and how changes in a client's condition are identified, managed, and communicated to staff and other health care providers as appropriate
  7. Orientation to and implementation of the home care client bill of rights
  8. Infection control practices
  9. Reminders for medications, treatments, or exercises, if provided
  10. Conducting appropriate screenings, or documentation of prior screenings, to show that staff are free of tuberculosis, consistent with current United States Centers for Disease Control and Prevention standards
15. Other information required by the department
Comprehensive home care licensure. In addition to the information and fee required in subdivision 1, applicants applying for a comprehensive home care license must also provide verification that the applicant has the following policies and procedures in place so that if a license is issued, the applicant will implement the policies and procedures in this subdivision and keep them current:
1. Conducting initial and ongoing assessments of the client's needs by a registered nurse or appropriate licensed health professional, including how changes in the client's conditions are identified, managed, and communicated to staff and other health care providers, as appropriate
2. Ensuring that nurses and licensed health professionals have current and valid licenses to practice
3. Medication and treatment management
4. Delegation of home care tasks by registered nurses or licensed health professionals
5. Supervision of registered nurses and licensed health professionals
6. Supervision of unlicensed personnel performing delegated home care tasks

Home Management Services: Home management services include at least two of the following services: housekeeping, meal preparation, and shopping. Providers of home management services must register annually with the MDH. (MN Stat. sec. 144A.43, subd. 3)

Instrumental Activities of Daily Living (IADL): Individual activities relating to ADL that include: meal planning and preparation; managing finances; shopping for food, clothing, and other essential items; completing necessary homemaking tasks; communication by telephone and other media; and getting around and participating in the community. PrimeWest Health considers IADL to be parental responsibility in the majority of cases where a child is the recipient.

Medical Necessity: A health service that is consistent with the member’s diagnosis or condition and is:

Recognized as the prevailing medical community standard or current practice by the provider’s peer group; and
Rendered in response to a life-threatening condition or pain; or to treat an injury, illness, or infection; or to treat a condition that could result in physical or mental disability; or to care for the mother and child through the maternity period; or to achieve community standards for diagnosis or condition; or
Is a preventive health service as defined in MN Rules part 9505.0355.

Participant’s Representative: An individual who is age 18 or over and capable of directing care on behalf of a person receiving PCA/CFSS when the person is assessed as unable to direct their own care. The participant’s representative cannot be any of the following:

PCA/CFSS worker, including a parent serving as a worker for their minor child or a spouse serving as a worker for their spouse
Provider agency owner or manager
Provider agency staff member, unless related by blood, marriage or adoption
Lead agency staff member or contractor acting as an employee
Qualified professional (QP) (PCA only)
Financial management services (FMS) provider owner or manager (CFSS only)
FMS provider agency staff member, unless related by blood, marriage or adoption (CFSS only)
Consultation services provider owner or manager (CFSS only)
Consultation services provider staff member, unless related by blood, marriage or adoption (CFSS only)
Worker training and development provider (CFSS only)

Personal Care Assistant (PCA): An individual employed by a personal care assistance provider agency, enrolled by the Minnesota Department of Human Services (DHS), and who provides personal care assistance services (MN Stat. sec. 245A, MN Stat. sec. 252A.02, subd. 3a, MN Stat. sec. 256B.0659, subd. 11). QPs include a registered nurse (RN), licensed social worker, mental health professional, or qualified developmental disabilities specialist (QDDS).

Personal Care Assistance (PCA) Services: Human assistance and support to people of any age with disabilities and special health care needs living independently in the community.

Personal Care Provider Organization (PCPO): An agency that meets DHS standards and has signed a provider agreement with PrimeWest Health to provide PCA services, also known as a Personal Care Provider or PCA Agency.

Personal Care Assistance (PCA) Assessment: A review and evaluation of a member’s need for home care services. This assessment must be performed by a county PHN or PHN contracted with the county. A new assessment is required annually.

Personal Care Assistance (PCA) Choice Option: A member-directed option within the PCA program under which the recipient of services, or his/her responsible party, is responsible for hiring, firing, training, and directing his/her PCA. PCA Choice allows the member more choice and control over his/her services as well as decreased administrative overhead expense.

Personal Care Assistance (PCA) Choice Provider (also known as fiscal intermediary): A provider who enrolls with PrimeWest Health to give fiscal intermediary supports to members choosing the PCA Choice Option.

Private Duty Nursing (PDN) Agency: An agency holding a Class A Home Care license enrolled with PrimeWest Health to provide PDN services.

Qualified Professional (QP): A professional providing training, supervision, and evaluation of PCA services and staff. A QP must be one of the following:

An RN as defined in MN Stat. sec. 148.171
A licensed social worker as defined in MN Stat. sec. 148E.055
A qualified designated coordinator as defined in 245D.081, subd. 2

Residence: The place a member lives. A residence does not include a hospital, nursing facility (NF), or Intermediate Care Facility (ICF).

Responsible Party: An individual, at least 18 years of age, who is capable of providing the support necessary to assist a person to live in the community and actively participates in the planning and direction of PCA services. The responsible party cannot be the PCA or any of the following:

PCA/CFSS worker, including a parent serving as a worker for their minor child or a spouse serving as a worker for their spouse
Provider agency owner or manager
Provider agency staff member, unless related by blood, marriage or adoption
Lead agency staff member or contractor acting as an employee
Qualified professional (QP) (PCA only)
Financial management services (FMS) provider owner or manager (CFSS only)
FMS provider agency staff member, unless related by blood, marriage or adoption (CFSS only)
Consultation services provider owner or manager (CFSS only)
Consultation services provider staff member, unless related by blood, marriage or adoption (CFSS only)
Worker training and development provider (CFSS only)

Service Authorization: The document used to identify services, providers, and payment information for a person receiving services. The Medical Service Authorization Request Form allows providers to bill for approved services and allows the PrimeWest Health to audit usage and payment data.

Service Plan: A written description of the services needed by the member based on the assessment. The service plan must include a description of the home care services, the frequency and duration of services, the member’s functional level, medications, treatments, and the expected outcomes and goals.

Skilled Nurse Visits (SNVs): Intermittent nursing services provided by a Medicare-certified agency and ordered by a physician for a member whose illness, injury, physical, or mental condition creates a need for the service. Services under the direction of an RN are provided in the member’s residence by an RN or licensed practical nurse (LPN) and provided under a plan of care or service plan that specifies a level of care that the nurse is qualified to provide.

Standard PCA: Limited use of PCA service hours/units to a monthly basis: daily and weekly usage of PCA service hours/units should be close to the daily average allocation. Hours do not transfer from month-to-month.

Temporary Disenrollment from PrimeWest Health: Refer to the PCA Services chapter of the DHS Provider Manual.

Ventilator-Dependent Member: A member 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.

PW_03-19_133
Updated_12/18/2025

Policies & Guidelines

Home Care

Definitions