OLR Bill Analysis

sHB 6443

AN ACT CONCERNING DIRECT BILLING FOR HOME CARE NURSING SERVICES PROVIDED TO MEDICAID RECIPIENTS.

SUMMARY:

This bill requires the Department of Social Services (DSS), to the extent permitted under federal law, to allow a registered nurse (RN) or licensed practical nurse (LPN) to directly bill the state for services provided to Medicaid recipients. It also requires any RN or LPN hired by a Medicaid recipient or his or her family member, to obtain a Medicaid provider number and submit it to DSS before providing services (see COMMENT).

EFFECTIVE DATE: July 1, 2009

BACKGROUND

Direct Medicaid Billing for Nursing Services

Federal Medicaid regulations and the State Nurse Practice Act allow only advanced practice registered nurses (APRN) to provide direct primary health care (Federal regulations refer to them as “nurse practitioners. ”). By law, RNs and LPNs must provide care under the direction of a licensed physician, dentist, or APRN (CGS § 20-87a, 42 CFR § 440. 166).

Currently, under the state's Medicaid plan, only APRNs can receive a Medicaid provider number and bill the state as independent providers. APRNs are reimbursed 90% of the rates on the physicians' fee schedule for evaluation and management services. (The physicians' fee schedule does not include home health services. )

Federal Medicaid regulations allow states the option of providing private duty nursing services by RNs or LPNs under the direction of a physician. Services can be provided to Medicaid recipients in a nursing home, hospital, or the client's home. But, Connecticut opted not to include private duty nursing services as a covered service under its Medicaid state plan (42 CFR § 440. 80).

COMMENT

Medicaid Home Health Services

This bill would allow RNs and LPNs to directly bill the state for home health services provided to Medicaid recipients. But, federal Medicaid regulations only allow home health nursing services to be provided to Medicaid recipients if (1) they are ordered in writing by a physician and (2) they are provided on a part-time or intermittent basis by a licensed home health care agency (42 CFR § 440. 70 (b)(1)). Consequently, if RNs and LPNs directly billed for these services, the state would not receive federal matching funds.

COMMITTEE ACTION

Human Services Committee

Joint Favorable Substitute