Bill
HF 3488
Expands PCA and CFSS to allow certain medication injections under RN delegation, trained supervision, and oversight, with eligibility tied to federal approval.
Purpose and intent
- Expand and modify the scope of Personal Care Assistance (PCA) and Community First Services and Supports (CFSS) to explicitly include the provision of certain medication injections by trained CFSS support workers, under defined supervision and training requirements.
- Align CFSS with enhanced health-related tasks and ensure injections can be delivered only under specified professional delegation and oversight.
- Effective date contingent on federal approval.
Key provisions and changes
1) Personal Care Assistance (PCA) – health-related procedures and tasks
- PCA covered services include ADLs, health-related procedures and tasks, observation/redirection of behaviors, and instrumental activities of daily living (IADLs).
- Health-related procedures and tasks may be provided by a PCA where:
- The tasks are within scope and appropriate for PCA,
- The PCA is trained by a qualified professional and demonstrates competency,
- Delegation and training are documented in the PCA care plan and files.
- New specific addition:
- Medication injections are added as a health-related procedure only if:
- A registered nurse (RN) or advance practice RN (APRN) delegates and provides training,
- The PCA receives individualized training about the recipient’s needs,
- The PCA is supervised by a qualified professional who is an RN.
- Other existing protocols (e.g., tracheostomy suctioning on ventilators) remain subject to RN delegation, training, supervision, and specialized requirements.
- Effective date: upon federal approval.
2) PCA – Noncovered services (what PCA cannot bill for)
- Injections of fluids and medications into veins, muscles, or skin are not eligible for MA payment unless the requirements for delegations and supervision in subdivision 2, paragraph (f) are met.
- Other noncovered items remain (e.g., sterile procedures, home maintenance, children’s IADLs without health rationale, etc.).
- Effective date: upon federal approval.
3) CFSS (Community First Services and Supports) – definitions and scope
- Reiterates CFSS terms (ADLs, IADLs, health-related tasks, budget model, agency-provider model, lead agency, etc.).
- Adds formal definition for health-related procedures and tasks and clarifies that injections can be part of CFSS if delegated, trained, and supervised per requirements.
- Medication assistance is defined to include reminders and assistance with medications, but not dose or time for injections unless injection-specific requirements are met.
4) CFSS service delivery and delivery models
- Clarifies CFSS service delivery plan requirements, including person-centered planning, consultation services, and coordination with financial management services (FMS) for the budget model.
- Expanded terminology for “complex health-related needs” to explicitly include medication injections when the delegated, trained, and supervised pathway is followed.
5) CFSS support workers – qualifications and rates
- Support workers must enroll after a background check, demonstrate communication skills, and complete standardized CFSS training (including first aid, vulnerable adult, child maltreatment, OSHA, etc.) and pass a certification test.
- Employers must provide employer-directed training on the participant’s needs.
- Restrictions on hours: a CFSS worker cannot be paid for more than 310 hours per month.
- Enhanced rates/budget eligibility for workers providing 10+ hours/day of CFSS to participants, contingent on meeting Medicare-like training/competency standards (with a transition to 2026 for certain provisions).
- Effective date for enhanced rate provisions: January 1, 2026, or upon federal approval, whichever is later.
6) Effective date
- Most changes are "effective upon federal approval" or dependent on federal approval for CFSS-related provisions.
- The specific injection-related changes under PCA and related noncovered services similarly hinge on federal approval.
Who is affected
- Individuals receiving PCA and CFSS services (including those with complex health needs requiring injections).
- Personal care assistants and CFSS support workers (training, supervision, delegation requirements, and wage/budget considerations).
- Agencies/providers delivering CFSS or PCA services and their fiscal management services (FMS).
Timeline notes
- Key provisions tied to federal approval.
- Some provisions have explicit dates (e.g., 2026 for enhanced rate eligibility related to training/competency).
Sponsor and status
- Introduced and referred to the Health and Human Services policy group on 2026-02-19.
- Co-sponsor: Matt Norris.
Bottom line
HF 3488 seeks to formalize and expand the role of CFSS and PCA in delivering certain medication injections, with robust RN delegation, individualized training, and professional supervision. It also tightens certain noncovered services, aligns definitions across PCA and CFSS, and introduces enhanced reimbursement considerations for high-need CFSS scenarios, all contingent on federal approvals.
Compiled from official sources — confirm details with the bill’s official record.
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