Improving Support for Health Maintenance in Home and Community-Based Services: How States Adapt Nursing Rules for the Community First Choice Program
Many people with disabilities who get paid help with daily activities also need help with health maintenance tasks, such as ostomy care, ventilator management, bowel and bladder care, tube feeding, insulin injections, and management of other medications. In many states, laws prohibit paid workers without nursing or other medical licenses from performing such tasks. In others, nurses are permitted to delegate such tasks to these workers. In some instances, such workers can perform health maintenance tasks under the direction of the consumer, without nurse delegation or supervision. The more restrictive regulations found in many states can increase the cost and reduce the availability of the health maintenance support that people need.
The Affordable Care Act created a new Medicaid Program, known as Community First Choice, that provides an incentive for states to change laws and regulations to allow personal assistance workers to perform health maintenance tasks. This report takes a detailed look at how three states adapted, or are thinking of adapting, their laws and regulations related to nursing scope of practice to improve availability and lower costs of supporting health maintenance for people who receive home and community-based services.
Last modified Mar 2, 2018