An Act providing for licensure of family members to provide skilled care to designated children, for applications for licensure, for qualifications for licensure, for employment and compensation of licensed family members, for limitations and supervision of licensed family members, for notice to parents of recipients and for authorization of covered skilled care.

PRINTER'S NO. 1168
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1068
Session of
2025
INTRODUCED BY MARKOSEK, MADDEN, GIRAL, SMITH-WADE-EL, SANCHEZ,
HILL-EVANS, FREEMAN, DEASY, CERRATO, MALAGARI, STEELE AND
MULLINS, MARCH 31, 2025
REFERRED TO COMMITTEE ON HUMAN SERVICES, MARCH 31, 2025
AN ACT
Providing for licensure of family members to provide skilled
care to designated children, for applications for licensure,
for qualifications for licensure, for employment and
compensation of licensed family members, for limitations and
supervision of licensed family members, for notice to parents
of recipients and for authorization of covered skilled care.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Families
Providing Extraordinary Care Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Applicant." An individual who submits an application to the
board under section 3 to become a licensed family member.
"Board." The State Board of Nursing.
"Child." An individual younger than 21 years of age with a
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diagnosed medical condition for which shift nursing care is
needed.
"Covered skilled care." Medically necessary skilled care
within a recipient's Medicaid or home and community-based
services waiver benefit during an authorization period,
including skilled monitoring, and the unskilled health care
necessary during the same authorization period to the same
extent a nurse would be paid for an authorized shift.
"Decision-maker." Any of the following:
(1) A parent, health care representative or legal
guardian of a child who makes decisions on behalf of the
child.
(2) In the case of a child 18 years of age or older who
does not have a parent, health care representative or legal
guardian, the child or an individual selected by the child to
make decisions on the child's behalf.
"Designated child." A child designated by a licensed family
member to receive skilled care by the licensed family member.
"Eligible family member." Any of the following:
(1) A parent or legal guardian of a child.
(2) A stepparent, grandparent, aunt, uncle or adult
sibling of a child.
(3) A person living with a child.
(4) In the case of a child 18 years of age or older, the
individual selected by the child to be the child's decision-
maker.
"Licensed family member." An individual licensed to provide
skilled care to a child for compensation under this act.
"Medicaid agency." The Office of Medical Assistance Programs
within the Department of Human Services or any of its contracted
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managed care organizations.
"Parent." A biological or adoptive parent.
"Recipient." A child who is enrolled in the medical
assistance program administered by the Department of Human
Services.
"Skilled care." Care related to the practice of practical
nursing as defined in section 2(1) of the act of March 2, 1956
(1955 P.L.1211, No.376), known as the Practical Nurse Law.
"Supervising agency." A Medicare-certified home health
agency or any other similar entity designated by the Department
of Human Services.
Section 3. Application for licensure.
(a) Submission.--In accordance with this act, an individual
may submit an application to the board to provide skilled care
to a designated child for compensation as a licensed family
member in a form and manner determined by the board.
(b) Process.--The board shall be responsible for the
licensure of applicants, including obtaining and maintaining
proof of qualifications under section 4, and shall use the same
procedures as used for licensed practical nurses under the act
of March 2, 1956 (1955 P.L.1211, No.376), known as the Practical
Nurse Law.
Section 4. Qualifications for licensure.
In order to qualify as a licensed family member, an applicant
shall demonstrate proof of all of the following to the board in
an application submitted under section 3:
(1) The applicant is an eligible family member.
(2) The applicant complies with the training
requirements specified under section 5, including receipt of
a written verification of competency from the training entity
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under section 5(5).
(3) The applicant has received a Pennsylvania Child
Abuse History Clearance.
Section 5. Training requirements for applicants and licensed
family members.
The following shall apply:
(1) An applicant or a licensed family member shall
comply with the training requirements of 42 CFR 484.80(b)
(relating to condition of participation: home health aide
services).
(2) An applicant or licensed family member shall also
train in all medical and therapeutic procedures necessary for
a designated child.
(3) A hospital or supervising agency may provide the
training specified under this subsection.
(4) A Medicaid agency shall ensure that training
programs under this subsection are available, timely and
offered in multiple languages or with interpretation support.
(5) In order to receive a written verification of
competency from a training entity under this subsection, an
applicant or licensed family member shall demonstrate an
understanding of the needs of a designated child and the
ability to perform all required care to the satisfaction of
the training entity.
(6) If a designated child is a recipient, a Medicaid
agency shall pay for all of the following:
(i) The initial training of an applicant under this
subsection and licensure renewal training every two years
thereafter.
(ii) Covered authorized care for the recipient while
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the applicant is being trained under this subsection.
(iii) Specialized training under this subsection
that is needed by the recipient's supervising nurse as
determined by a supervising agency.
(iv) Training under this subsection for an eligible
family member of the recipient, regardless of whether or
not the eligible family member is seeking licensure as a
licensed family member.
Section 6. Employment and compensation of licensed family
members.
(a) Employment.--
(1) A licensed family member must be employed by a
supervising agency. The board shall place the license of a
licensed family member who ceases employment with a
supervising agency in inactive status.
(2) A supervising agency shall use the supervising
agency's professional judgment in hiring, terminating or
refusing employment to a licensed family member. A
supervising agency may not adopt a policy prohibiting the
hiring of licensed family members as employees of the
supervising agency.
(3) A supervising agency shall plan for and make every
effort to ensure that a nonfamily member nurse is available
to a designated child when a licensed family member or a
scheduled nurse is unavailable to provide skilled care to the
child.
(4) A supervising agency shall provide all employment-
related requirements to a licensed family member in the
language of the licensed family member's choice.
(b) Compensation.--
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(1) A Medicaid agency shall, and any other insurer may,
compensate a licensed family member for the covered skilled
care provided to a recipient, provided that the licensed
family member is employed by a supervising agency. A Medicaid
agency may not reimburse a supervising agency for a licensed
family member at a rate lower than the reimbursement rate for
a licensed practical nurse.
(2) A supervising agency shall compensate a licensed
family member at a rate commensurate with a licensed
practical nurse. A supervising agency shall compensate a
licensed family member for overtime when the licensed family
member works more than 40 hours per week at the supervising
agency. A supervising agency shall compensate an employed
licensed family member for planned shifts and for filling
unfilled shifts.
(3) Upon the hiring of a licensed family member, a
supervising agency shall have the following duties:
(i) Ensure that the licensed family member and the
decision-maker sign an agreement indicating whether the
licensed family member is the primary skilled caregiver
for a designated child for a specified number of hours
per week, or whether each party prefers that the
supervising agency identify all available nurses for the
designated child.
(ii) Compensate the licensed family member for
filling in when a nurse is not available for the
designated child.
(iii) Submit a copy of the agreement under
subparagraph (i) to the designated child's Medicaid
agency, decision-maker and the licensed family member
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within seven days of the execution of the agreement. The
licensed family member or the designated child's
decision-maker may elect to change the agreement under
subparagraph (i) by notifying the supervising agency and
the Medicaid agency in writing.
(4) In a calculation of coverage for authorized nursing
hours for recipients individually or collectively, for a
shift that was filled by a licensed family member, not
including a shift for which the licensed family member opted
to be a primary skilled caregiver under paragraph (3)(i), the
supervising agency and the Medicaid agency shall report the
shift as a missed shift.
Section 7. Limitations and supervision of licensed family
members.
(a) Limitations.--
(1) A licensed family member may be scheduled to
provide skilled care up to 12 hours per day, but shall be
compensated for additional hours when there is no nurse
available.
(2) A licensed family member may not deny a designated
child reasonable opportunities for socialization, community
integration and growing independence.
(3) A license issued to a licensed family member shall
only authorize the licensed family member to receive
compensation for skilled care provided to a designated child.
(4) A Medicaid agency may not require a family member to
become a licensed family member or a licensed family member
to accept an employment position with a supervising agency. A
Medicaid agency or supervising agency may not require a
licensed family member to accept a shift that the licensed
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family member has not agreed to cover.
(b) Supervision.--A supervising agency shall provide in-
person supervision of a licensed family member as often as
deemed medically necessary by a physician, but no less than
every two weeks by a registered nurse or by a skilled nurse who
has been trained in the specific needs of the designated child.
The supervising agency shall make an appropriately trained nurse
available to the licensed family member at all times. The
supervising nurse shall document each area in which the licensed
family member needs additional or repeated training and the
supervising agency shall ensure that the training is provided to
the licensed family member.
Section 8. Notice to parents of recipients.
A Medicaid agency shall notify each parent of a recipient in
writing within 14 days of a request for authorization of nursing
of the procedures for becoming a licensed family member. The
notice shall include information on how to file a complaint or
request information with the Department of Human Services
regarding any issue related to the parent's application,
training, work or supervision under this act.
Section 9. Authorization of covered skilled care.
A Medicaid agency shall authorize covered skilled care based
on the medical needs of a recipient without reference to whether
covered skilled care is provided by a licensed nurse or a
licensed family member. A Medicaid agency may not deny
authorization for covered skilled care on the basis that a
family member is a licensed family member or available to
provide the skilled care.
Section 10. Construction.
Nothing in this act shall be construed to prevent a parent or
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parental designee from providing skilled care to a child without
compensation or in any circumstance otherwise permitted by
Federal or State law. Nothing in this act shall be construed to
discharge a Medicaid agency of the duty to provide all medically
necessary home health services.
Section 11. State plan amendment or Federal waiver.
If a State plan amendment or Federal waiver necessary for the
provisions of this act is approved or is not necessary, the
Secretary of Human Services shall transmit a notice to the
Legislative Reference Bureau for publication in the next
available issue of the Pennsylvania Bulletin.
Section 12. Effective date.
This act shall take effect as follows:
(1) Section 11 and this section shall take effect
immediately.
(2) The remainder of this act shall take effect 60 days
after the publication of the notice under section 11.
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