An Act amending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in public assistance, providing for medical assistance for complex care assistant services.

PRINTER'S NO. 2806
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2164
Session of
2026
INTRODUCED BY KOSIEROWSKI, HARKINS, KINKEAD, HILL-EVANS, PARKER,
HOWARD, FREEMAN, DOUGHERTY, ISAACSON, PROBST, RIVERA,
BOROWSKI, HOHENSTEIN, SANCHEZ, DONAHUE, CEPEDA-FREYTIZ,
MULLINS, OTTEN, SHUSTERMAN, MADDEN, FRIEL, DIAMOND, FRITZ,
BENNINGHOFF, DALEY, MAYES, KAZEEM AND HANBIDGE,
JANUARY 28, 2026
REFERRED TO COMMITTEE ON HUMAN SERVICES, JANUARY 28, 2026
AN ACT
Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
act to consolidate, editorially revise, and codify the public
welfare laws of the Commonwealth," in public assistance,
providing for medical assistance for complex care assistant
services.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of June 13, 1967 (P.L.31, No.21), known
as the Human Services Code, is amended by adding a section to
read:
Section 443.16. Medical Assistance for Complex Care
Assistant Services.--(a) No later than one year after the
effective date of this subsection and subject to Federal
approval, the department shall establish a program in which a
family member of a recipient of medical assistance may be
certified as a complex care assistant and, after receiving the
certification, may, under the direction of a registered nurse,
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provide complex care assistant services to the recipient through
a home health agency under the reimbursement rates specified
under subsection (g). The program shall operate as a home health
care service benefit under the medical assistance program. For
the purpose of the program, a recipient shall meet any of the
following criteria:
(1) The recipient shall be younger than twenty-one years of
age.
(2) The recipient shall qualify for private duty nursing
services under the medical assistance program.
(3) The recipient can receive both complex care assistance
and private duty nursing services if it is deemed medically
necessary. Complex care assistance services are meant as a
supplement to private duty nursing and not a replacement.
(b) The department shall develop an assessment tool to
identify recipients who meet the criteria specified under
subsection (a).
(c) (1) A complex care assistant must meet the training and
competency evaluation program standards for home health aides
established at 42 CFR 483.151 (relating to state review and
approval of nurse aide training and competency evaluation
programs), 483.152 (relating to requirements for approval of a
nurse aide training and competency evaluation program), 483.154
(relating to nurse aide competency evaluation) and 484.80
(relating to condition of participation: home health aide
services), including completing seventy-five hours of training
and a competency evaluation.
(2) A home health aide may, except for skilled tasks,
provide complex care assistant services to their child.
(d) A home health agency that employs a family member of a
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recipient shall pay all costs for the family member to become
certified as a complex care assistant under the program before
providing complex care assistant services. The family member who
becomes certified as a complex care assistant under the program
shall not be required to repay or reimburse the home health
agency for the costs incurred by the family member to become
certified as a complex care assistant.
(e) A family member of a recipient who becomes certified as
a complex care assistant under the program shall perform all of
the following tasks under the scope of practice of a complex
care assistant as applicable for the recipient:
(1) The tasks associated with t ransferring, positioning,
ambulation, feeding, personal care, catheter care, range of
motion, vital signs, blood pressure, medication administration,
enteral care and therapy.
(2) Administering enteral feedings, including the tasks
associated with formula types and preparation.
(3) Other tasks approved by the Department of Health for a
family member who becomes certified as a complex care assistant
under the program.
(f) Notwithstanding subsection (e), a home visit to a
recipient that is required by the medical assistance program
shall be conducted by a r egistered nurse every thirty days.
(g) C omplex care assistant services provided by a family
member of a recipient who becomes certified as a complex care
assistant under the program shall be reimbursed to a home health
agency under the medical assistance program at a provider rate
of no less than forty-five dollars ($45) per hour.
(h) The parent or guardian of a medical assistance enrollee
shall choose whether to participate in the program. A Medicaid-
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enrolled home health provider may choose whether to participate
in the program.
(i) Medical assistance shall seek Federal approval,
including seeking the appropriate Federal waiver or State plan
amendment, to exclude income earned through employment as a
complex care assistant from the family's countable income.
(j) Medical assistance shall convene an advisory working
group of stakeholders to provide guidance and expertise
regarding implementing the complex care assistant program.
Medicaid shall convene this advisory working group within sixty
days after the effective date of this subsection. This working
group may include representatives of home health agencies,
physicians, or other medical practitioners with medical
experience with the population being served by the program,
representatives from a children's hospital or children's
facilities and medically fragile family advocacy groups or
family members as described in subsection (c).
(k) No later than three years after the date the program is
established under this section, the Deputy Secretary of the
Office of Medical Assistance Programs shall prepare and submit a
report to the Governor and the General Assembly concerning the
viability of the program and recommendations concerning the
program. Medical assistance may not require a home health agency
to provide information or data for this report, except if the
home health agency is paid by Medicaid.
(l) The department shall seek a State plan amendment or
Federal waiver as necessary for the purpose of implementing this
section.
(m) The department shall promulgate regulations as necessary
to implement this section.
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(n) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection unless
the context clearly indicates otherwise:
"Family member" includes a legal guardian, an individual
related by blood or marriage and any other individual with a
close association that is the equivalent of a family
relationship.
"Skilled tasks" means tasks involving medical administration,
enteral care and therapy.
Section 2. If a State plan amendment or Federal waiver
necessary for the addition of section 443.16 of the 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 3. This act shall take effect as follows:
(1) Section 2 of this act and this section shall take
effect immediately.
(2) The remainder of this act shall take effect upon the
publication of the notice under section 2 of this act.
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