Non-Covered Home Care Services

1. Home Care Nursing (HCN) or Personal Care Assistance (PCA)/Community First Services and Supports (CFSS) services provided to MinnesotaCare non-pregnant members or MinnesotaCare members over age 18
2. Services provided to a person who is not an eligible PrimeWest Health member
3. Services provided by a provider that is not enrolled or does not have a valid provider agreement with PrimeWest Health
4. Services that are not ordered by the member’s physician, Advanced Practice Registered Nurse (APRN), or Physician Assistant (PA)
5. Services that are not specified in the member’s service plan or care plan
6. Services provided without authorization from PrimeWest Health when required
7. Services that have already been paid by Medicare, health plans, health insurance policies, or any other liable third party at more than the PrimeWest Health allowable amount
8. Services to other members of the member’s household
9. Home care services included in the daily rate of a community-based residential facility where the member is residing
10. Services that are the responsibility of the foster care provider under the terms of the foster care placement agreement and administrative rules
11. HCN and PCA/CFSS services provided when the number of foster care residents is greater than six, unless conditions are met for granting a variance for a sibling group
12. Home health agency services without the required documentation of a face-to-face visit
13. Any additional noncovered services are detailed within each provider type's Covered Services section

PW_11-19_552
Updated_12/23/2025