HB 1068 — 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
 1   Providing for licensure of family members to provide skilled
 2      care to designated children, for applications for licensure,
 3      for qualifications for licensure, for employment and
 4      compensation of licensed family members, for limitations and
 5      supervision of licensed family members, for notice to parents
 6      of recipients and for authorization of covered skilled care.
 7      The General Assembly of the Commonwealth of Pennsylvania
 8   hereby enacts as follows:
 9   Section 1.    Short title.
10      This act shall be known and may be cited as the Families
11   Providing Extraordinary Care Act.
12   Section 2.    Definitions.
13      The following words and phrases when used in this act shall
14   have the meanings given to them in this section unless the
15   context clearly indicates otherwise:
16      "Applicant."    An individual who submits an application to the
17   board under section 3 to become a licensed family member.
18      "Board."    The State Board of Nursing.
19      "Child."    An individual younger than 21 years of age with a
 1   diagnosed medical condition for which shift nursing care is
 2   needed.
 3      "Covered skilled care."     Medically necessary skilled care
 4   within a recipient's Medicaid or home and community-based
 5   services waiver benefit during an authorization period,
 6   including skilled monitoring, and the unskilled health care
 7   necessary during the same authorization period to the same
 8   extent a nurse would be paid for an authorized shift.
 9      "Decision-maker."     Any of the following:
10             (1)   A parent, health care representative or legal
11      guardian of a child who makes decisions on behalf of the
12      child.
13             (2)   In the case of a child 18 years of age or older who
14      does not have a parent, health care representative or legal
15      guardian, the child or an individual selected by the child to
16      make decisions on the child's behalf.
17      "Designated child."     A child designated by a licensed family
18   member to receive skilled care by the licensed family member.
19      "Eligible family member."     Any of the following:
20             (1)   A parent or legal guardian of a child.
21             (2)   A stepparent, grandparent, aunt, uncle or adult
22      sibling of a child.
23             (3)   A person living with a child.
24             (4)   In the case of a child 18 years of age or older, the
25      individual selected by the child to be the child's decision-
26      maker.
27      "Licensed family member."     An individual licensed to provide
28   skilled care to a child for compensation under this act.
29      "Medicaid agency."     The Office of Medical Assistance Programs
30   within the Department of Human Services or any of its contracted

20250HB1068PN1168                     - 2 -
 1   managed care organizations.
 2      "Parent."     A biological or adoptive parent.
 3      "Recipient."     A child who is enrolled in the medical
 4   assistance program administered by the Department of Human
 5   Services.
 6      "Skilled care."     Care related to the practice of practical
 7   nursing as defined in section 2(1) of the act of March 2, 1956
 8   (1955 P.L.1211, No.376), known as the Practical Nurse Law.
 9      "Supervising agency."     A Medicare-certified home health
10   agency or any other similar entity designated by the Department
11   of Human Services.
12   Section 3.     Application for licensure.
13      (a)   Submission.--In accordance with this act, an individual
14   may submit an application to the board to provide skilled care
15   to a designated child for compensation as a licensed family
16   member in a form and manner determined by the board.
17      (b)   Process.--The board shall be responsible for the
18   licensure of applicants, including obtaining and maintaining
19   proof of qualifications under section 4, and shall use the same
20   procedures as used for licensed practical nurses under the act
21   of March 2, 1956 (1955 P.L.1211, No.376), known as the Practical
22   Nurse Law.
23   Section 4.     Qualifications for licensure.
24      In order to qualify as a licensed family member, an applicant
25   shall demonstrate proof of all of the following to the board in
26   an application submitted under section 3:
27            (1)   The applicant is an eligible family member.
28            (2)   The applicant complies with the training
29      requirements specified under section 5, including receipt       of
30      a written verification of competency from the training entity

20250HB1068PN1168                    - 3 -
 1      under section 5(5).
 2          (3)   The applicant has received a Pennsylvania Child
 3      Abuse History Clearance.
 4   Section 5.   Training requirements for applicants and licensed
 5                family members.
 6      The following shall apply:
 7          (1)   An applicant or a licensed family member shall
 8      comply with the training requirements of 42 CFR 484.80(b)
 9      (relating to condition of participation: home health aide
10      services).
11          (2)   An applicant or licensed family member shall also
12      train in all medical and therapeutic procedures necessary for
13      a designated child.
14          (3)   A hospital or supervising agency may provide the
15      training specified under this subsection.
16          (4)   A Medicaid agency shall ensure that training
17      programs under this subsection are available, timely and
18      offered in multiple languages or with interpretation support.
19          (5)   In order to receive a written verification of
20      competency from a training entity under this subsection, an
21      applicant or licensed family member shall demonstrate an
22      understanding of the needs of a designated child and the
23      ability to perform all required care to the satisfaction of
24      the training entity.
25          (6)   If a designated child is a recipient, a Medicaid
26      agency shall pay for all of the following:
27                (i)    The initial training of an applicant under this
28          subsection and licensure renewal training every two years
29          thereafter.
30                (ii)   Covered authorized care for the recipient while

20250HB1068PN1168                     - 4 -
 1            the applicant is being trained under this subsection.
 2                  (iii)   Specialized training under this subsection
 3            that is needed by the recipient's supervising nurse as
 4            determined by a supervising agency.
 5                  (iv)    Training under this subsection for an eligible
 6            family member of the recipient, regardless of whether or
 7            not the eligible family member is seeking licensure as a
 8            licensed family member.
 9   Section 6.     Employment and compensation of licensed family
10                  members.
11      (a)   Employment.--
12            (1)   A licensed family member must be employed by a
13      supervising agency. The board shall place the license of a
14      licensed family member who ceases employment with a
15      supervising agency in inactive status.
16            (2)   A supervising agency shall use the supervising
17      agency's professional judgment in hiring, terminating or
18      refusing employment to a licensed family member. A
19      supervising agency may not adopt a policy prohibiting the
20      hiring of licensed family members as employees of the
21      supervising agency.
22            (3)   A supervising agency shall plan for and make every
23      effort to ensure that a nonfamily member nurse is available
24      to a designated child when a licensed family member or a
25      scheduled nurse is unavailable to provide skilled care to the
26      child.
27            (4)   A supervising agency shall provide all employment-
28      related requirements to a licensed family member in the
29      language of the licensed family member's choice.
30      (b)   Compensation.--

20250HB1068PN1168                       - 5 -
 1        (1)   A Medicaid agency shall, and any other insurer may,
 2    compensate a licensed family member for the covered skilled
 3    care provided to a recipient, provided that the licensed
 4    family member is employed by a supervising agency. A Medicaid
 5    agency may not reimburse a supervising agency for a licensed
 6    family member at a rate lower than the reimbursement rate for
 7    a licensed practical nurse.
 8        (2)   A supervising agency shall compensate a licensed
 9    family member at a rate commensurate with a licensed
10    practical nurse. A supervising agency shall compensate a
11    licensed family member for overtime when the licensed family
12    member works more than 40 hours per week at the supervising
13    agency. A supervising agency shall compensate an employed
14    licensed family member for planned shifts and for filling
15    unfilled shifts.
16        (3)   Upon the hiring of a licensed family member, a
17    supervising agency shall have the following duties:
18              (i)    Ensure that the licensed family member and the
19        decision-maker sign an agreement indicating whether the
20        licensed family member is the primary skilled caregiver
21        for a designated child for a specified number of hours
22        per week, or whether each party prefers that the
23        supervising agency identify all available nurses for the
24        designated child.
25              (ii)    Compensate the licensed family member for
26        filling in when a nurse is not available for the
27        designated child.
28              (iii)    Submit a copy of the agreement under
29        subparagraph (i) to the designated child's Medicaid
30        agency, decision-maker and the licensed family member

20250HB1068PN1168                   - 6 -
 1            within seven days of the execution of the agreement. The
 2            licensed family member or the designated child's
 3            decision-maker may elect to change the agreement under
 4            subparagraph (i) by notifying the supervising agency and
 5            the Medicaid agency in writing.
 6            (4)   In a calculation of coverage for authorized nursing
 7      hours for recipients individually or collectively, for a
 8      shift that was filled by a licensed family member, not
 9      including a shift for which the licensed family member opted
10      to be a primary skilled caregiver under paragraph (3)(i), the
11      supervising agency and the Medicaid agency shall report the
12      shift as a missed shift.
13   Section 7.     Limitations and supervision of licensed family
14                  members.
15      (a)   Limitations.--
16            (1)   A licensed family member may be scheduled to
17      provide skilled care up to 12 hours per day, but shall be
18      compensated for additional hours when there is no nurse
19      available.
20            (2)   A licensed family member may not deny a designated
21      child reasonable opportunities for socialization, community
22      integration and growing independence.
23            (3)   A license issued to a licensed family member shall
24      only authorize the licensed family member to receive
25      compensation for skilled care provided to a designated child.
26            (4)   A Medicaid agency may not require a family member to
27      become a licensed family member or a licensed family member
28      to accept an employment position with a supervising agency. A
29      Medicaid agency or supervising agency may not require a
30      licensed family member to accept a shift that the licensed

20250HB1068PN1168                    - 7 -
 1      family member has not agreed to cover.
 2      (b)   Supervision.--A supervising agency shall provide in-
 3   person supervision of a licensed family member as often as
 4   deemed medically necessary by a physician, but no less than
 5   every two weeks by a registered nurse or by a skilled nurse who
 6   has been trained in the specific needs of the designated child.
 7   The supervising agency shall make an appropriately trained nurse
 8   available to the licensed family member at all times. The
 9   supervising nurse shall document each area in which the licensed
10   family member needs additional or repeated training and the
11   supervising agency shall ensure that the training is provided to
12   the licensed family member.
13   Section 8.    Notice to parents of recipients.
14      A Medicaid agency shall notify each parent of a recipient in
15   writing within 14 days of a request for authorization of nursing
16   of the procedures for becoming a licensed family member. The
17   notice shall include information on how to file a complaint or
18   request information with the Department of Human Services
19   regarding any issue related to the parent's application,
20   training, work or supervision under this act.
21   Section 9.    Authorization of covered skilled care.
22      A Medicaid agency shall authorize covered skilled care based
23   on the medical needs of a recipient without reference to whether
24   covered skilled care is provided by a licensed nurse or a
25   licensed family member. A Medicaid agency may not deny
26   authorization for covered skilled care on the basis that a
27   family member is a licensed family member or available to
28   provide the skilled care.
29   Section 10.    Construction.
30      Nothing in this act shall be construed to prevent a parent or

20250HB1068PN1168                   - 8 -
 1   parental designee from providing skilled care to a child without
 2   compensation or in any circumstance otherwise permitted by
 3   Federal or State law. Nothing in this act shall be construed to
 4   discharge a Medicaid agency of the duty to provide all medically
 5   necessary home health services.
 6   Section 11.   State plan amendment or Federal waiver.
 7      If a State plan amendment or Federal waiver necessary for the
 8   provisions of this act is approved or is not necessary, the
 9   Secretary of Human Services shall transmit a notice to the
10   Legislative Reference Bureau for publication in the next
11   available issue of the Pennsylvania Bulletin.
12   Section 12.   Effective date.
13      This act shall take effect as follows:
14          (1)    Section 11 and this section shall take effect
15      immediately.
16          (2)    The remainder of this act shall take effect 60 days
17      after the publication of the notice under section 11.




20250HB1068PN1168                    - 9 -