HB 2164 — 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
 1   Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
 2      act to consolidate, editorially revise, and codify the public
 3      welfare laws of the Commonwealth," in public assistance,
 4      providing for medical assistance for complex care assistant
 5      services.
 6      The General Assembly of the Commonwealth of Pennsylvania
 7   hereby enacts as follows:
 8      Section 1.    The act of June 13, 1967 (P.L.31, No.21), known
 9   as the Human Services Code, is amended by adding a section to
10   read:
11      Section 443.16.    Medical Assistance for Complex Care
12   Assistant Services.--(a)    No later than one year after the
13   effective date of this subsection and subject to Federal
14   approval, the department shall establish a program in which a
15   family member of a recipient of medical assistance may be
16   certified as a complex care assistant and, after receiving the
17   certification, may, under the direction of a registered nurse,
 1   provide complex care assistant services to the recipient through
 2   a home health agency under the reimbursement rates specified
 3   under subsection (g). The program shall operate as a home health
 4   care service benefit under the medical assistance program. For
 5   the purpose of the program, a recipient shall meet any of the
 6   following criteria:
 7      (1)   The recipient shall be younger than twenty-one years of
 8   age.
 9      (2)   The recipient shall qualify for private duty nursing
10   services under the medical assistance program.
11      (3)   The recipient can receive both complex care assistance
12   and private duty nursing services if it is deemed medically
13   necessary. Complex care assistance services are meant as a
14   supplement to private duty nursing and not a replacement.
15      (b)   The department shall develop an assessment tool to
16   identify recipients who meet the criteria specified under
17   subsection (a).
18      (c)   (1)   A complex care assistant must meet the training and
19   competency evaluation program standards for home health aides
20   established at 42 CFR 483.151 (relating to state review and
21   approval of nurse aide training and competency evaluation
22   programs), 483.152 (relating to requirements for approval of a
23   nurse aide training and competency evaluation program), 483.154
24   (relating to nurse aide competency evaluation) and 484.80
25   (relating to condition of participation: home health aide
26   services), including completing seventy-five hours of training
27   and a competency evaluation.
28      (2)   A home health aide may, except for skilled tasks,
29   provide complex care assistant services to their child.
30      (d)   A home health agency that employs a family member of a

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 1   recipient shall pay all costs for the family member to become
 2   certified as a complex care assistant under the program before
 3   providing complex care assistant services. The family member who
 4   becomes certified as a complex care assistant under the program
 5   shall not be required to repay or reimburse the home health
 6   agency for the costs incurred by the family member to become
 7   certified as a complex care assistant.
 8      (e)   A family member of a recipient who becomes certified as
 9   a complex care assistant under the program shall perform all of
10   the following tasks under the scope of practice of a complex
11   care assistant as applicable for the recipient:
12      (1)   The tasks associated with transferring, positioning,
13   ambulation, feeding, personal care, catheter care, range of
14   motion, vital signs, blood pressure, medication administration,
15   enteral care and therapy.
16      (2)   Administering enteral feedings, including the tasks
17   associated with formula types and preparation.
18      (3)   Other tasks approved by the Department of Health for a
19   family member who becomes certified as a complex care assistant
20   under the program.
21      (f)   Notwithstanding subsection (e), a home visit to a
22   recipient that is required by the medical assistance program
23   shall be conducted by a registered nurse every thirty days.
24      (g)   Complex care assistant services provided by a family
25   member of a recipient who becomes certified as a complex care
26   assistant under the program shall be reimbursed to a home health
27   agency under the medical assistance program at a provider rate
28   of no less than forty-five dollars ($45) per hour.
29      (h)   The parent or guardian of a medical assistance enrollee
30   shall choose whether to participate in the program. A Medicaid-

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 1   enrolled home health provider may choose whether to participate
 2   in the program.
 3      (i)     Medical assistance shall seek Federal approval,
 4   including seeking the appropriate Federal waiver or State plan
 5   amendment, to exclude income earned through employment as a
 6   complex care assistant from the family's countable income.
 7      (j)     Medical assistance shall convene an advisory working
 8   group of stakeholders to provide guidance and expertise
 9   regarding implementing the complex care assistant program.
10   Medicaid shall convene this advisory working group within sixty
11   days after the effective date of this subsection. This working
12   group may include representatives of home health agencies,
13   physicians, or other medical practitioners with medical
14   experience with the population being served by the program,
15   representatives from a children's hospital or children's
16   facilities and medically fragile family advocacy groups or
17   family members as described in subsection (c).
18      (k)     No later than three years after the date the program is
19   established under this section, the Deputy Secretary of the
20   Office of Medical Assistance Programs shall prepare and submit a
21   report to the Governor and the General Assembly concerning the
22   viability of the program and recommendations concerning the
23   program. Medical assistance may not require a home health agency
24   to provide information or data for this report, except if the
25   home health agency is paid by Medicaid.
26      (l)     The department shall seek a State plan amendment or
27   Federal waiver as necessary for the purpose of implementing this
28   section.
29      (m)     The department shall promulgate regulations as necessary
30   to implement this section.

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 1      (n)   As used in this section, the following words and phrases
 2   shall have the meanings given to them in this subsection unless
 3   the context clearly indicates otherwise:
 4      "Family member" includes a legal guardian, an individual
 5   related by blood or marriage and any other individual with a
 6   close association that is the equivalent of a family
 7   relationship.
 8      "Skilled tasks" means tasks involving medical administration,
 9   enteral care and therapy.
10      Section 2.    If a State plan amendment or Federal waiver
11   necessary for the addition of section 443.16 of the act is
12   approved or is not necessary, the Secretary of Human Services
13   shall transmit a notice to the Legislative Reference Bureau for
14   publication in the next available issue of the Pennsylvania
15   Bulletin.
16      Section 3.    This act shall take effect as follows:
17            (1)   Section 2 of this act and this section shall take
18      effect immediately.
19            (2)   The remainder of this act shall take effect upon the
20      publication of the notice under section 2 of this act.




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