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Measure to expand CNAs’ in-home duties fails after nurses and DHS raise concerns
Summary
A proposal to authorize certified nursing assistants (CNAs) to perform expanded in-home clinical tasks failed in committee after debate about supervision, reimbursement, and patient safety; DHS said a federal waiver or state-plan change would need further review.
Senate Bill 110 would have authorized CNAs who provide in-home services to perform expanded duties beyond the current in-home personal-care role. Sponsor Senator Penzo argued the change would help address workforce shortages and allow continuity of care for patients discharged from hospitals with complex needs.
Senator Penzo described the bill’s motivation with a personal example: his sister, who uses a ventilator and feeding tube, was discharged with family members trained informally to perform clinical tasks. He said CNAs who provide in-home care should be permitted to perform certain trained clinical tasks under proper supervision to reduce reliance on higher-cost RNs for routine in-home services.
Elizabeth Pittman from the Division of Medical Services (DHS) told the committee that Medicaid currently pays for private-duty nursing (RNs and LPNs) and for personal-care aides (unskilled/direct-care). DHS said it would need to evaluate whether the change requires a federal waiver or state plan amendment and how supervision, training, and documentation would be handled. Nursing organizations had registered opposition and raised patient-safety and supervision concerns.
After discussion, the committee voted on the bill and the roll call recorded a failure to secure passage: the clerk recorded three affirmative votes and the motion failed. The transcript shows several members voiced safety and scope concerns and asked for more work on implementation, supervision, and payment mechanisms.
Why it matters: The bill aimed to address workforce shortages and expand home-based care options but drew concerns about scope of practice, supervision, and federal Medicaid rules. DHS indicated significant implementation issues that would need to be resolved before adoption.
