Current through November 28, 2024
(a)
The department will pay for private-duty nursing services, if they are provided
to a recipient who
(1) is under 21 years of
age;
(2) has been recently
discharged from a general acute care hospital or long-term care facility, or
has a physical health status that would justify admission to a general acute
care hospital or long-term care facility;
(3) with the provision of private-duty
nursing services, will be able to live in a family setting, and for whom those
services will prevent admission to, or promote early discharge from, a general
acute care hospital or long-term care facility; and
(4) requires more individual and continuous
care than is available from a visiting nurse or is routinely provided by the
nursing staff of a hospital, a skilled nursing facility, or an intermediate
care facility; in this paragraph, "continuous care" means a minimum of eight
hours provided to an individual in a 24-hour period;
(b) The department will pay for private-duty
nursing services only if
(1) the services are
for a life threatening condition, and a private-duty nursing agency employee
can safely provide them outside of an institution;
(2) the services are provided under a plan of
care approved by the recipient's attending physician, who has participated in
the development of the plan of care before any private-duty nursing services
were provided and has made a commitment to oversee the recipient's care
throughout the duration of the plan of care;
(3) the services are required less than 24
hours per day; and
(4) a competent
individual residing with the recipient has agreed to participate in caring for
the recipient in accordance with the plan of care developed under (2) of this
subsection.
(c) If a
private-duty nursing agency provides a skilled nursing service, that service
must be provided by a private-duty nursing agency employee for whom the service
is within the scope of that employee's license to practice, and who provides
the service while under the continued direction of the recipient's attending
physician. In this subsection, "skilled nursing service" has the meaning given
in 7 AAC 125.399.
(d) Private-duty nursing services include
(2) administration of treatment related to
technological dependence; and
(3)
monitoring and maintaining parameters, machinery, and interventions.
(e) A private-duty nursing service
may not be performed by
(1) a personal care
assistant;
(3) a member of the immediate
family; or
(4) other members of the
recipient's household.
(f) Private-duty nursing services do not
include housekeeping, laundry, shopping, meal preparation, or
transportation.
(g) This section
does not apply to specialized private-duty nursing services under
7
AAC 130.285 provided to a recipient who is receiving
home and community-based waiver services.
(h) The department will not pay for a
private-duty nursing service
(1) if requested
to enable the recipient to attend school or other activities outside the home,
and if the same service is not needed to enable the recipient to live
successfully in the home, hospital, or nursing facility;
(2) during the hours a recipient attends a
child care facility;
(3) for a
recipient that is home schooled;
(4) in excess of the private-duty nursing
services already authorized by the department;
(5) that is considered nurse supervision,
including chart reviews, case discussions, scheduling of services, and respite
care;
(6) that is provided for
other members of the recipient's household; or
(7) for which the department has not given
prior authorization under
7
AAC 110.530.
Authority:AS
47.05.010
AS 47.07.030
AS
47.07.040
