(a) The department
will pay for specialized private-duty nursing services that
(1) are provided to a recipient 21 years of
age or older that meets the requirements of
7
AAC 110.525(a) (2) - (4) and that is
in one of the following recipient categories:
(A) adults with physical and developmental
disabilities;
(B) individuals with
intellectual and developmental disabilities;
(C) older adults or adults with physical
disabilities;
(2) are
approved under
7
AAC 130.217 and
7
AAC 130.218 as part of the recipient's support plan;
and
(3) receive prior
authorization.
(b) The
department will consider services to be specialized private-duty nursing
services if the services
(1) provide
individualized care that is tailored to the specific needs of the recipient on
a part-time, intermittent, or continuous basis;
(2) are provided by an individual licensed
under AS 08.68 other than a certified nurse aide;
(3) are prescribed by a physician, a
physician assistant, or an advanced practice registered nurse, licensed under
AS 08, that specifies in writing the scope of care to be provided, including
the type, frequency, and duration of that care; and
(4) are included in the recipient's support
plan.
(c) The department
will not pay for a service as a specialized private-duty nursing service if
(1) the service does not meet the
requirements and limitations of
7
AAC 110.520 -
7
AAC 110.530; or
(2) an individual that is an employee of the
home and community-based waiver services provider is not enrolled individually
and separately in accordance with
7
AAC 110.520(b).
(d) A provider of specialized private duty
nursing services under this section shall use an electronic visit verification
(EVV) system that is either provided or approved by the department. If a
provider decides to use its own EVV system or vendor, that system must include
at the time of service delivery, and report to the state's EVV system, the
following data:
(1) the name of the
agency;
(2) the identity of the
rendering provider;
(3) the
identity of the recipient;
(4) the
location of the service;
(5) the
date of the service;
(6) the start
and stop times of the service; and
(7) the type of service provided.
(e) A provider of specialized private duty
nursing services under this section
(1) may
not submit a claim for payment of specialized private duty nursing under this
section without also submitting the EVV data to support the claim;
(2) must affirm the accuracy of each EVV
submission, and must review and resolve, at least every calendar quarter, any
exceptions in the EVV system that the provider uses;
(3) must repay to the department any
identified overpayment within 90 days; and
(4) must coordinate and upload all aggregate data into the
department's EW system on a daily basis or at another frequency specified by
the department, if the provider is not using the department's EVV
system.
(f) In this
section, "EVV" means electronic visit verification.
