Current through Register Vol. 50, No. 9, September 20, 2024
A. The
fund will provide and/or fund, at the lesser of the billed amount or the
maximum amount allowed under the reimbursement schedule, inpatient or
outpatient nursing or sitter care when such care is required to provide
reasonable medical, surgical, hospitalization, physical rehabilitation, or
custodial services made necessary by the health care provider's malpractice,
subject to the following limitations.
1. All
nursing or sitter care shall be specifically prescribed or ordered by a
patient's treating health care provider.
2. All nursing or sitter care shall be
rendered by a licensed and/or qualified registered nurse or licensed practical
nurse or by a sitter, a member of the patient's family or household, or other
person as specifically approved by the fund.
3. There shall be a presumption that the
person rendering nursing or sitter care is qualified if the treating health
care provider issues a statement that that person is competent and qualified to
render the nursing or sitter care required by the patient.
4. All claims for nursing or sitter care
payments, including those for family members providing such care, must include
a signed, detailed statement by the person rendering nursing or sitter care,
setting forth the date, time, and type of care rendered to and for the
patient.
B.
1. Providers of nursing or sitter care shall
be funded, at the lesser of the billed amount or the maximum amount allowed
under the reimbursement schedule. If the reimbursement schedule contains no
applicable rate for such care, then the care shall be funded at the lesser of
the billed amount or the usual and customary rate charged by similarly licensed
or qualified healthcare providers in a patient's home state, city, or town.
However, nursing or sitter care provided by members of the patient's family or
household will be funded at a rate not to be less than the federal minimum
hourly wage rate as may be revised from time to time regardless of the
licensure or qualification of the provider.
2. However, notwithstanding the foregoing,
future nursing or sitter care provided by members of the patient's family or
household will be funded at a rate not to exceed the equivalent of $6 per hour
plus inflation at the annual consumer price index published by the United
States Bureau of Labor Statistics for each year beginning in November 2001.
However, at no time will the hourly rate paid be below the federal minimum
hourly wage rate as may be revised from time to time.
C. The fund shall be entitled to periodic
inspections or assessments of the physical environment in which the nursing or
sitter care is being rendered. The fund may seek a judicial ruling to
discontinue the payments for future medical care and related benefits if, upon
inspection and recommendation of a licensed or qualified health care provider,
it is determined that the physical environment in which the nursing or sitter
care being rendered is inadequate or inappropriate and not in the best interest
of the patient.
D. The fund may
seek a judicial ruling to discontinue the payments for future medical care and
related benefits if, upon a physical or mental examination of the patient,
pursuant to §1911, and recommendation of a licensed or qualified health care
provider, it is determined that the nursing or sitter care being rendered is
inadequate or inappropriate and not in the best interest of the
patient.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
40:1299.44(D)(3).
