Current through Register Vol. 50, No. 9, September 20, 2024
A. Nursing
services are medically necessary services ordered by a physician and provided
by a licensed registered nurse or a licensed practical nurse under the
supervision of a registered nurse, within the scope of the State's Nurse
Practice Act. Nursing services provided in the ROW are an extension of nursing
services provided through the Home Health Program covered under the Medicaid
State Plan.
1. Nursing services must be
included in the beneficiary's plan of care and must have the following:
a. physician's order,
b. physician's letter of medical
necessity,
c. Form 90-L,
d. Form 485,
e. individual nursing service plan,
f. summary of medical history, and
g. skilled nursing checklist.
2. The beneficiary's nurse must
submit updates every 60 days and include any changes to the beneficiary's needs
and/or physician's orders.
B. Consultations include assessments, health
related training/education for the participant and the participant's
caregivers, and healthcare needs related to prevention and primary care
activities.
1. Assessment services are
offered on an individualized basis only and must be performed by a registered
nurse
2. Consulting services may
also address healthcare needs related to prevention and primary care
activities.
3. Health related
training and education service is the only nursing procedure which can be
provided to more than one beneficiary simultaneously.
C. Service Limitations
1. Services are based on 15-minute units of
service.
D. Service
Requirements
1. Nursing services are
secondary to EPSDT services for beneficiaries under the age of 21 years.
Beneficiaries under the age of 21 have access to nursing services (home health
and extended care) under the Medicaid State Plan.
2. Adults have access only to home health
nursing services under the Medicaid State Plan. Beneficiaries must access and
exhaust all available Medicaid State Plan services prior to accessing ROW
nursing services.
E.
Provider Qualifications
1. In order to
participate in the Medicaid Program, a provider agency must possess a current,
valid license as a home health agency under
R.S.
40:2116.31-40:2116.40 as verified by the LDH
Health Standards Section; or
2. If
under the ROW shared living conversion model, a provider agency must be
licensed by the Department of Health as a home and community-based services
provider and meet the module requirements for supervised independent
living-conversion in LAC 48:I.Chapter 50.
2.a
- 4.b. Repealed.
F. Staffing Requirements
1. Nursing services shall be provided by
individuals with either a current, valid license as a registered nurse from the
State Board of Nursing or a current, valid license as a practical nurse from
the Board of Practical Nurse Examiners.
2. Nurses must have one-year experience
serving persons with developmental disabilities. Experience may include any of
the following:
a. full-time experience gained
in advanced and accredited training programs, (i.e., masters or residency level
training programs) which includes treatment services to persons with a
developmental disability;
b. paid,
full-time nursing experience in specialized service/treatment settings for
persons with a developmental disability (i.e., intermediate care facilities for
persons with a developmental disability);
c. paid, full-time nursing experience in
multidisciplinary programs for persons with a developmental disability (i.e.,
mental health treatment programs for persons with dual diagnosis - mental
illness and a developmental disability); or
d. paid, full-time nursing experience in
specialized educational, vocational, and therapeutic programs or settings for
persons with a developmental disability (i.e., school special education
program).
3. Two years
of part-time experience (minimum of 20 hours per week) may be substituted for
one year of full-time experience.
4. The following activities do not qualify
for the required experience:
a. volunteer
nursing experience; or
b.
experience gained by caring for a relative or friend with developmental
disabilities.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
