Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-40 - Private Duty Nursing Services
Section R414-40-3 - Program Access Requirements

(1) Only a licensed home health agency enrolled as a Medicaid provider may be reimbursed for private duty nursing services.

(2) A member must have a written physician order establishing the need for private duty nursing services. The private duty nursing provider must develop a care plan consistent with the member's diagnosis, the severity of illness, and intensity of services. If medically necessary nursing services require four hours or less of skilled nursing, the service is covered under the home health program.

(3) Medicaid providers shall submit an initial prior authorization request with medical documentation that demonstrates the need for nursing services. The home health agency shall submit an initial certification and recertification at least every 60 days as required by 42 CFR 440.70.

(4) Private duty nursing is only available if a parent, guardian, or primary caregiver is committed to and capable of performing the medical skills necessary to ensure quality care.

(5) The home health agency shall verify that the hospital has provided specialized training for the caregiver before patient discharge to enable the caregiver to provide hands-on care in the home. The private duty nurse initially supervises the caregiver who provides this care to ensure that training has been assimilated to ensure safe, quality patient care.