Section 69-10.11 - Prior Approval for Private Duty Nursing

69-10.11 Prior Approval for Private Duty Nursing.

(a) A request for private duty nursing in the hospital or in the home must be accompanied by a physician's written order and treatment plan.

(b) In a hospital setting, the physician's order must state that the enrollee is in need of individual and continuous care beyond that available by the staff of a hospital, including that which is available in the hospital's critical care area.

(c) For nursing services to be provided in the enrollee's home, the physician's order must state either that there is no approved home health agency available to provide the intermittent or part-time nursing services needed by the enrollee or that the enrollee is in need of individual and continuous care beyond that available from an approved home health agency. The Fund Administrator may request such periodic treatment plans and other medical information as he or she determines the particular circumstances warrant prior to approving additional periods of private duty nursing.

(d) In an emergency situation, the treating physician may order the services of a private duty nurse for no more than two nursing days and immediately submit a prior approval request for private duty nursing services on behalf of the enrollee on an expedited basis pursuant to ยง 69-10.15.

Effective Date: 
Wednesday, June 18, 2014
Doc Status: 
Complete