Section 7 AAC 110.525 - Private-duty nursing services; covered and noncovered services(a) The department will pay for private-duty nursing services, if they are provided to a recipient who (1) is under 21 years of age;(2) has been recently discharged from a general acute care hospital or long-term care facility, or has a physical health status that would justify admission to a general acute care hospital or long-term care facility;(3) with the provision of private-duty nursing services, will be able to live in a family setting, and for whom those services will prevent admission to, or promote early discharge from, a general acute care hospital or long-term care facility; and(4) requires more individual and continuous care than is available from a visiting nurse or is routinely provided by the nursing staff of a hospital, a skilled nursing facility, or an intermediate care facility; in this paragraph, "continuous care" means a minimum of eight hours provided to an individual in a 24-hour period;(b) The department will pay for private-duty nursing services only if (1) the services are for a life threatening condition, and a private-duty nursing agency employee can safely provide them outside of an institution;(2) the services are provided under a plan of care approved by the recipient's attending physician, who has participated in the development of the plan of care before any private-duty nursing services were provided and has made a commitment to oversee the recipient's care throughout the duration of the plan of care;(3) the services are required less than 24 hours per day; and(4) a competent individual residing with the recipient has agreed to participate in caring for the recipient in accordance with the plan of care developed under (2) of this subsection.(c) If a private-duty nursing agency provides a skilled nursing service, that service must be provided by a private-duty nursing agency employee for whom the service is within the scope of that employee's license to practice, and who provides the service while under the continued direction of the recipient's attending physician. In this subsection, "skilled nursing service" has the meaning given in 7 AAC 125.399.(d) Private-duty nursing services include (2) administration of treatment related to technological dependence; and(3) monitoring and maintaining parameters, machinery, and interventions.(e) A private-duty nursing service may not be performed by(1) a personal care assistant;(3) a member of the immediate family; or(4) other members of the recipient's household.(f) Private-duty nursing services do not include housekeeping, laundry, shopping, meal preparation, or transportation.(g) This section does not apply to specialized private-duty nursing services under 7 AAC 130.285 provided to a recipient who is receiving home and community-based waiver services.(h) The department will not pay for a private-duty nursing service (1) if requested to enable the recipient to attend school or other activities outside the home, and if the same service is not needed to enable the recipient to live successfully in the home, hospital, or nursing facility;(2) during the hours a recipient attends a child care facility;(3) for a recipient that is home schooled;(4) in excess of the private-duty nursing services already authorized by the department;(5) that is considered nurse supervision, including chart reviews, case discussions, scheduling of services, and respite care;(6) that is provided for other members of the recipient's household; or(7) for which the department has not given prior authorization under 7 AAC 110.530.Eff. 2/1/2010, Register 193; am 10/1/2011, Register 199; am 5/1/2016, Register 218, July 2016Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040