Section 7 AAC 110.530 - Private-duty nursing services; prior authorization(a) Private-duty nursing services must be authorized by the department before services are provided. The department will authorize private-duty nursing services for periods up to 60 days, starting on the date the first service is to be provided.(b) To be considered by the department, a prior authorization request must originate from a private-duty nursing agency provider who submits the request in writing or electronically on a form provided by the department. The prior authorization request must (1) include the plan of care developed in accordance with 7 AAC 110.525(b) (2) and signed by the recipient's attending physician;(2) include a nursing assessment;(3) include any supporting documentation, if applicable;(4) identify the day of actual or planned hospital or nursing facility discharge, if applicable;(5) identify any planned surgical interventions;(6) identify the number of days services are needed, not to exceed a 60-day period; and(7) identify the exact number of hours requested per day.(c) To request additional hours within a 60-day period under (a) of this section, the private-duty nursing agency must submit, before the expiration of the current 60-day period, a new request for prior authorization. The new request must include (2) an updated plan of care signed by the recipient's attending physician;(3) the attending physician's order for service dated no sooner than seven days before the date of the request under this subsection;(4) recent significant clinical findings from the recipient's attending physician; and(5) recent clinic summaries.(d) The department will approve a request for additional hours under (c) of this section, if (1) the department finds that the individual who has agreed, in accordance with 7 AAC 110.525(b)(4), to participate in caring for the recipient, (A) needs additional training;(C) is temporarily unable to provide the required care for the recipient; or(D) is unable to provide the required care for the recipient because of a family emergency involving the caregiver;(2) an acute episode has occurred that would otherwise require hospitalization, and the attending physician has determined that noninstitutionalized care is still safe for the recipient; or(3) the need for additional hours is medically necessary.(e) The department may increase or decrease the number of hours authorized under (c) of this section at any time based upon evidence from the attending physician that the recipient's condition, needs, or situation has changed.Eff. 2/1/2010, Register 193; am 5/1/2016, Register 218, July 2016Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040