7 AAC 43.1051. Specialized private duty nursing services

(a) The department will reimburse for specialized private duty nursing services that

(1) are provided to a recipient

(A) in one of the following recipient categories:

(i) adults with physical disabilities;

(ii) individuals with mental retardation or developmental disabilities; however, the department will reimburse only if a recipient in that recipient category is 21 years of age or older;

(iii) older adults; and

(B) who meets the eligibility requirements that apply to a Medicaid recipient under 21 years of age under 7 AAC 43.456(a) , (b)(2), and (b)(4);

(2) are approved under 7 AAC 43.1030 as part of the recipient's plan of care; and

(3) receive prior authorization.

(b) The department will consider services to be specialized private duty nursing services if they

(1) provide individual and continuous care by individuals licensed under AS 08.68 other than certified nurse aides; and

(2) are tailored to the specific needs of a particular individual.

(c) The department will not reimburse under this section for temporary or intermittent services, and will not reimburse under this section for services that fail to satisfy the requirements and limitations of 7 AAC 43.456(c) - (g), except that the cost cap limitations in 7 AAC 43.456(f) do not apply.

(d) To provide services under this section, an employee subject to 7 AAC 43.456(d) must be enrolled separately under that subsection.

History: Eff. 5/15/2004, Register 170

Authority: AS 47.05.010

AS 47.07.030

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