- (1) The medical assistance program in this state shall include private-duty nursing to persons who are technology dependent and otherwise eligible as provided under this section.
(2) A member is eligible for private-duty nursing services if the member:
- (a) Is dependent on technology at least part of each day;
- (b) Requires private-duty nursing care as determined in accordance with state department rules;
- (c) Is able to be served safely under the limitations of the private-duty nursing benefit and within the availability of services; and
- (d) Is not residing in a nursing facility or hospital at the time of the delivery of the private-duty nursing services.
(3)
- (a) The state board shall establish rules in accordance with this section that identify medical criteria for determining the circumstances under which private-duty nursing services will be delivered to assure that only persons who need the services receive them and only to the extent medically necessary.
- (b) Private-duty nursing services shall not be provided as twenty-four-hour care except in special circumstances and for limited time periods as established by the state department pursuant to this section.
- (c) The home health agency, in conjunction with the family or in-home caregiver and the attending physician, shall include in a care plan that includes private-duty nursing services a process by which the eligible person may receive necessary care, which may include respite care, if the family or in-home caregiver is unavailable due to an emergency situation or to unforeseen circumstances. The family or in-home caregiver shall be duly informed by the home health agency of these alternative care provisions at the time the care plan is initiated.
- (4) As used in this section, unless the context otherwise requires, private-duty nursing means nursing care that is more individualized and continuous than both the nursing care available under the home health benefit and the nursing care routinely provided in a hospital or nursing facility.
Source: L. 2006: Entire article added with relocations, p. 1867, § 7, effective July 1. L. 2024: IP(2) amended, (SB 24-176), ch. 152, p. 646, § 47, effective August 7.
Editor's note: This section is similar to former § 26-4-517 as it existed prior to 2006.