Private duty nursing services for a technology-dependent individual are covered when the following requirements are met:

1. (1) The services are medically necessary;
2. (2) The services are provided by a nursing agency;
3. (3) The services are provided in the individual's residence, or other setting as prior authorized. For the purpose of this rule, an individual's residence does not include an intermediate care facility for individuals with intellectual disabilities or an institution for individuals with a mental disease, hospital, or nursing facility;
4. (4) The services are provided to an individual requiring more patient care than could be provided by a home health agency or professional day care when a condition or illness would result in institutionalization if not cared for at home;
5. (5) The services are prescribed by the individual's attending physician and contained in the individual's plan of care; and

6. (6) The services are authorized by the department before they are provided.

   The individual's record must contain written documentation verifying that these requirements have been met.

   Cross-References: Private duty nursing services -- Extended home health aide services -- Prior authorization -- Reauthorization, § 67:16:11:03.22; Covered services must be medically necessary, § 67:16:01:06.02.

Source: 18 SDR 209, effective June 23, 1992; 40 SDR 122, effective January 8, 2014; 44 SDR 94, effective December 4, 2017.

General Authority: SDCL 28-6-1(1)(2).

Law Implemented: SDCL 28-6-1(1)(2).

Prior versions effective: 2014-01-08.