1. (a) Private duty nursing is considered medically necessary if a person requires continuous, skillful observation and judgment to maintain or improve health status; and

   1. (1) is dependent on technology to sustain life; or

   2. (2) requires ongoing and frequent skilled interventions to maintain or improve health status, and delayed skilled intervention is expected to result in:

      1. (A) deterioration of a chronic condition;
      2. (B) loss of function;
      3. (C) imminent risk to health status due to medical fragility; or
      4. (D) risk of death.

2. (b) Determining medical necessity for private duty nursing includes assessment of the following elements:

   1. (1) complexity and intensity of the client's care;
   2. (2) stability and predictability of the client's condition; and
   3. (3) frequency of the client's need for skilled nursing care.

Source Note:The provisions of this §363.309 adopted to be effective March 31, 1999, 23 TexReg 13077; transferred effective September 1, 2002, as published in the Texas Register December 6, 2002, 27 TexReg 11527.