Iowa Admin. Code r. 655-12.6

Current through Register Vol. 47, No. 5, September 4, 2024

Rule 655-12.6 - Scope of review

(1) Factors to determine appropriateness of nursing care deemed medically necessary shall include, but not be limited to, the following:

a. Utilization of the nursing process in establishing a nursing diagnosis.

b. Development of a nursing care plan based on documentation of client needs and standards of care for that particular clinical specialty.

c. Adequate completion of recommended nursing care plan.

d. Quality of care as measured by outcome.

e. Proper referral to specialists/physicians when conditions indicate.

(2) Cost review shall result in an opinion as to the fairness of charges for nursing care services based on criteria which shall include, but not be limited to, the following:

a. The nurse's usual charge for the service.

b. The customary charge for the service based on a review of peer group charges.

c. Reasonable variance due to degree of difficulty factors which require extraordinary skill and judgment.

Iowa Admin. Code r. 655-12.6