La. Admin. Code tit. 40 § I-3509

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-3509 - Training Requirements and Reimbursement Guidelines

A. Payment may be made for authorized services to the following provider types, subject to the following guidelines.

1. Trained professional nursing personnel who provide services through the auspices of public or private home health agencies who are paid for their services by their employer.

2. Trained professional nursing personnel who are self employed may be paid directly for their services at a rate not to exceed the maximum allowable reimbursement for nursing/attendant care services. Self-employed nurses and attendants are considered independent contractors by the carrier/self-insured employer; therefore, the carrier/self-insured employer takes no responsibility for producing income tax forms (such as W-2 Forms) for those individuals.

3. Nursing and personal care homes will be reimbursed at the approved per diem rates established for institutional services.

4. Nursing manpower agencies and home health agencies will be reimbursed using the same procedure codes and maximum allowable reimbursement schedule established for Nurse/Attendant Care Services.

5. Authorized services by nonprofessional family members are reimbursable up to eight hours in any 24-hour period. Any family member who is a medical professional may provide services under the same restrictions placed on self-employed nurses and attendants.

6. Family members and other persons who are not trained professional nursing personnel may receive payment in the amount of the current minimum wage if the following requirements have been satisfied:

a. the attendant has received adequate instruction from the authorized treating provider regarding the services to be provided in the home;

b. the services provided must be beyond the scope of normal household duties and must be in the nature of services ordinarily rendered by trained professional personnel in hospitals or nursing homes; and

c. the medical evidence of record must be sufficient to identify the nature and approximate value of the services provided.

7. The purpose of private duty nurses is to provide skilled constant attention and observation to a seriously ill patient. The need for, and the length of, service usually depends on the condition of the patient and the level of care required rather than the nature of the disease, illness, or condition.

8. Patients recovering from major surgery, severe systemic disease or one of the catastrophic diseases, frequently require a level of skilled care beyond that afforded by the general nursing service provided by a hospital or other institution.

9. The following are examples of services which require "skilled" personnel for proper administration. This list is not all-inclusive:

a. intravenous injections and feeding;

b. insertion and replacement of urethral catheters;

c. dressing open or draining wounds involving prescription medications and aseptic techniques;

d. insertion and replacement of tubes for gastric feedings;

e. nasopharyngeal and tracheotomy aspiration;

f. care of extensive decubitus ulcers (2 cm or greater), or care of other widespread skin disorders;

g. initial phases of a regimen involving administrations of medical gases.

10. "Supportive" service to a patient is not necessarily a skilled service and may require only a nonprofessional level of care. For example, a nonambulatory patient may need frequent changes of position in the bed to avoid the development of ulcers. Changing of position can ordinarily be accomplished by untrained, nonprofessional personnel, so this is not considered a "skilled" service.

11. The following are specific activities which are not considered to be "skilled" nursing services and a person of lesser training can be utilized. This listing is not all-inclusive:

a. administration of routine oral medications; eye drops; ointments;

b. general maintenance care of colostomy or ileostomy;

c. routine services in connection with indwelling bladder catheters (emptying and cleaning containers; clamping tubing; and refilling irrigation containers with solution);

d. changes of dressings in noninfected postoperative or chronic conditions;

e. prophylactic and palliative skin care; including bathing, and application of skin creams, or treatment of minor skin problems;

f. general maintenance care in connection with a plaster cast;

g. routine care in connection with braces and similar devices;

h. administration of medical gases after the initial training of the patient in self-administration;

i. general supervision of exercises which have been taught to the patient;

j. assisting the patient in routine activities; dressing, eating, hygiene, etc.

La. Admin. Code tit. 40, § I-3509

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.