La. Admin. Code tit. 50 § XXI-16317

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

Section XXI-16317 - Nursing Services

A. Nursing services are medically necessary services ordered by a physician and provided by a licensed registered nurse or a licensed practical nurse under the supervision of a registered nurse, within the scope of the State's Nurse Practice Act. Nursing services provided in the ROW are an extension of nursing services provided through the Home Health Program covered under the Medicaid State Plan.

1. Nursing services must be included in the beneficiary's plan of care and must have the following:

a. physician's order,

b. physician's letter of medical necessity,

c. Form 90-L,

d. Form 485,

e. individual nursing service plan,

f. summary of medical history, and

g. skilled nursing checklist.

2. The beneficiary's nurse must submit updates every 60 days and include any changes to the beneficiary's needs and/or physician's orders.

B. Consultations include assessments, health related training/education for the participant and the participant's caregivers, and healthcare needs related to prevention and primary care activities.

1. Assessment services are offered on an individualized basis only and must be performed by a registered nurse

2. Consulting services may also address healthcare needs related to prevention and primary care activities.

3. Health related training and education service is the only nursing procedure which can be provided to more than one beneficiary simultaneously.

C. Service Limitations

1. Services are based on 15-minute units of service.

D. Service Requirements

1. Nursing services are secondary to EPSDT services for beneficiaries under the age of 21 years. Beneficiaries under the age of 21 have access to nursing services (home health and extended care) under the Medicaid State Plan.

2. Adults have access only to home health nursing services under the Medicaid State Plan. Beneficiaries must access and exhaust all available Medicaid State Plan services prior to accessing ROW nursing services.

E. Provider Qualifications

1. In order to participate in the Medicaid Program, a provider agency must possess a current, valid license as a home health agency under R.S. 40:2116.31-40:2116.40 as verified by the LDH Health Standards Section; or

2. If under the ROW shared living conversion model, a provider agency must be licensed by the Department of Health as a home and community-based services provider and meet the module requirements for supervised independent living-conversion in LAC 48:I.Chapter 50.

2.a - 4.b. Repealed.

F. Staffing Requirements

1. Nursing services shall be provided by individuals with either a current, valid license as a registered nurse from the State Board of Nursing or a current, valid license as a practical nurse from the Board of Practical Nurse Examiners.

2. Nurses must have one-year experience serving persons with developmental disabilities. Experience may include any of the following:

a. full-time experience gained in advanced and accredited training programs, (i.e., masters or residency level training programs) which includes treatment services to persons with a developmental disability;

b. paid, full-time nursing experience in specialized service/treatment settings for persons with a developmental disability (i.e., intermediate care facilities for persons with a developmental disability);

c. paid, full-time nursing experience in multidisciplinary programs for persons with a developmental disability (i.e., mental health treatment programs for persons with dual diagnosis - mental illness and a developmental disability); or

d. paid, full-time nursing experience in specialized educational, vocational, and therapeutic programs or settings for persons with a developmental disability (i.e., school special education program).

3. Two years of part-time experience (minimum of 20 hours per week) may be substituted for one year of full-time experience.

4. The following activities do not qualify for the required experience:

a. volunteer nursing experience; or

b. experience gained by caring for a relative or friend with developmental disabilities.

La. Admin. Code tit. 50, § XXI-16317

Promulgated by the Department of Health and Hospitals, Office for Citizens with Developmental Disabilities, LR 33:2449 (November 2007), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 422161 (10/1/2015), Amended by the Department of Health, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 471515 (10/1/2021), Amended LR 481564 (6/1/2022).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.