§ 25.5-5-303 — Private-duty nursing

(1) The medical assistance program in
this state shall include private-duty nursing to persons who are technology
dependent and otherwise eligible as provided under this section.

(2) A member is eligible for private-duty nursing services if the member:

(a) Is dependent on technology at least part of each day;

(b) Requires private-duty nursing care as determined in accordance with
state department rules;

(c) Is able to be served safely under the limitations of the private-duty
nursing benefit and within the availability of services; and

(d) Is not residing in a nursing facility or hospital at the time of the delivery of
the private-duty nursing services.

(3) (a) The state board shall establish rules in accordance with this section
that identify medical criteria for determining the circumstances under which
private-duty nursing services will be delivered to assure that only persons who need
the services receive them and only to the extent medically necessary.

(b) Private-duty nursing services shall not be provided as twenty-four-hour
care except in special circumstances and for limited time periods as established by
the state department pursuant to this section.

(c) The home health agency, in conjunction with the family or in-home
caregiver and the attending physician, shall include in a care plan that includes
private-duty nursing services a process by which the eligible person may receive
necessary care, which may include respite care, if the family or in-home caregiver is
unavailable due to an emergency situation or to unforeseen circumstances. The
family or in-home caregiver shall be duly informed by the home health agency of
these alternative care provisions at the time the care plan is initiated.

(4) As used in this section, unless the context otherwise requires, private-duty nursing means nursing care that is more individualized and continuous than
both the nursing care available under the home health benefit and the nursing care
routinely provided in a hospital or nursing facility.

Legislative History

Source: L. 2006: Entire article added with relocations, p. 1867, � 7, effective July 1. L. 2024: IP(2) amended, (SB 24-176), ch. 152, p. 646, � 47, effective August 7.