Nursing services means the patient care performed or supervised by a registered nurse according to a plan of care. Nursing services means patient care services pertaining to the curative, palliative, restorative, or preventive aspects of nursing that are prepared or supervised by a registered nurse.
Nursing services and home health aide services combined must total less than or equal to eight (8) hours per day and 35 or fewer hours per week.
Nursing services (provided as part of home health services or by a private duty nurse) will be approved only if the requested service(s) is of the type that must be provided by a nurse as opposed to an aide, except that the MCO may elect to have a nurse perform home health aide services in addition to nursing services if the MCO determines that this is a less costly alternative than providing the services of both a nurse and an aide.
Nursing services are reimbursed at either an hourly or per visit rate for the allowable procedure codes.
Nursing services may include medication administration; however, a nursing visit will not be extended in order to administer medication or perform other skilled nursing functions at more than one point during the day, unless skilled nursing services are medically necessary throughout the intervening period.
Nursing services are medically necessary services ordered by a physician and provided by a licensed registered nurse or a licensed practical nurse within the scope of the State’s Nurse Practice Act.