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Long Term Care Division. Alabama Medicaid Agency Long Term Care Division Outreach and Education Unit May 2003. P R E S E N T S An Overview of. PRIVATE DUTY NURSING. What is Private Duty Nursing?.

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Long Term Care Division

Alabama Medicaid Agency

Long Term Care Division

Outreach and Education Unit

May 2003


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P R E S E N T SAn Overview of

PRIVATE DUTY NURSING


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What is Private Duty Nursing?

  • Nursing services provided in the home for eligible individuals requiring continuous skilled nursing care.

  • These services must be a result of an EPSDT screening referral.

  • The service must be prior authorized by the Alabama Medicaid Agency, prior authorization unit.


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Targeted Population

  • Alabama Medicaid provides Private Duty Nursing Services to individuals under age 21 years of age who has been diagnosed with a life threatening condition requiring attention around the clock.

  • The need for constant care must exceed the family’s ability to care for the recipient without the assistance of at least four hours of continuous skilled nursing care.


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Medicaid Coverage

  • Alabama Medicaid provides professional nursing services for infants, children and adolescents with chronic conditions within a nurturing home environment that maximizes the capabilities of the individual and minimizes the effects of the condition or disability.

  • The agency also provides teaching, supervising, and delegating care to caregivers by the private duty nurse is critical in reaching the goal of the program.


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Medical Criteria

  • Non-ventilator dependent individuals

  • Primary conditions:

    • Tracheotomy

    • Total Parental Nutrition

    • Intravenous Therapy


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Medical Criteria

  • Secondary Conditions:

    • Decubitus Ulcers

    • Colostomy or Ileostomy care

    • Suprapubic Catheter Care

    • Internal Nasogastic or Gastrostomy Feedings


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Medical Criteria

Diagnosis Criteria

  • Severe neuromuscular, respiratory, or cardiovascular disease not requiring mechanical ventilator support;

  • Chronic liver or gastrointestinal disorders with associated nutritional compromise;

  • Multiple congenital anomalies or malignacies with severe involvement of vital body functions;

  • Serious infections which require prolonged treatment.


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Primary Conditions

  • Ventilator Dependent Individuals

  • Mechanical ventilator support is necessary for at least six hours per day and attempted weaning is in progress at least weekly.

  • Frequent ventilator checks are necessary

  • Oxygen supplementation for ventilator dependent individuals is at below an inspired fraction of 40%.


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Diagnosis Criteria

  • Neuro muscular disease involving the respiratory muscles

  • Brainstem respiratory center dysfunction

  • Severe thoracic cage abnormalities

  • Lung disease associated with cardiovascular disorders


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Provider Information

  • Private Duty Nursing Agencies

  • Enrollment


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Rates

  • Services provided by a registered nurse - $27.50 per hour

  • Services provided by a licensed practical nurse - $20.00 per hour.


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