22G .0508 - PRIVATE DUTY NURSING

22G .0508. PRIVATE DUTY NURSING

(a) Private duty nursing services shall be reimbursed at the lower of billed customary charges or an established hourly rate. The rate shall be derived from the average billed charges per hour in the base year and, beginning July 1, 1990 shall be adjusted annually by the percentage change in the rate for a skilled nursing visit by a home health agency.

(b) Effective October 1, 1993, payment for Private Duty Nursing Medical Supplies, except those related to provision and use of DME, shall be reimbursed at the lower of a provider's billed customary charges or the maximum fee established for certified home health agencies. The maximum amount for each item shall be determined by multiplying the prevailing Medicare Part B allowable amount by 145 percent to account for the allocation of overhead costs and by 80 percent to encourage maximum efficiency. Fees shall be established based on average, reasonable charges if a Medicare allowable amount cannot be obtained for a particular supply item. The Medicare allowable amounts shall be those amounts available to the Division of Medical Assistance as of July 1 of each year. This reimbursement limitation shall become effective in accordance with the provisions of G.S. 108A-55(c).

(Authority G.S. 108A-25(b); 108A-54; 42 C.F.R. 440.80; Eff. January 1, 1994; Temporary Amendment Eff. December 20, 2002; July 1, 2002; Temporary Amendment Expired November 28, 2003.)

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