Ohio Admin. Code 5123-9-39 - [Effective until 7/1/2025] Home and community-based services waivers - waiver nursing services under the individual options waiver
(A) Purpose
This rule defines waiver nursing services and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.
(B) Definitions
For the purposes of this rule, the following definitions apply:
(1) "Adult day support" has the
same meaning as in rule
5123-9-17 of the Administrative
Code.
(2) "Agency provider"
has the same meaning as in
means an entity that directly employs at least one
person in addition to a director of operations for the purpose of providing
services for which the entity is certified in accordance with rule
5123-2-08 of the Administrative
Code.
(3) "Community respite" has
the same meaning as in rule
5123-9-22 of the Administrative
Code.
(4) "County board" means a
county board of developmental disabilities.
(5) "Department" means the Ohio department of
developmental disabilities.
(6)
"Homemaker/personal care" has the same meaning as in rule
5123-9-30 of the Administrative
Code.
(7) "Independent provider"
has the same meaning as in
means a self-employed person who provides services for
which the person is certified in accordance with rule
5123-2-09 of the Administrative
Code and does not employ, either directly or through
contract, anyone else to provide the services.
(8) "Individual" means a person with a
developmental disability or for the purposes of giving, refusing to give, or
withdrawing consent for services, his or
her
the person's guardian in accordance
with section 5126.043 of the Revised Code or
other person authorized to give consent.
(9) "Individual service plan" means the
written description of services, supports, and activities to be provided to an
individual.
(10) "Intermediate care
facility for individuals with intellectual disabilities" has the same meaning
as in section 5124.01 of the Revised
Code.
(11) "Licensed practical
nurse" has the same meaning as in section
4723.01 of the Revised
Code.
(12) "Medically necessary"
has the same meaning as "medical necessity" described in rule
5160-1-01 of the Administrative
Code.
(13) "Plan of care" means the
medical treatment plan that is established, approved, and signed by the
treating physician, physician's assistant, or advanced
practice nurse. The plan of care must be signed and dated by the treating
physician, physician's assistant, or advanced practice
nurse prior to requesting payment for a service. The plan of care is not
the same as the individual service plan.
(14) "Registered nurse" has the same meaning
as in section 4723.01 of the Revised
Code.
(15) "Residential respite"
has the same meaning as in rule
5123-9-34 of the Administrative
Code.
(16) "Service documentation"
means all records and information on one or more documents, including documents
that may be created or maintained in electronic software programs, created and
maintained contemporaneously with the delivery of services, and kept in a
manner as to fully disclose the nature and extent of services delivered that
shall include
includes the items delineated in paragraph (F) of this
rule to validate payment for medicaid services.
(17) "Significant change" means a change
experienced by an individual including but not limited to, a change in health
status, caregiver status, or location/residence; referral to or active
involvement on the part of a protective services agency; or
institutionalization.
(18)
"Vocational habilitation" has the same meaning as in rule
5123-9-14 of the Administrative
Code.
(19) "Waiver nursing
services" means services provided to an individual who requires the skills of a
registered nurse or licensed practical nurse working at the direction of a
registered nurse. Waiver nursing services shall
does not
include:
(a) Services delegated in accordance
with Chapter 4723. of the Revised Code and rules adopted thereunder, and
performed by persons who are not licensed nurses in accordance with Chapter
4723. of the Revised Code;
(b)
Services that require the skills of a psychiatric nurse;
(c) Visits performed for the purpose of
conducting a registered nurse assessment as set forth in rule
5160-12-08 of the Administrative
Code including but not limited to, an outcome and assessment information set or
any other assessment;
(d)
Registered nurse consultations as set forth in rule
5160-12-08 of the Administrative
Code including but not limited to, those performed by registered nurses for the
sole purpose of directing licensed practical nurses in the performance of
waiver nursing services or directing personal care aides or home health aides
employed by a medicare-certified home health agency or otherwise-accredited
agency;
(e) Visits performed for
the sole purpose of meeting the home care attendant service registered nurse
visit requirements set forth in rules
173-39-02.24 and
5160-46-04.1 of the
Administrative Code;
(f) Services
performed in excess of the number of hours approved pursuant to, and as
specified in, the individual service plan; or
(g) Services performed that meet the
definition of waiver nursing delegation/assessment or waiver nursing
delegation/consultation set forth in rule 5123:2-9-37
5123-9-37
of the Administrative Code.
(C) Provider qualifications
(1) Waiver nursing services
shall
will be
provided by an independent provider or an agency provider that meets the
requirements of this rule and that has a medicaid provider agreement with the
Ohio department of medicaid.
(2)
Waiver nursing services shall
will be provided by a registered nurse or by a
licensed practical nurse working at the direction of a registered nurse who:
(a) Possesses a
current, valid, and unrestricted license issued by the Ohio board of
nursing
current valid licensure in good
standing to practice nursing in Ohio pursuant to Chapter 4723. of the Revised
Code; and
(b) Is working
within his or her
the scope of practice as set forth in Chapter 4723. of
the Revised Code and rules adopted thereunder.
(3) Nursing tasks and activities that
shall
must be
performed only by a registered nurse include but are not limited to:
(a) Intravenous insertion, removal, or
discontinuation;
(b) Intravenous
medication administration;
(c)
Programming of a pump to deliver medication including but not limited to,
epidural, subcutaneous, and intravenous (except routine doses of insulin
through a programmed pump);
(d)
Insertion or initiation of infusion therapies;
(e) Central line dressing changes;
and
(f) Blood product
administration.
(4)
Waiver nursing services shall
will not be provided by a county board or a
regional council of governments formed in accordance with section
5126.13 of the Revised Code by
two or more county boards.
(D)
Service authorization
(1) A county board or
its contracted agent shall
will complete and submit a service authorization
request for waiver nursing services to the department for review and approval
at least annually and upon identification of a significant change that affects
a service authorization. Each service authorization request
shall
will
include:
(a) An assessment of resources
available to address each skilled nursing task ordered by a physician, physician's assistant, or advanced practice
nurse;
(b) A proposed weekly
schedule with corresponding budget; and
(c) A nursing task inventory that identifies
the nursing tasks to be performed, the frequency and duration of each nursing
task to be performed, and the current method by which each nursing task is
performed.
(2) Waiver
nursing services shall
will be authorized only when an individual's
needs cannot be met by developmental disabilities personnel holding
certification issued in accordance with rule
5123-6-06 of the Administrative
Code and when applicable, through nursing delegation in accordance with rules
adopted by the Ohio board of nursing pursuant to Chapter 4723. of the Revised
Code, and/or state plan nursing services as defined in Chapter 5160-12 of the
Administrative Code.
(3) The
department shall
will review a service authorization request to
determine whether the requested services are medically necessary. When the
department or the Ohio department of medicaid has determined within the
previous twelve months that the requested services are not medically necessary,
the department may without further review accept the Ohio department of
medicaid determination. The department shall
will determine
the services to be medically necessary if the services:
(a) Are appropriate for the individual's
health and welfare needs, living arrangement, circumstances, and expected
outcomes; and
(b) Are of an
appropriate type, amount, duration, scope, and intensity; and
(c) Are the most efficient, effective, and
lowest cost alternative that, when combined with non-waiver services, ensure
the health and welfare of the individual receiving the services; and
(d) In accordance with rule
5123-9-02 of the Administrative
Code, are not otherwise available through other resources.
(4) The department may approve a service
authorization request in its entirety or may partially approve a service
authorization request if it determines that the services are medically
necessary. A service authorization request shall
will not be
denied without review by a registered nurse.
(5) The individual shall
will be
afforded notice and hearing rights regarding service authorizations in
accordance with section
5101.35 of the Revised Code.
Providers shall have no standing in appeals
under this paragraph. A change in staffing ratios does not necessarily result
in a change in the level of services received by an individual which would
affect the annual service authorization.
(E) Requirements for service delivery
(1) Waiver nursing services
shall
will be
provided pursuant to an individual service plan that conforms to the
requirements of rule
5123-4-02 of the Administrative
Code.
(2) Waiver nursing services
shall
will
not be provided to an individual during the same time the individual is
receiving adult day support, community respite, residential respite being
provided at an intermediate care facility for individuals with intellectual
disabilities, or vocational habilitation.
(3) A provider of waiver nursing services
shall
will be
identified as the provider and have specified in the individual service plan
the number of hours for which the provider is authorized to furnish waiver
nursing services.
(4) A registered
nurse or licensed practical nurse working at the direction of a registered
nurse may provide services for no more than three individuals in a group
setting during a face-to-face waiver nursing services visit.
(5) A waiver nursing services visit by a
registered nurse or a licensed practical nurse working at the direction of a
registered nurse shall
will not exceed twelve hours in length during a
twenty-four hour period unless an unforeseen event causes a medically necessary
scheduled visit to extend beyond twelve hours, in which case the visit
shall
will
not exceed sixteen hours.
(6)
Individuals who receive waiver nursing services must be under the supervision
of a treating physician, physician's assistant, or advanced practice nurse who
is directly providing care and treatment to the individual (and not merely
engaged to authorize plans of care for waiver nursing services).
(7) A provider of waiver nursing services who
is a licensed practical nurse working at the direction of a registered nurse
shall
will
conduct a face-to-face visit with the individual and the directing registered
nurse prior to initiating services and at least once every one hundred twenty
days for the purpose of evaluating the provision of waiver nursing services,
the individual's satisfaction with care delivery and performance of the
licensed practical nurse, and to ensure that waiver nursing services are being
provided in accordance with the approved plan of care.
(8) In all instances, when a treating
physician, physician's assistant, or advanced practice
nurse gives verbal orders to the registered nurse or licensed practical
nurse working at the direction of a registered nurse, the nurse
shall
will
record in writing, the physician's orders,
the date and time the orders were given, and sign the entry in the service
documentation. The nurse shall
will subsequently secure documentation of the
verbal orders signed and dated by the treating physician, physician's assistant, or advanced practice
nurse.
(9) In all instances,
when an independent provider who is a licensed practical nurse working at the
direction of a registered nurse is providing waiver nursing services, the
licensed practical nurse shall
will provide clinical notes, signed and dated by
the licensed practical nurse, documenting all consultations between the
licensed practical nurse and the directing registered nurse, documenting the
face-to-face visits between the licensed practical nurse and the directing
registered nurse, and documenting the face-to-face visits between the licensed
practical nurse, the individual receiving waiver nursing services, and the
directing registered nurse. The clinical notes may be collected and maintained
in electronic software programs.
(10) Waiver nursing services may be provided
on the same day as, but not concurrently with, a registered nurse assessment
and/or registered nurse consultation as set forth in rule
5160-12-08 of the Administrative
Code.
(F) Documentation
of services
(1) Service documentation for
waiver nursing services shall
will include each of the following to validate
payment for medicaid services:
(a) Type of
service.
(b) Date of
service.
(c) Place of
service.
(d) Name of individual
receiving service.
(e) Medicaid
identification number of individual receiving service.
(f) Name of provider.
(g) Provider identifier/contract
number.
(h) Written or electronic
signature of the person delivering the service or initials of the person
delivering the service if a signature and corresponding initials are on file
with the provider.
(i) Group size
in which the service was provided.
(j) Description and details of the service
delivered that directly relate to the services specified in the approved
individual service plan as the services to be provided, including the
individual's response to each medication, treatment, or procedure performed in
accordance with the physician's orders
issued by the treating physician, physician's
assistant, or advanced practice nurse or the plan of care.
(k) Begin and end times of the delivered
service.
(l) Number of units of the
delivered service or continuous amount of uninterrupted time during which the
service was provided.
(2) In addition to service documentation
specified in paragraph (F)(1) of this rule, providers of waiver nursing
services shall
will maintain a clinical record for each individual
which includes:
(a) Individual's medical
history.
(b) Name and national
provider identifier number of individual's treating physician, physician's assistant, or advanced practice
nurse.
(c) A copy of all
individual service plans in effect when the provider provides
services.
(d) A copy of the initial
and all subsequent plans of care, specifying the type, frequency, scope, and
duration of the waiver nursing services being performed. When waiver nursing
services are performed by a licensed practical nurse working at the direction
of a registered nurse, the record shall
will include documentation that the registered
nurse has reviewed the plan of care with the licensed practical nurse. The plan
of care shall
will be certified by the treating physician, physician's assistant, or advanced practice nurse
initially and recertified at least annually thereafter, or more frequently if
there is a significant change in the individual's condition.
(e) Documentation of verbal orders from the
treating physician, physician's assistant, or advanced
practice nurse in accordance with paragraph (E)(8) of this
rule.
(f) The clinical notes of an
independent provider who is a licensed practical nurse working at the direction
of a registered nurse in accordance with paragraph (E)(9) of this
rule.
(g) A copy of any advance
directives including but not limited to, a "do not resuscitate" order or
medical power of attorney, if they exist.
(h) Documentation of drug and food
interactions, allergies, and dietary restrictions.
(i) Clinical notes signed and dated by the
registered nurse or licensed practical nurse working at the direction of a
registered nurse, documenting all communications with the treating
physician, physician's assistant, or advanced practice
nurse and other members of the multidisciplinary team.
(3) Providers of waiver nursing
services shall
will maintain, in a confidential manner for at least
thirty days at the individual's residence, medication and/or treatment records
which indicate the person who prescribed the medication and/or treatment and
the date, time, and person who administered the medication and/or
treatment.
(G) Payment
standards
(1) The billing units, service
codes, and payment rates for waiver nursing services are contained in the
appendix to this rule.
(2) Services
meeting the definition of "homemaker/personal care" may be reimbursed as waiver
nursing services when provided incidental to waiver nursing services performed
during an authorized waiver nursing services visit.
Notes
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.049, 5123.1611
Rule Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
Prior Effective Dates: 07/01/2016, 01/01/2017, 06/11/2020 (Emer.), 11/19/2020, 06/17/2021 (Emer.), 01/01/2022
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(A) Purpose
This rule defines waiver nursing services and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.
(B) Definitions
For the purposes of this rule, the following definitions apply:
(1) "Adult day support" has the same meaning as in rule 5123-9-17 of the Administrative Code.
(2) "Agency provider" has the same meaning as in means an entity that directly employs at least one person in addition to a director of operations for the purpose of providing services for which the entity is certified in accordance with rule 5123-2-08 of the Administrative Code.
(3) "Community respite" has the same meaning as in rule 5123-9-22 of the Administrative Code.
(4) "County board" means a county board of developmental disabilities.
(5) "Department" means the Ohio department of developmental disabilities.
(6) "Homemaker/personal care" has the same meaning as in rule 5123-9-30 of the Administrative Code.
(7) "Independent provider" has the same meaning as in means a self-employed person who provides services for which the person is certified in accordance with rule 5123-2-09 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.
(8) "Individual" means a person with a developmental disability or for the purposes of giving, refusing to give, or withdrawing consent for services, his or her the person's guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.
(9) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.
(10) "Intermediate care facility for individuals with intellectual disabilities" has the same meaning as in section 5124.01 of the Revised Code.
(11) "Licensed practical nurse" has the same meaning as in section 4723.01 of the Revised Code.
(12) "Medically necessary" has the same meaning as "medical necessity" described in rule 5160-1-01 of the Administrative Code.
(13) "Plan of care" means the medical treatment plan that is established, approved, and signed by the treating physician, physician's assistant, or advanced practice nurse. The plan of care must be signed and dated by the treating physician, physician's assistant, or advanced practice nurse prior to requesting payment for a service. The plan of care is not the same as the individual service plan.
(14) "Registered nurse" has the same meaning as in section 4723.01 of the Revised Code.
(15) "Residential respite" has the same meaning as in rule 5123-9-34 of the Administrative Code.
(16) "Service documentation" means all records and information on one or more documents, including documents that may be created or maintained in electronic software programs, created and maintained contemporaneously with the delivery of services, and kept in a manner as to fully disclose the nature and extent of services delivered that shall include includes the items delineated in paragraph (F) of this rule to validate payment for medicaid services.
(17) "Significant change" means a change experienced by an individual including but not limited to, a change in health status, caregiver status, or location/residence; referral to or active involvement on the part of a protective services agency; or institutionalization.
(18) "Vocational habilitation" has the same meaning as in rule 5123-9-14 of the Administrative Code.
(19) "Waiver nursing services" means services provided to an individual who requires the skills of a registered nurse or licensed practical nurse working at the direction of a registered nurse. Waiver nursing services shall does not include:
(a) Services delegated in accordance with Chapter 4723. of the Revised Code and rules adopted thereunder, and performed by persons who are not licensed nurses in accordance with Chapter 4723. of the Revised Code;
(b) Services that require the skills of a psychiatric nurse;
(c) Visits performed for the purpose of conducting a registered nurse assessment as set forth in rule 5160-12-08 of the Administrative Code including but not limited to, an outcome and assessment information set or any other assessment;
(d) Registered nurse consultations as set forth in rule 5160-12-08 of the Administrative Code including but not limited to, those performed by registered nurses for the sole purpose of directing licensed practical nurses in the performance of waiver nursing services or directing personal care aides or home health aides employed by a medicare-certified home health agency or otherwise-accredited agency;
(e) Visits performed for the sole purpose of meeting the home care attendant service registered nurse visit requirements set forth in rules 173-39-02.24 and 5160-46-04.1 of the Administrative Code;
(f) Services performed in excess of the number of hours approved pursuant to, and as specified in, the individual service plan; or
(g) Services performed that meet the definition of waiver nursing delegation/assessment or waiver nursing delegation/consultation set forth in rule 5123:2-9-37 5123-9-37 of the Administrative Code.
(C) Provider qualifications
(1) Waiver nursing services shall will be provided by an independent provider or an agency provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid.
(2) Waiver nursing services shall will be provided by a registered nurse or by a licensed practical nurse working at the direction of a registered nurse who:
(a) Possesses a current, valid, and unrestricted license issued by the Ohio board of nursing current valid licensure in good standing to practice nursing in Ohio pursuant to Chapter 4723. of the Revised Code; and
(b) Is working within his or her the scope of practice as set forth in Chapter 4723. of the Revised Code and rules adopted thereunder.
(3) Nursing tasks and activities that shall must be performed only by a registered nurse include but are not limited to:
(a) Intravenous insertion, removal, or discontinuation;
(b) Intravenous medication administration;
(c) Programming of a pump to deliver medication including but not limited to, epidural, subcutaneous, and intravenous (except routine doses of insulin through a programmed pump);
(d) Insertion or initiation of infusion therapies;
(e) Central line dressing changes; and
(f) Blood product administration.
(4) Waiver nursing services shall will not be provided by a county board or a regional council of governments formed in accordance with section 5126.13 of the Revised Code by two or more county boards.
(D) Service authorization
(1) A county board or its contracted agent shall will complete and submit a service authorization request for waiver nursing services to the department for review and approval at least annually and upon identification of a significant change that affects a service authorization. Each service authorization request shall will include:
(a) An assessment of resources available to address each skilled nursing task ordered by a physician, physician's assistant, or advanced practice nurse;
(b) A proposed weekly schedule with corresponding budget; and
(c) A nursing task inventory that identifies the nursing tasks to be performed, the frequency and duration of each nursing task to be performed, and the current method by which each nursing task is performed.
(2) Waiver nursing services shall will be authorized only when an individual's needs cannot be met by developmental disabilities personnel holding certification issued in accordance with rule 5123-6-06 of the Administrative Code and when applicable, through nursing delegation in accordance with rules adopted by the Ohio board of nursing pursuant to Chapter 4723. of the Revised Code, and/or state plan nursing services as defined in Chapter 5160-12 of the Administrative Code.
(3) The department shall will review a service authorization request to determine whether the requested services are medically necessary. When the department or the Ohio department of medicaid has determined within the previous twelve months that the requested services are not medically necessary, the department may without further review accept the Ohio department of medicaid determination. The department shall will determine the services to be medically necessary if the services:
(a) Are appropriate for the individual's health and welfare needs, living arrangement, circumstances, and expected outcomes; and
(b) Are of an appropriate type, amount, duration, scope, and intensity; and
(c) Are the most efficient, effective, and lowest cost alternative that, when combined with non-waiver services, ensure the health and welfare of the individual receiving the services; and
(d) In accordance with rule 5123-9-02 of the Administrative Code, are not otherwise available through other resources.
(4) The department may approve a service authorization request in its entirety or may partially approve a service authorization request if it determines that the services are medically necessary. A service authorization request shall will not be denied without review by a registered nurse.
(5) The individual shall will be afforded notice and hearing rights regarding service authorizations in accordance with section 5101.35 of the Revised Code. Providers shall have no standing in appeals under this paragraph. A change in staffing ratios does not necessarily result in a change in the level of services received by an individual which would affect the annual service authorization.
(E) Requirements for service delivery
(1) Waiver nursing services shall will be provided pursuant to an individual service plan that conforms to the requirements of rule 5123-4-02 of the Administrative Code.
(2) Waiver nursing services shall will not be provided to an individual during the same time the individual is receiving adult day support, community respite, residential respite being provided at an intermediate care facility for individuals with intellectual disabilities, or vocational habilitation.
(3) A provider of waiver nursing services shall will be identified as the provider and have specified in the individual service plan the number of hours for which the provider is authorized to furnish waiver nursing services.
(4) A registered nurse or licensed practical nurse working at the direction of a registered nurse may provide services for no more than three individuals in a group setting during a face-to-face waiver nursing services visit.
(5) A waiver nursing services visit by a registered nurse or a licensed practical nurse working at the direction of a registered nurse shall will not exceed twelve hours in length during a twenty-four hour period unless an unforeseen event causes a medically necessary scheduled visit to extend beyond twelve hours, in which case the visit shall will not exceed sixteen hours.
(6) Individuals who receive waiver nursing services must be under the supervision of a treating physician, physician's assistant, or advanced practice nurse who is directly providing care and treatment to the individual (and not merely engaged to authorize plans of care for waiver nursing services).
(7) A provider of waiver nursing services who is a licensed practical nurse working at the direction of a registered nurse shall will conduct a face-to-face visit with the individual and the directing registered nurse prior to initiating services and at least once every one hundred twenty days for the purpose of evaluating the provision of waiver nursing services, the individual's satisfaction with care delivery and performance of the licensed practical nurse, and to ensure that waiver nursing services are being provided in accordance with the approved plan of care.
(8) In all instances, when a treating physician, physician's assistant, or advanced practice nurse gives verbal orders to the registered nurse or licensed practical nurse working at the direction of a registered nurse, the nurse shall will record in writing, the physician's orders, the date and time the orders were given, and sign the entry in the service documentation. The nurse shall will subsequently secure documentation of the verbal orders signed and dated by the treating physician, physician's assistant, or advanced practice nurse.
(9) In all instances, when an independent provider who is a licensed practical nurse working at the direction of a registered nurse is providing waiver nursing services, the licensed practical nurse shall will provide clinical notes, signed and dated by the licensed practical nurse, documenting all consultations between the licensed practical nurse and the directing registered nurse, documenting the face-to-face visits between the licensed practical nurse and the directing registered nurse, and documenting the face-to-face visits between the licensed practical nurse, the individual receiving waiver nursing services, and the directing registered nurse. The clinical notes may be collected and maintained in electronic software programs.
(10) Waiver nursing services may be provided on the same day as, but not concurrently with, a registered nurse assessment and/or registered nurse consultation as set forth in rule 5160-12-08 of the Administrative Code.
(F) Documentation of services
(1) Service documentation for waiver nursing services shall will include each of the following to validate payment for medicaid services:
(a) Type of service.
(b) Date of service.
(c) Place of service.
(d) Name of individual receiving service.
(e) Medicaid identification number of individual receiving service.
(f) Name of provider.
(g) Provider identifier/contract number.
(h) Written or electronic signature of the person delivering the service or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.
(i) Group size in which the service was provided.
(j) Description and details of the service delivered that directly relate to the services specified in the approved individual service plan as the services to be provided, including the individual's response to each medication, treatment, or procedure performed in accordance with the physician's orders issued by the treating physician, physician's assistant, or advanced practice nurse or the plan of care.
(k) Begin and end times of the delivered service.
(l) Number of units of the delivered service or continuous amount of uninterrupted time during which the service was provided.
(2) In addition to service documentation specified in paragraph (F)(1) of this rule, providers of waiver nursing services shall will maintain a clinical record for each individual which includes:
(a) Individual's medical history.
(b) Name and national provider identifier number of individual's treating physician, physician's assistant, or advanced practice nurse.
(c) A copy of all individual service plans in effect when the provider provides services.
(d) A copy of the initial and all subsequent plans of care, specifying the type, frequency, scope, and duration of the waiver nursing services being performed. When waiver nursing services are performed by a licensed practical nurse working at the direction of a registered nurse, the record shall will include documentation that the registered nurse has reviewed the plan of care with the licensed practical nurse. The plan of care shall will be certified by the treating physician, physician's assistant, or advanced practice nurse initially and recertified at least annually thereafter, or more frequently if there is a significant change in the individual's condition.
(e) Documentation of verbal orders from the treating physician, physician's assistant, or advanced practice nurse in accordance with paragraph (E)(8) of this rule.
(f) The clinical notes of an independent provider who is a licensed practical nurse working at the direction of a registered nurse in accordance with paragraph (E)(9) of this rule.
(g) A copy of any advance directives including but not limited to, a "do not resuscitate" order or medical power of attorney, if they exist.
(h) Documentation of drug and food interactions, allergies, and dietary restrictions.
(i) Clinical notes signed and dated by the registered nurse or licensed practical nurse working at the direction of a registered nurse, documenting all communications with the treating physician, physician's assistant, or advanced practice nurse and other members of the multidisciplinary team.
(3) Providers of waiver nursing services shall will maintain, in a confidential manner for at least thirty days at the individual's residence, medication and/or treatment records which indicate the person who prescribed the medication and/or treatment and the date, time, and person who administered the medication and/or treatment.
(G) Payment standards
(1) The billing units, service codes, and payment rates for waiver nursing services are contained in the appendix to this rule.
(2) Services meeting the definition of "homemaker/personal care" may be reimbursed as waiver nursing services when provided incidental to waiver nursing services performed during an authorized waiver nursing services visit.
Notes
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.049, 5123.1611
Rule Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
Prior Effective Dates: 07/01/2016, 01/01/2017, 06/11/2020 (Emer.), 11/19/2020, 06/17/2021 (Emer.), 01/01/2022