Utah Admin. Code R414-40-3 - Program Access Requirements

(1) Only a licensed home health agency enrolled as a Medicaid provider may be reimbursed for private duty nursing services.
(2) A member shall have a written physician order establishing the need for private duty nursing services. The private duty nursing provider shall develop a care plan consistent with the member's diagnosis, severity of illness, and intensity of services. If medically necessary nursing services require four hours or fewer of skilled nursing, the service is covered under the home health program.
(3) Private duty nursing is only available if a parent, guardian, or primary caregiver is committed to and capable of performing the medical skills necessary to ensure safe, quality care.
(4)
(a) The home health agency shall verify that the hospital has provided specialized training for the caregiver before patient discharge to enable the caregiver to provide hands-on care in the home.
(b) The private duty nurse shall initially supervise the caregiver who provides this care to ensure that training has been assimilated to ensure safe, quality patient care.

Notes

Utah Admin. Code R414-40-3
Amended by Utah State Bulletin Number 2022-17, effective 8/24/2022 Amended by Utah State Bulletin Number 2025-05, effective 2/18/2025

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