Section 7 AAC 130.285 - Specialized private-duty nursing services(a) The department will pay for specialized private-duty nursing services that (1) are provided to a recipient 21 years of age or older that meets the requirements of 7 AAC 110.525(a) (2) - (4) and that is in one of the following recipient categories: (A) adults with physical and developmental disabilities;(B) individuals with intellectual and developmental disabilities;(C) older adults or adults with physical disabilities;(2) are approved under 7 AAC 130.217 and 7 AAC 130.218 as part of the recipient's support plan; and(3) receive prior authorization.(b) The department will consider services to be specialized private-duty nursing services if the services (1) provide individualized care that is tailored to the specific needs of the recipient on a part-time, intermittent, or continuous basis;(2) are provided by an individual licensed under AS 08.68 other than a certified nurse aide;(3) are prescribed by a physician, a physician assistant, or an advanced practice registered nurse, licensed under AS 08, that specifies in writing the scope of care to be provided, including the type, frequency, and duration of that care; and(4) are included in the recipient's support plan. (c) The department will not pay for a service as a specialized private-duty nursing service if (1) the service does not meet the requirements and limitations of 7 AAC 110.520 - 7 AAC 110.530; or(2) an individual that is an employee of the home and community-based waiver services provider is not enrolled individually and separately in accordance with 7 AAC 110.520(b).(d) A provider of specialized private duty nursing services under this section shall use an electronic visit verification (EVV) system that is either provided or approved by the department. If a provider decides to use its own EVV system or vendor, that system must include at the time of service delivery, and report to the state's EVV system, the following data: (1) the name of the agency; (2) the identity of the rendering provider; (3) the identity of the recipient; (4) the location of the service; (5) the date of the service; (6) the start and stop times of the service; and (7) the type of service provided. (e) A provider of specialized private duty nursing services under this section (1) may not submit a claim for payment of specialized private duty nursing under this section without also submitting the EVV data to support the claim; (2) must affirm the accuracy of each EVV submission, and must review and resolve, at least every calendar quarter, any exceptions in the EVV system that the provider uses; (3) must repay to the department any identified overpayment within 90 days; and (4) must coordinate and upload all aggregate data into the department's EW system on a daily basis or at another frequency specified by the department, if the provider is not using the department's EVV system. (f) In this section, "EVV" means electronic visit verification.Eff. 2/1/2010, Register 193; am 7/1/2013, Register 206; am 11/5/2017, Register 224, January 2018; am 4/24/2020, Register 234, April 2020; am 3/3/2021, Register 238, July 2021; am 1/1/2023, Register 244, January 2023Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040