OAC 5160-12-02 — Private duty nursing services: provision requirements, coverage and service specification

What this rule requires your agency to do

• 1Individuals receiving PDN must be under the supervision of a treating physician, physician assistant, or advance practice nurse actively involved in their care, and must participate in developing the plan of care (para. (G)(1)-(2)).(OAC 5160-12-02 — Private duty nursing services: provision requirements, coverage and service specification)
• 2PDN not specified in a plan of care — and, for waiver individuals, not identified on the all services plan or services plan — is not reimbursable (para. (E)(2)).(OAC 5160-12-02 — Private duty nursing services: provision requirements, coverage and service specification)
• 3Certain nursing tasks may only be performed by an RN, including IV insertion/removal, IV medication administration, pump programming, insertion of infusion therapies, central line dressing changes, and blood product administration (para. (C)).(OAC 5160-12-02 — Private duty nursing services: provision requirements, coverage and service specification)
• 4The provider must ensure and document that a child (para. (I)) or adult (para. (J)) meets all additional-PDN qualification requirements before providing and billing for PDN services (para. (I)(4), (J)(4)).(OAC 5160-12-02 — Private duty nursing services: provision requirements, coverage and service specification)
• 5Providers must bill only after all documentation for services rendered during a visit is completed per rule 5160-12-03 (para. (E)(5)).(OAC 5160-12-02 — Private duty nursing services: provision requirements, coverage and service specification)
• 6PDN must be performed within the nurse's scope of practice under R.C. Chapter 4723 and provided/documented in accordance with the individual's plan of care per rule 5160-12-03 (para. (B)(1)-(2)).(OAC 5160-12-02 — Private duty nursing services: provision requirements, coverage and service specification)
• 7The treating physician/PA/APN must certify medical necessity using the ODM 07137 Certificate of Medical Necessity; PDN must not be for maintenance care in the post-hospital benefit (para. (H)(2)-(3)).(OAC 5160-12-02 — Private duty nursing services: provision requirements, coverage and service specification)
• 8PDN must be medically necessary per rule 5160-1-01 and provided in person in the individual's place of residence unless it is medically necessary for the nurse to accompany the individual in the community (para. (B)(3)-(4)).(OAC 5160-12-02 — Private duty nursing services: provision requirements, coverage and service specification)