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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 363TEXAS HEALTH STEPS COMPREHENSIVE CARE PROGRAM
SUBCHAPTER CPRIVATE DUTY NURSING SERVICES
RULE §363.307Client Eligibility Criteria

(a) To be eligible for private duty nursing services, a client must:

  (1) be under 21 years of age and eligible for THSteps-CCP;

  (2) meet medical necessity criteria for private duty nursing;

  (3) have a primary physician who:

    (A) provides a prescription for private duty nursing services;

    (B) establishes a plan of care;

    (C) provides a statement that private duty nursing services as defined in this section are medically necessary for the client;

    (D) provides a statement that the client's medical condition is sufficiently stable to permit safe delivery of private duty nursing as described in the plan of care;

    (E) provides continuing care and medical supervision including but not limited to examination or treatment within 30 days prior to the start of private duty nursing services. Medical care must comply with the American Academy of Pediatrics recommended schedule of visits that are applicable to the client's age, or within six months, whichever is sooner; and

    (F) provides specific written, dated orders for clients receiving private duty nursing services.

  (4) require care beyond the level of services delivered under §354.103 and §354.1041 of this title (relating to Medicaid Home Health Services); and

  (5) have an identified primary care giver residing in the client's residence and an identified alternate care giver who is or can be trained to provide part of the client's care, or if no alternate care giver is identified, a current plan to enable the client to receive care in an alternate setting or situation if the primary care giver is unable to fulfill his or her role.

(b) HHSC may waive any client eligibility criteria in subsection (a)(3)(E) of this section upon review of a client's specific circumstances.


Source Note: The provisions of this §363.307 adopted to be effective March 31, 1999, 23 TexReg 13077; transferred effective September 1, 2002, as published in the Texas Register December 6, 2002, 27 TexReg 11527; amended to be effective January 1, 2006, 30 TexReg 8661

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