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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 §363.309Medical Necessity Criteria for Private Duty Nursing

(a) Private duty nursing is considered medically necessary if a person requires continuous, skillful observation and judgment to maintain or improve health status; and

  (1) is dependent on technology to sustain life; or

  (2) requires ongoing and frequent skilled interventions to maintain or improve health status, and delayed skilled intervention is expected to result in:

    (A) deterioration of a chronic condition;

    (B) loss of function;

    (C) imminent risk to health status due to medical fragility; or

    (D) risk of death.

(b) Determining medical necessity for private duty nursing includes assessment of the following elements:

  (1) complexity and intensity of the client's care;

  (2) stability and predictability of the client's condition; and

  (3) frequency of the client's need for skilled nursing care.


Source Note: The provisions of this §363.309 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

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