Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-40

Private Duty Nursing Service

Five-Year Notice of Review and Statement of Continuation

DAR File No.: 34154
Filed: 10/14/2010 12:17:49 PM

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

Section 26-1-5 grants the Department the authority to adopt rules to carry out the provisions of the Medicaid program that allow Medicaid clients to receive Medicaid services. In addition, Section 26-18-3 requires the Department to implement these provisions of the Medicaid program through its administrative rules. Further, 42 CFR 440.80 specifies the continuous care requirements for private duty nursing services.

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

During the last five years, this rule has undergone extensive review and discussion. The Department received public comments on the rule that focus on the need for 24-hour care of ventilator dependent recipients. Concerned parents stated that they could not provide 24-hour care and that their children who require round-the-clock care should not be institutionalized.

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

This rule is necessary because it provides medically necessary private duty nursing services for recipients who need continuous care in their homes. Therefore, this rule should be continued. The Department does not disagree with comments that focus on the need for 24-hour care, but the Department is limited in the resources it can provide and cannot provide constant supervision for these services. The Department, therefore, has amended this rule to allow for a better allocation of private duty nursing services among Medicaid recipients, and to allow caregivers the opportunity to receive training from private duty nursing service providers to provide necessary care.

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Authorized by:

David Sundwall, Executive Director

Effective:

10/14/2010