10:60-5.9 Limitation, duration and location of home andservices waiver/private duty nursing (waiver/PDN)
(a) Home and community-based services waiver/private duty nursing services shall be provided in the community only and not in an inpatient hospital or nursing facility setting. Services shall be provided by a registered nurse (RN) or a licensed practical nurse (LPN).
1. Private duty nursing services rendered during hours when the beneficiary's normal life activities take him or her outside the home will be reimbursed. If a beneficiary seeks to obtain EPSDT/PDN services to attend school or other activities outside the home, but does not need such services in the home, there is no basis for authorizing EPSDT/PDN services. Only those EPSDT/PDN beneficiaries who require, and are authorized by DMAHS/DDD/DDS to receive, private duty nursing services in the home may utilize the approved hours outside the home during those hours when normal life activities take the beneficiary out of the home.
2. Due to safety concerns, the nurse shall not be authorized to engage in non-medical activities while accompanying the client, including the operation of a motor vehicle.
(b) Private duty nursing shall be a covered service only for those beneficiaries enrolled in Community Resources for People with Disabilities (CRPD), ABC, or ACCAP. Under CRPD, ABC and ACCAP, when payment for private duty nursing services is being provided or paid for by another source (that is, insurance), DDS or DMAHS shall supplement payment up to a maximum of 16 hours per day, including services provided or paid for by the other sources, if medically necessary, and if cost of service provided by the Division is less than institutional care.
(c) Private duty nursing services shall be limited to a maximum of 16 hours, including services provided or paid for by other sources, in a 24-hour period, per person in CRPD, ABC and ACCAP. There shall be a live-in primary adult caregiver (as defined in N.J.A.C. 10:60-1.2) who accepts 24-hour per day responsibility for the health and welfare of the beneficiary unless the sole purpose of the private duty nursing is the administration of IV therapy. (See N.J.A.C.10:60-6.3(b)2 and 7.4(a)2 for exceptions to 16-hour maximum in a 24-hour period.)
Recodified from N.J.A.C. 10:60-5.8 by R. 2003 d. 103, effective March 3, 2003. See: 34 N.J.R. 2705(a), 35 N.J.R. 1279(a). Former N.J.A.C. 10:60-5.9, Basis for reimbursement for home and community-based services waiver/PDN, recodified to N.J.A.C. 10:60-5.10. Amended by R. 2004 d. 92, effective March 1, 2004. See: 35 N.J.R. 4424(a), 36 N.J.R. 1206(b). Rewrote (a); in (b) and (c), substituted references to CRPD/PDN for references to Model Waiver 3. Amended by R. 2006 d. 238, effective July 3, 2006. See: 38 N.J.R. 1136(a), 38 N.J.R. 2810(a). In (a)1, substituted "DMAHS/DDD/DDS" for "the Division"; and in (b), substituted "Community Resources for People with Disabilities (CRPD)," for the first occurrence of "CRPD/PDN", "CRPD," for the second occurrence of "CRPD/PDN" and "DDS or DMAHS" for "the Division" and inserted "or paid for" following "provided" two times; and in (c), inserted "including services provided or paid for by other sources" and substituted "CRPD," for "CRPD/PDN".