10.09.69.11

.11 Covered Optional Services — Private Duty Nursing, Certified Nursing Assistant, and Home Health Aide.

A. The Program shall cover shift nursing services provided by a licensed registered nurse or a licensed practical nurse when:

(1) The complexity of the service or the condition of a participant requires the judgment, knowledge, and skills of a licensed nurse for a shift of 4 or more continuous hours;

(2) The services are delivered to the participant in the participant's home, in school, or in other normal life activity setting or settings which occur outside the participant's home;

(3) Services are provided to a REM participant who is 21 years old or older;

(4) Services are rendered in accordance with COMAR 10.09.53;

(5) Services are rendered in accordance with Health Occupations Article, Title 8, Annotated Code of Maryland;

(6) Sufficient documentation concerning the services provided is maintained by the registered nurse or licensed practical nurse, including:

(a) Verification of the participant's receipt of services as documented by the participant's signature or the signature of the participant's witness on the provider's official forms; and

(b) Signed and dated progress notes which are reviewed monthly by the nurse supervisor;

(7) The nurse's shift is limited to not more than 16 consecutive hours and the nurse is off 8 or more hours before starting another shift;

(8) Services are rendered by a licensed registered or practical nurse who is certified in cardiopulmonary resuscitation and the certification is renewed every 2 years;

(9) Services are preauthorized in accordance with the criteria set forth in COMAR 10.09.53; and

(10) Monthly supervisory visits of a licensed practical nurse are conducted and documented by a registered nurse.

B. The Program shall cover services provided by a certified nursing assistant when:

(1) The certified nursing assistant is certified by the Maryland Board of Nursing and meets all the requirements to render services pursuant to Health Occupations Article, Title 8, Annotated Code of Maryland;

(2) The complexity of the service or the condition of a participant requires the judgment, knowledge, and skills of a certified nursing assistant for a shift of 4 or more continuous hours as specified in COMAR 10.09.27;

(3) The services provided include but are not limited to:

(a) Assistance with activities of daily living when performed in conjunction with other delegated nursing services; or

(b) Other health care services properly delegated by a licensed nurse pursuant to Health Occupations Article, Title 8, Annotated Code of Maryland;

(4) Services are rendered by a certified nursing assistant who is certified in cardiopulmonary resuscitation and the certification is renewed every 2 years;

(5) The certified nursing assistant's shift is limited to not more than 16 consecutive hours and the certified nursing assistant has 8 hours or more off before starting another shift;

(6) Sufficient documentation concerning the services provided is maintained by the certified nursing assistant including:

(a) Verification of the participant's receipt of services as documented by the participant's signature or the signature of the participant's witness on the provider's official forms; and

(b) Signed and dated progress notes which are reviewed every 2 weeks by the nurse supervisor;

(7) Supervisory visits are conducted every 2 weeks and documented by a registered nurse;

(8) The services are included in the REM participant's plan of care developed by the case manager; and

(9) Services are preauthorized by the Department.

C. The Program shall cover services provided by a home health aide when:

(1) The complexity of the service or the condition of a participant requires the judgment, knowledge, and skills of a home health aide for a shift of 4 or more continuous hours as specified in COMAR 10.09.27;

(2) Services are provided by an unlicensed person who meets all the conditions of participation specified by the Medicare program in 42 CFR §484.36 and Health Occupations Article, Title 8, Annotated Code of Maryland;

(3) The services provided include but are not limited to:

(a) Assistance with activities of daily living when performed in conjunction with other delegated nursing services; or

(b) Other health care services properly delegated by a licensed nurse pursuant to Health Occupations Article, Title 8, Annotated Code of Maryland;

(4) Services are rendered by a home health aide who is certified in cardiopulmonary resuscitation and the certification is renewed every 2 years;

(5) The home health aide's shift is limited to not more than 16 consecutive hours and the home health aide has 8 hours or more off before starting another shift;

(6) Sufficient documentation is maintained by the home health aide including:

(a) Verification of the participant's receipt of services as documented by the participant's signature or the signature of the participant's witness on the provider's official forms; and

(b) Signed and dated progress notes which are reviewed every 2 weeks by the nurse supervisor;

(7) Supervisory visits are conducted every 2 weeks and documented by a registered nurse;

(8) The services are included in the REM participant's plan of care developed by the case manager; and

(9) Services are preauthorized by the Department.