woodbury

 

Residential Nursing Services

Provider Requirements and Service Limitations

From The July 2007 Florida Medicaid Provider Handbook

Residential Nursing- Requirements To Receive

Description

Residential nursing services are services prescribed by a physician and consist of
continuous nursing care provided by registered or licensed practical nurses, in
accordance with Chapter 464, F.S., and within the scope of Florida’s Nurse
Practice Act, for recipients who require ongoing nursing intervention in a licensed
residential facility, group or foster home.
A nursing assessment may be performed to determine the need for the service or
to evaluate the recipient for care plan development. Reimbursement for a nursing
assessment is considered two hours of service at the registered nurse rate. Only
registered nurses may perform an assessment. Nursing assessments should be
updated annually or if there is a significant change in the recipient's health status.

Limitations

This service supplements nursing services available through the Medicaid State
Plan Home Health Program. Private duty nursing services are available to children
under the age of 21 with complex medical needs. Licensed nursing is available to
children and adults when determined medically necessary by the Medicaid State
Plan Program and related to the care of a medical condition. Nursing services not
available to recipients under the Medicaid State Plan Home Health Program may be
paid for by the DD waiver, if determined medically necessary by the APD.
A recipient may receive up to 96 units (24 hours) of nursing services a day. A unit
is defined as a 15-minute time period or a portion thereof. This service may be
provided concurrently (at the same date and time) with another service being
furnished by another provider.
Note: Refer to the Florida Medicaid Home Health Services Coverage and
Limitations Handbook for additional information on Medicaid state plan coverage.
The handbook is available on the Medicaid fiscal agent’s Web Portal at
http://mymedicaid-florida.com. Click on Public Information for Providers, then on
Provider Support, and then on Provider Handbooks. It is incorporated by reference
in 59G-4.130, F.A.C.

Documentation Requirements
Reimbursement* and monitoring documentation to be maintained by the provider:
1. *Copy of claim(s) submitted for payment;
2. *Service log;
3. *Monthly summary (must include details, such as health risk indicators,
information about medication, treatments, medical appointments, and other
relevant information);
4. *Nursing assessment, must be completed at the time of initial claim submission
and annually thereafter or as needed, should the recipient’s condition change;
5. *Nursing care plan;
6. *Prescription for the service; and
7. List of duties to be performed by the nurse.
Documentation to be submitted to the waiver support coordinator by the provider:
1. Copy of nursing assessment at time of initial claim submission and annually
thereafter;
2. Copy of monthly summary at time of claim submission;
3. Copy of service log, monthly; and
4. Nursing care plan.
*Indicates reimbursement documentation.


Place of Service

Residential nursing services must be provided at a licensed group or foster home
considered to be the recipient’s place of residence.

Residential Nursing Provider Requirements

Residential Nursing Services Provider Requirements

Provider Qualifications
Providers of residential nursing services shall be nurses registered or licensed
in accordance with Chapter 464, F.S. Nurses may provide these services as
independent vendors or as employees of licensed residential facilities.


Training Requirements
Proof of training in the areas of Cardiopulmonary Resuscitation (CPR),
HIV/AIDS and infection control is required within 30 days of initially providing
residential nursing services. Proof of annual or required updated training shall
be maintained on file for review. The provider is responsible for all training
requirements outlined in the Core Assurances.

Note: Refer to the Core Assurances in Appendix A for the provider training
requirements.