Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 2 - Medical Guidelines › Chapter 35 - Nursing/Attendant Care and Home Health Services Reimbursement Schedule, Billing Instruction and Maintenance Procedures › Section I-3509 - Training Requirements and Reimbursement Guidelines

Current through Register Vol. 50, No. 6, June 20, 2024
A. Payment may be made for authorized
				  services to the following provider types, subject to the following guidelines.
1. Trained professional nursing personnel who
				  provide services through the auspices of public or private home health agencies
				  who are paid for their services by their employer.
2. Trained professional nursing personnel who
				  are self employed may be paid directly for their services at a rate not to
				  exceed the maximum allowable reimbursement for nursing/attendant care services.
				  Self-employed nurses and attendants are considered independent contractors by
				  the carrier/self-insured employer; therefore, the carrier/self-insured employer
				  takes no responsibility for producing income tax forms (such as W-2 Forms) for
				  those individuals.
3. Nursing and
				  personal care homes will be reimbursed at the approved per diem rates
				  established for institutional services.
4. Nursing manpower agencies and home health
				  agencies will be reimbursed using the same procedure codes and maximum
				  allowable reimbursement schedule established for Nurse/Attendant Care
				  Services.
5. Authorized services by
				  nonprofessional family members are reimbursable up to eight hours in any
				  24-hour period. Any family member who is a medical professional may provide
				  services under the same restrictions placed on self-employed nurses and
				  attendants.
6. Family members and
				  other persons who are not trained professional nursing personnel may receive
				  payment in the amount of the current minimum wage if the following requirements
				  have been satisfied:
a. the attendant has
				  received adequate instruction from the authorized treating provider regarding
				  the services to be provided in the home;
b. the services provided must be beyond the
				  scope of normal household duties and must be in the nature of services
				  ordinarily rendered by trained professional personnel in hospitals or nursing
				  homes; and
c. the medical evidence
				  of record must be sufficient to identify the nature and approximate value of
				  the services provided.
7. The purpose of private duty nurses is to
				  provide skilled constant attention and observation to a seriously ill patient.
				  The need for, and the length of, service usually depends on the condition of
				  the patient and the level of care required rather than the nature of the
				  disease, illness, or condition.
8.
				  Patients recovering from major surgery, severe systemic disease or one of the
				  catastrophic diseases, frequently require a level of skilled care beyond that
				  afforded by the general nursing service provided by a hospital or other
				  institution.
9. The following are
				  examples of services which require "skilled" personnel for proper
				  administration. This list is not all-inclusive:
a. intravenous injections and
				  feeding;
b. insertion and
				  replacement of urethral catheters;
c. dressing open or draining wounds involving
				  prescription medications and aseptic techniques;
d. insertion and replacement of tubes for
				  gastric feedings;
e. nasopharyngeal
				  and tracheotomy aspiration;
f. care
				  of extensive decubitus ulcers (2 cm or greater), or care of other widespread
				  skin disorders;
g. initial phases
				  of a regimen involving administrations of medical gases.
10. "Supportive" service to a patient is not
				  necessarily a skilled service and may require only a nonprofessional level of
				  care. For example, a nonambulatory patient may need frequent changes of
				  position in the bed to avoid the development of ulcers. Changing of position
				  can ordinarily be accomplished by untrained, nonprofessional personnel, so this
				  is not considered a "skilled" service.
11. The following are specific activities
				  which are not considered to be "skilled" nursing services and a person of
				  lesser training can be utilized. This listing is not all-inclusive:
a. administration of routine oral
				  medications; eye drops; ointments;
b. general maintenance care of colostomy or
				  ileostomy;
c. routine services in
				  connection with indwelling bladder catheters (emptying and cleaning containers;
				  clamping tubing; and refilling irrigation containers with solution);
d. changes of dressings in noninfected
				  postoperative or chronic conditions;
e. prophylactic and palliative skin care;
				  including bathing, and application of skin creams, or treatment of minor skin
				  problems;
f. general maintenance
				  care in connection with a plaster cast;
g. routine care in connection with braces and
				  similar devices;
h. administration
				  of medical gases after the initial training of the patient in
				  self-administration;
i. general
				  supervision of exercises which have been taught to the patient;
j. assisting the patient in routine
				  activities; dressing, eating, hygiene, etc.