Virginia Administrative Code › Title 14 - INSURANCE › Agency 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM › Chapter 10 - VIRGINIA BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION PROGRAM REGULATIONS › Part II - Benefits › Section 14VAC10-10-50 - Personal nursing and assistive care

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Virginia Birth-Related Neurological
				  Injury Compensation Program (Program) will pay for appropriate medically
				  necessary and reasonable nursing care or assistive care as recommended in
				  writing by the admitted claimant's primary care physician.
B. The Program will review or consult
				  periodically with medical professionals concerning the continued
				  appropriateness of the nursing hours.
C. The Program utilizes nursing agencies when
				  available. All nursing agencies utilized by the Program must provide to the
				  Program copies of their employment policies regarding the criminal history
				  records checks and sex offender searches conducted on their employees. All
				  nursing agencies utilized by the Program must provide a certification to the
				  Program for each employee the agencies places for care of admitted claimants
				  that verifies that the named employee has not been convicted of any offense
				  listed as a barrier crime pursuant to §
										37.2-314,
				  37.2-416, or
				  37.2-506 of the Code of
				  Virginia. No nursing agency shall be reimbursed for any hours worked by an
				  agency employee for which such certification has not been provided to the
				  Program. Signed and dated time sheets and monthly care summaries must be
				  submitted with each request for reimbursement. If an agency is unable to
				  provide care, the Executive Director of the Program is authorized to approve
				  other arrangements.
D. If a nursing
				  agency is not available, or the admitted claimant's parent or legal guardian
				  chooses to employ a relative or legal guardian of the admitted claimant to
				  provide prescribed nursing or attendant care authorized by the admitted
				  claimant's primary care physician or appropriate treating specialist physician,
				  the Program may reimburse the admitted claimant's parent or legal guardian for
				  care providers who are employed by the admitted claimant's family as
				  independent contractors or household employees, as the case may be, upon
				  approval of the Executive Director of the Program. The Program will reimburse
				  admitted claimant families for employment-related taxes such as FICA or
				  unemployment tax, related to the hiring of an independent contractor upon
				  receipt of proper documentation of payment of these taxes. The parent or legal
				  guardian of the admitted claimant must provide a certification to the Program
				  for each independent contractor or household employee who the parent or legal
				  guardian hires for an admitted claimant's care that verifies that the named
				  independent contractor or household employee has not been convicted of any
				  offense listed as a barrier crime pursuant to §
										37.2-314,
				  37.2-416, or
				  37.2-506 of the Code of
				  Virginia. No parent or legal guardian shall be reimbursed for any hours worked
				  by an independent contractor for which such certification has not been provided
				  to the Program. The parent or legal guardian of the admitted claimant will pay
				  any application fees associated with requesting these background checks of the
				  Virginia State Police. Upon receipt of the certification and a receipt from the
				  Virginia State Police or an authenticated copy of the canceled check, the
				  Program will reimburse those application fees associated with the application
				  of the independent contractor or household employee actually hired. Signed and
				  dated time sheets, signed and dated receipts of payment, and monthly care
				  summaries must be submitted with each request for reimbursement.
E. The Program will not reimburse a care
				  provider for more than a 16-hour shift within a 24-hour period unless there is
				  an emergency and no other care provider is available to care for the admitted
				  claimant. Overtime is not paid unless preauthorized by the Program. The Program
				  will not reimburse for work by a full-time caregiver for more than 40 hours per
				  week unless preauthorized by the Program.
F. The Program will not provide a private
				  duty nurse while an admitted claimant is hospitalized unless the attending
				  physician considers it medically necessary and a written order for private duty
				  nursing is provided to the Program. The Program will pay for a sitter who is
				  not a family member and may not have medical experience while the child is
				  hospitalized, if requested, and with prior approval from the Program and a
				  letter of medical necessity from the attending physician.
G. The Program will provide nurses or
				  caregivers to accompany admitted claimants during school hours provided such
				  care is deemed medically necessary and is not otherwise available. This care
				  counts toward the total approved nursing hours.
H. The Program will reimburse medically
				  necessary care provider expenses if they have not been previously filed with
				  the tax authorities as deductions or credits. If they have been filed with the
				  tax authorities as deductions or credits, then an amended tax report must be
				  filed with the tax authorities and a copy of the amended tax report provided to
				  the Program before the family will be reimbursed for these expenses.
I. The Program may reimburse for medically
				  necessary and reasonable nursing and attendant care that is provided by a
				  relative or legal guardian of an admitted claimant so long as that care is
				  beyond the scope of childcare duties and services normally and gratuitously
				  provided by family members to uninjured children and so long as such care and
				  reimbursement requests are in accordance with other applicable provisions and
				  the following:
1. The relative or legal
				  guardian providing the care must be at least 18 years of age.
2. The parent or legal guardian of the
				  admitted claimant must submit a letter of medical necessity from the admitted
				  claimant's primary care physician or appropriate treating specialist physician
				  that sets forth the number of nursing or attendant care hours needed per day;
				  the physician's assessment regarding the level of care required; and
				  certification that the intended caregiver is appropriately trained, qualified,
				  and physically capable of performing the required home medical and attendant
				  care duties. Medically necessary care to be provided by a relative or legal
				  guardian of an admitted claimant shall be performed only at the direction and
				  control of the admitted claimant's primary care physician or appropriate
				  treating specialist physician.
3.
				  The parent or legal guardian of the admitted claimant must provide a
				  certification to the Program for each caregiver the parent or legal guardian
				  hires for an admitted claimant's care that verifies that the named caregiver
				  has not been convicted of any offense listed as a barrier crime pursuant to
				  §§
											37.2-314,
				  37.2-416, or
				  37.2-506 of the Code of
				  Virginia. No parent or legal guardian shall be reimbursed for any hours worked
				  by a caregiver for whom such certification has not been provided to the
				  Program. The parent or legal guardian of the admitted claimant will pay any
				  application fees associated with requesting these background checks of the
				  Virginia State Police. Upon receipt of the certification and a receipt from the
				  Virginia State Police or an authenticated copy of the canceled check, the
				  Program will reimburse those application fees associated with the application
				  of the caregiver actually hired.
4.
				  Any relative or legal guardian of an admitted claimant providing caregiver
				  services must provide a signed release of liability form to the Program
				  regarding any potential injury sustained during the course of providing
				  services to the admitted claimant.
5. Any parent or legal guardian of an
				  admitted claimant choosing to utilize nursing or attendant care that is
				  provided by a relative or legal guardian in lieu of nursing or other
				  professional caregiver services must provide a signed release of liability form
				  to the Program regarding any potential injury sustained by the admitted
				  claimant during the course of receiving care.
6. Signed and dated time sheets, signed and
				  dated receipts of payment, and monthly care summaries must be submitted with
				  each request for reimbursement.
7.
				  The Program will not reimburse for care provided by a nurse or other
				  professional caregiver and by a relative or legal guardian for the same hours.
				  Hours of care provided by a relative or legal guardian of an admitted claimant
				  cannot be used to supplement hours of care provided by professional caregivers
				  or nursing agencies to the extent that those hours would exceed the total hours
				  deemed medically necessary and authorized by the Program.
8. No more than 12 hours within a 24-hour
				  period may be reimbursed for care provided by any single relative or legal
				  guardian of an admitted claimant.
9. The rate of reimbursement for nursing and
				  attendant care that is provided by a relative or legal guardian of an admitted
				  claimant shall be the average hourly rate for a home health aide (combined all
				  industries) as reported by the Commonwealth of Virginia's Labor Market Data
				  report for the applicable metropolitan statistical area in the most recently
				  published data available. The Program will reimburse an admitted claimant's
				  parent or legal guardian for employment-related taxes, such as FICA or
				  unemployment tax, resulting from that parent or legal guardian's employment of
				  a relative or legal guardian as the admitted claimant's caregiver as set forth
				  in this chapter, upon receipt of proper documentation of payment of these
				  taxes.
10. The Program's Executive
				  Director and staff reserve the right to have reviewed each nursing or attendant
				  care plan or physician order for medical necessity.