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Statutory Authority: Authority: AS 47.05.010 AS 47.07.030 AS 47.07.040 7 AAC 110.525. Private-duty nursing services; covered and noncovered services. (a) The department will pay for private-duty nursing services, if they are provided to a recipient who

(1) is under 21 years of age;

(2) has been recently discharged from a general acute care hospital or long-term care facility, or has a physical health status that would justify admission to a general acute care hospital or long-term care facility;

(3) with the provision of private-duty nursing services, will be able to live in a family setting, and for whom those services will prevent admission to, or promote early discharge from, a general acute care hospital or long-term care facility; and

(4) requires more individual and continuous care than is available from a visiting nurse or is routinely provided by the nursing staff of a hospital, a skilled nursing facility, or an intermediate care facility; in this paragraph, “continuous care” means a minimum of eight hours provided to an individual in a 24-hour period. (b) The department will pay for private-duty nursing services only if

(1) the services are for a life threatening condition, and a private-duty nursing agency employee can safely provide them outside of an institution;

(2) the services are provided under a plan of care approved by the recipient’s attending physician, who has participated in the development of the plan of care before any private-duty nursing services were provided and has made a commitment to oversee the recipient’s care throughout the duration of the plan of care;

(3) the services are required less than 24 hours per day; and

(4) a competent individual residing with the recipient has agreed to participate in caring for the recipient in accordance with the plan of care developed under (2) of this subsection. (c) If a private-duty nursing agency provides a skilled nursing service, that service must be provided by a private-duty nursing agency employee for whom the service is within the scope of that employee’s license to practice, and who provides the service while under the continued