Nursing Services shall mean skilled nursing services that fall within the scope of Tennessee’s Nurse Practice Act and that are directly provided to the waiver participant in accordance with a plan of care. Nursing Services shall be ordered by the waiver participant’s physician, physician assistant, or nurse practitioner, who shall document the medical necessity of the services and specify the nature and frequency of the nursing services. Nursing Services shall be provided face to face with the waiver participant by a licensed registered nurse or licensed practical nurse under the supervision of a registered nurse. The waiver participant must require a specifically identified skilled nursing service, excluding nursing assessment and oversight, which state law requires to be performed by a nurse. Nursing assessment and/or nursing oversight shall not be a separate billable service under this definition. Nursing Services are not intended to replace services that can be appropriately provided by unlicensed direct care staff. Therapeutic goals and objectives shall be required for waiver participants receiving Nursing Services.
Nursing Services shall consist of 2 categories of services and reimbursement:
This service shall be provided in home and community settings, as specified in the Plan of Care, excluding schools, inpatient hospitals, nursing facilities, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). A waiver participant who is receiving Medical Residential Services shall not be eligible to receive Nursing Services.
Nursing Services shall not be billed when provided during the same time period as other therapies unless there is documentation in the waiver participant’s record of medical justification for the two services to be provided concurrently.
Nursing Services are not intended to replace either intermittent home health skilled nursing visits or private duty nursing services available through the Medicaid State Plan/TennCare program or services available under the Rehabilitation Act of 1973 or Individuals with Disabilities Education Act.
To the extent that such services are covered in the Medicaid State Plan/TennCare Program, all applicable Medicaid State Plan/TennCare Program services shall be exhausted prior to using the waiver service. Nursing Services shall not be covered for children under age 21 years (since it would duplicate TennCare/EPSDT benefits).
Applicable limits, if any, on the amount, frequency, or duration of this service:
Nursing Services shall be limited to a maximum of 48 units (12 hours) per day per waiver participant.