[Revised 09-01-15]
An eligible provider may have private duty nursing services authorized by following all the following steps:
(1) create a treatment plan for the patient as expressed in OAC 317:30-5-560;
(2) submit the prior authorization request with the appropriate OHCA required forms, the treatment plan, and request the telephonic interview and/or personal visit by an OHCA Care Management Nurse; and
(3) have an OHCA physician determine medical necessity of the service including scoring the member's needs on the Private Duty Nursing Acuity Grid.