<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:11:03.22 Private duty nursing services -- Extended home health aide services -- Prior authorization -- Reauthorization.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:11:03.22"> <META NAME="Description" Content="Administrative Rules 67:16:11:03.22 Private duty nursing services -- Extended home health aide services -- Prior authorization -- Reauthorization."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="6716110000322d_files/filelist.xml"> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr14296</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Created>2008-06-20T13:56:00Z</o:Created> <o:LastSaved>2008-06-20T13:56:00Z</o:LastSaved> <o:Pages>1</o:Pages> <o:Words>176</o:Words> <o:Characters>1006</o:Characters> <o:Company>State of South Dakota</o:Company> <o:Lines>8</o:Lines> <o:Paragraphs>2</o:Paragraphs> <o:CharactersWithSpaces>1180</o:CharactersWithSpaces> <o:Version>10.6839</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:DoNotRelyOnCSS/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:UseMarginsForDrawingGridOrigin/> <w:Compatibility> <w:FootnoteLayoutLikeWW8/> <w:ShapeLayoutLikeWW8/> <w:AlignTablesRowByRow/> <w:ForgetLastTabAlignment/> <w:LayoutRawTableWidth/> <w:LayoutTableRowsApart/> <w:UseWord97LineBreakingRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--> <style> <!-- /* Font Definitions */ @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:536902279 -2147483648 8 0 511 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:Times; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman";} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1026"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </head> <body lang=EN-US style='tab-interval:.5in'> <div class=Section1> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>67:16:11:03.22.&nbsp;&nbsp;Private duty nursing services -- Extended home health aide services -- Prior authorization -- Reauthorization.</span></b> A provider must have authorization from the department before providing either private duty nursing services or extended home health aide services.<span style='mso-spacerun:yes'>&nbsp; </span>The provider must submit to the department a written plan of care which has been reviewed and signed by the attending physician. The department's authorization is based on its review of the required documentation to determine if the conditions for payment have been met. The department may verbally authorize services after the plan of care is submitted; however, the department shall verify a verbal authorization in writing before the services are paid.<o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>An authorization may not exceed two months. The provider may request reauthorization by submitting an updated plan of care and the physician's recertification indicating the need for continued private duty nursing services or extended home health aide services.<o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>Source:</span></b> 18 SDR 209, effective June 23, 1992; 19 SDR 202, effective July 5, 1993; 26 SDR 168, effective July 1, 2000.<o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>General Authority:</span></b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A><o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>Law Implemented:</span></b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A><o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> </div> </body> </html>