skilled nursing scope of services
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TRANSCRIPT
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Skilled Nursing Scope of Services
Mary Claire Ikenberry, R.N., M.S.Department of Education
Anne Young, R.N.Department of Medical Assistance Services
October 2-3,2007
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Skilled Nursing Scope of Services
Services are to be: rendered in accordance to the licensing standards and
criteria of the Virginia Board of Nursing. performed by a Virginia licensed RN or LPN under the
supervision of an RN.The supervision of the LPN is to be consistent
with the regulatory standards of the Board of Nursing.
Skilled nursing must be part of the I.E.P. or the IEP must be amended to include the skilled nursing service
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Skilled Nursing Scope of Services
The service provider must be employed by the school division or under contract to the school division.
All skilled nursing services must be directly provided and medically necessary.
Services deemed not medically necessary on utilization review audit, will not be covered.
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Skilled Nursing Scope of Services
SN services will be limited to 6.5 hrs per day or 26 units per day.
A unit is 15 minutes of nursing care.School year is 180 days.Annual maximum number of units for
Skilled Nursing services is 4680.
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Skilled Nursing Scope of Services
Services will be consistent with skilled nursing services within the scope of their practice.
These services can include but are not limited to: Dressing changes Urinary catheterizations Medication Administration
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Plan of Care (Med 10)
Services will be directly and specifically related to an active, written plan of care (POC).
POC is to be part of the nursing record and is the documentation for services.
The POC is based on a physicians’ (MD), Physicians’ Assistant (PA) or Nurse practitioner’s (NP) written order for skilled nursing services.
The RN is to establish, sign, and date the POC.
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Plan of Care (Med 10)
The signing of the POC predates the delivery of services.
The POC is to be periodically renewed or updated by a Physician (MD), Nurse Practitioner (NP), or Physician’s Assistant (PA). Usually this is done at the beginning of each school year or at anytime the MD/PA/NP’s orders are changed.
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Plan of Care (Med 10)
Services shall be specific and provide effective treatment for the child’s condition in accordance with accepted standards of skilled nursing practice.
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Plan of Care (Med 10)
Skilled nursing services that exceed the Skilled nursing services that exceed the MD, PA or NP’s written order for skilled MD, PA or NP’s written order for skilled nursing services will NOT be reimbursed by nursing services will NOT be reimbursed by DMAS.DMAS.
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Plan of Care (Med 10)
A copy of the Plan of Care shall be given to the child’s Medicaid Primary Care Physician.
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Documentation of Services
Will include:A written POC which identifies: The medical condition or conditions to be
addressed by skilled nursing services.Goals for skilled nursing services.Time tables for accomplishing such stated goals.Actual skilled nursing services to be delivered.
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Documentation of Services
Whether the services will be delivered by an RN or LPN.
Services which have been delivered and for which reimbursement from Medicaid is to be claimed, must be supported with documentation.
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Documentation of Services
Will include:Dates and times of Skilled Nursing services
entered by the responsible licensed nurseActual nursing services renderedID of the child on each page of the nursing
recordCurrent diagnosis
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Documentation of Services
The POC will include any prescribed drugs which are part of the:
Individualized Educational Program (IEP) Including dose, frequency and route
TreatmentFollowing the Specialized Health Care Procedures
ManualNotes to indicate progress made by the studentChanges from the Physician/NP/PA written order
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Documentation of Services
Response to treatmentActions related to SN services:
Notifying parents; Calling the physician; or Notifying the Emergency Medical Services
shall all be documented All documentation shall be signed and
dated by the person performing the service.
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Documentation of Services
Skilled nursing services may include extensive documentation
Documentation shall be written: immediately or as soon thereafter as possible after the procedure or treatment was
implemented including the date and time
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Documentation of Services
If nursing procedures are performed by an LPN, they must be supervised by a Registered Nurse in accordance with the Board of Nursing Regulations.
If nursing procedures performed by an LPN are to be billed to Medicaid then supervision must be documented by the RN within a minimum of 30 calendar days.
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Documentation of Services
Skilled nursing services documentation will be in accordance with the: Virginia Board of Nursing, Department of Health Professions Department of Education statues, regulations
and standards relating to school health School Division Medicaid Manual
• Chapter VI (Utilization Review)
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Service Limitations
Utilization review will be performed by DMAS to determine if services are appropriately provided to Medicaid recipients and to ensure the services are medically necessary and appropriate.
Failure to document services in the child’s school nursing record will be considered not performed and at utilization review by DMAS, payment may be revoked.
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Service Limitations
When services can be provided by someone other than the skilled nursing professional. These services may be reimbursable under “personal care assistant services”.
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Skilled Nursing Scope of Services
Codes have been identified for skilled nursing services
Codes have been identified for nursing services are: T1001 for an assessment T1002 for Registered Nursing Services T1003 for Services provided by a licensed
Practical Nurse
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Skilled Nursing Scope of Services
To calculate these services take the average amount of time for the procedure, multiply by the number of times a month the service is delivered and then divide by 15 (a unit) to get the total number of units to be billed.
Ex. 5 mins to give meds x 18 times a month=90 mins div by 15 mins= 6 units.
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Websites:
DOE- www.doe.virginia.govMedicaid-www.dmas.virginia.govFAMIS-www.famis.org
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Thank You