(1) Private duty nursing when provided through fee-for-service requires prior authorization from the department of social and health services/developmental disabilities community services (DSHS/DDCS).
(2) DSHS/DDCS authorizes requests for private duty nursing on a case-by-case basis when:
(a) The application requirements under WAC 182-551-3300 are met; and
(b) The nursing care consultant determines the services to be medically necessary, as defined in WAC 182-500-0070 and according to the process in WAC 182-501-0165.
(3) DSHS/DDCS authorizes only the number of private duty nursing hours that are medically necessary.
(a) Services are limited to 16 hours of private duty nursing per day.
(b) DSHS/DDCS may adjust the number of authorized hours when the client's condition or situation changes.
(c) Additional hours beyond 16 per day are subject to review as a limitation extension under WAC 182-501-0169.
(4) Private duty nursing provided to the client in excess of the authorized hours may be the financial responsibility of the client, the client's family, or the client's guardian. Providers must follow the provisions of WAC 182-502-0160.