SECTION 317:30-5-560. Treatment Plan

(a)   An eligible organization must create a treatment plan for the member as part of the authorization process for private duty nursing services. The initial treatment plan must be signed by the member's attending physician.

(b)   The treatment plan must include all of the following medical and social data so that an OHCA physician can appropriately determine medical necessity including use of the Private Duty Nursing Acuity Grid:

(1)   diagnosis;

(2)   prognosis;

(3)   anticipated length of treatment;

(4)   number of hours of private duty nursing requested per day;

(5)   assessment needs and frequency (e.g., vital signs, glucose checks, neuro checks, respiratory);

(6)   medication method of administration and frequency;

(7)   age-appropriate feeding requirements (diet, method and frequency);

(8)   respiratory needs;

(9)   mobility requirements including need for turning and positioning, and the potential for skin breakdown;

(10)   developmental deficits;

(11)   casting, orthotics, therapies;

(12)   age-appropriate elimination needs;

(13)   seizure activity and precautions;

(14)   age-appropriate sleep patterns;

(15)   disorientation and/or combative issues;

(16)   age-appropriate wound care and/or personal care;

(17)   communication issues;

(18)   social support needs;

(19)   name, skill level, and availability of all caregivers; and

(20)   other pertinent nursing needs such as dialysis, isolation.

[Source: Added at 23 Ok Reg 33, eff 8-1-05 (emergency); Added at 23 Ok Reg 1364, eff 5-25-06; Amended at 24 Ok Reg 333, eff 12-1-06 (emergency); Amended at 24 Ok Reg 930, eff 5-11-07; Amended at 28 Ok Reg 14, eff 8-13-10 (emergency); Amended at 28 Ok Reg 1429, eff 6-25-11; Amended at 32 Ok Reg 1081, eff 8-27-15]