Library: Policy

317:30-5-560. Treatment Plan

Revised 3/27/24

(a) An eligible organization must create a treatment plan for the member as part of the authorization process for private duty nursing (PDN) services. The initial treatment plan must be signed by the member's attending physician [medical doctor (MD), or doctor of osteopathy, (DO)], a physician assistant (PA), or advanced practice registered nurse (APRN).

(b) The treatment plan must include all of the following:

(1) Diagnosis;

(2) Prognosis;

(3) Anticipated length of treatment;

(4) Number of PDN requested hours per week;

(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.