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HealthPartners

Coverage criteria policies

Private duty aide in hospital or skilled nursing facility

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Does not require prior authorization.

Coverage

Private duty nurses/aides in a hospital or Skilled Nursing Facility are not covered per your plan documents.

Indications that are not covered

Private duty charges incurred in connection with in-patient room and board charges at a hospital or SNF are not covered. These services are within the realm of care which can be provided by the hospital/SNF and are generally considered as a part of the room and board charges.

  1. If the hospital/SNF has inadequate staff to manage a particular case, it is the hospital's responsibility to cover the charges.
  2. If the private duty nurse/aide is provided at the family's or member's request for comfort, security, or convenience, then the member is responsible for the charges.

Definitions

Private duty is considered the assignment of a nurse/aide to provide direct patient care to one patient only. This may be billed by an outside agency for the same dates of service as the patient's hospital room and board charges or it may be charged by the hospital as 1:1 aide or private duty care.

This coverage guideline does not refer to 1:1 nursing care in a covered intensive care unit.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 01/01/1994 - Date of origin
  • 05/01/2018 - Effective date
Review date
  • 05/2018
Revision date
  • 05/10/2016

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