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Home-health provider pitches in-school 1:1 nursing; committee asks for attorney review
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Summary
Danielle Romero of Louisiana Home Care described an in-school extended nursing program billed to Medicaid that would place 1:1 nurses with medically complex students; the committee asked legal staff to review sample contracts and tabled the item for further review.
Danielle Romero, who identified herself as an area administrator for Louisiana Home Care/NHC Group (a division of Boston Home Health), told the St. Landry Parish committee that her agency can provide extended-care nursing in homes and schools for children with complex medical needs and that Medicaid pays for the services.
Romero said the program serves students with tracheostomies, ventilators, feeding tubes and other needs and that nurses (registered nurses or licensed practical nurses overseen by an RN) can accompany students to school and provide 8–12 hour shifts of one-on-one care. "We bring the care to them," Romero said, adding that the agency handles hiring, vetting, training, fingerprinting and payroll.
Romero said the parish would contract with the agency and that the parish would bill Medicaid for services while the agency bills Medicaid and pays nurse wages. She described electronic visit verification and time-based GPS systems the agency uses to prevent overlapping billing and to document when a nurse is on duty.
Nurse Brown, identified in the meeting as a district nurse, urged caution around delegation and billing. "We bill Medicaid for our nursing skills," Brown said. She emphasized that assessment is a nursing function and that district nurses train staff "under their licensure." Brown recommended that any contract clearly identify who is the Medicaid biller and how supervision is delineated to avoid duplicate payments.
Board members pressed on eligibility and scope. When asked what health problems qualify, Romero said extended-care nursing typically covers students with feeding tubes and that intermittent nursing can cover wound care, insulin administration and other episodic needs. Romero recounted a case she described in which a child who needed suctioning was transported to the emergency room when a paraprofessional on campus could not act; she argued that 1:1 nursing can prevent rehospitalization and keep children in school.
Committee members asked for copies of sample contracts and recommended legal review. The committee moved to table further action and brought the matter back for consideration with attorney input and additional documentation; Romero agreed to provide redacted sample contracts and to invite the agency's executive director to return for a fuller explanation.
Next steps: the committee requested that district legal counsel and the Medicaid compliance office review the proposal and sample contract language before the item is considered by the full board.
