Private duty nursing is shift-based, hourly nursing care at home for adults and children, typically with a chronic illness, injury, or disability. Substitution of private duty nursing in lieu of placement in a skilled nursing facility has the same requirements and limitations as the facility benefit. For example, all deductibles and coinsurances apply and the benefit is limited to the equivalent of a maximum of 150 skilled nursing facility days per calendar year. Sleep therapy Preauthorization is required for any facility-based diagnostic or titration study (free-standing or hospital), and for sleep treatment equipment and related supplies, such as: • Initial treatment order and supplies (APAP, CPAP, BiPAP). • In-lab sleep study (PSG, MSLT, MWT). • Ongoing Treatment Order (APAP, CPAP, BiPAP). • Titration study. Exception The following supplies do not require a preauthorization: • Ongoing APAP supplies • Ongoing BiPAP supplies • Ongoing CPAP supplies Locations where sleep therapy services are not covered Sleep therapy services are not covered: • In the emergency room • At urgent-care facilities • During inpatient hospitalization Spinal and extremity manipulations The plan covers up to 24 visits per calendar year for manipulations (adjustments) of the spine and extremities (arms and legs). See the definition of “Limited benefit.” You pay the special rate (a $15 copay) for up to 24 visits for spinal and extremity manipulations when you see a preferred provider. The copay will not apply toward your medical deductible, but the copay will apply to the out-of-pocket limit. All visits apply to the 24-visit limit. You may receive an office visit (see the “Office visits” benefit for more details) and/or x-ray (see the “Diagnostic tests, laboratory, and x-rays” benefit for more details) at the time of your spinal and extremity manipulation service. Note: For participating providers and out-of-network providers, services are paid at the standard rate up to 24 visits per calendar year. Spinal injections The plan must preauthorize some spinal injections (see the “Limits on plan coverage” section for how this works). The following therapeutic injections are covered for treatment of chronic pain: • Cervical-thoracic epidural injections • Lumbar epidural injections 68 2024 UMP Select (PEBB) Certificate of Coverage