Family and Children's Medicaid MA-3540 Medicaid Covered Services
XXi. PRIVATE DUTY NURSING (PDN)
Refer to DMA’s website at http://www.dhhs.state.nc.us/dma/mp/mpindex.htm for specific coverage criteria, prior approval requirements, and service limitations.
A. Covered Services
Medically necessary continuous, substantial, and continuous skilled nursing services that require more individual and continuous care than is available from a visiting nurse or routinely provided by the nursing staff of a hospital or nursing facility.
1. PDN must be authorized by the recipient’s attending physician.
2. PDN must be provided in the recipient’s private and primary residence.
3. The required recipient care tasks can only be performed by a nurse (registered or licensed) licensed by N.C. Board of Nursing.
4. A recipient receiving PDN services must meet all criteria as specified in the PDN clinical coverage policy found at: www.dhhs.state.nc.us/dma.
5. PDN services shall be rendered in accordance with the clinical coverage policy at www.dhhs.state.nc.us/dma.
6. A recipient receiving hospice under Medicare and Medicaid cannot receive PDN.
7. PDN may not be provided during the same time of day as personal care services.
8. If a recipient chooses to receive HIT as a separate, reimbursable service, he is not eligible for PDN services. HIT nutrition therapy can be provided at the same time as PDN services, with PDN nurses providing needed nursing care.
9. PDN does not count toward a recipient’s professional services visit limit.
REVISED 08/01/11 – CHANGE NO. 14-11
D. Prior Approval
1. It is the provider’s responsibility to obtain prior approval. Refer to II.G. for additional information.
2. Prior approval is required for all recipients.