Private Duty Nursing
Private Duty Nursing (PDN) is a service that provides Medicaid-eligible individuals with continuous skilled nursing services in their home.Who can provide PDN?
- Be a Medicaid provider
- Obtain certification of medical necessity from the treating physician
- Provide services specified in the plan of care including amount, scope, duration, and type of PDN
- Follow the person-centered services plan for an individual enrolled in a home-and-community based services (HCBS) waiver administered by the Ohio Department of Medicaid, or the service plan for an individual enrolled in a HCBS waiver administered by the Ohio Department of Aging or the Ohio Department of Developmental Disabilities.
- The individual’s physician writes an order for continuous skilled nursing, and gives it to a Medicare-certified home health care agency, an otherwise accredited agency or Medicaid-enrolled non-agency provider to arrange for the services.
- The agency or independent provider requests a prior authorization to provide PDN services by downloading and completing the PDN request form ODM 02374. The form must include the individual’s or individual’sauthorized representative’s signature. The provider submits the form electronically into the Medicaid Information Systems (MITS) portal.
- The Ohio Department of Medicaid assigns a Medicaid nurse assessor to confirm medical necessity by performing a face-to-face assessment of the individual in his or her home. If confirmed, the nurse assessor will authorize the necessary services.
- Medicaid notifies the individual of the assessment outcome and, if approved, issues a prior authorization to the provider via MITS.
- Once Medicaid issues the prior authorization, PDN services can begin. Medicaid will not reimburse for services that have not been prior authorized.
- Individuals enrolled on a Medicaid managed care plan work through their managed care coordinator. Individuals enrolled on a HCBS waiver work through their waiver case manager.
- Individuals not enrolled on a managed care plan or a HCBS waiver need to follow the steps below::
- Call the Medicaid Provider Relations line at 1 (800) 686-1516
- Read Ohio Administrative Code Private Duty Nursing Rules
- Review the MITS “Request a Prior Authorization” tutorial.