DOH Increasing Private Duty Nursing Rate

Situation Report | September 14, 2020

The state Department of Health (DOH) is making rate enhancements to fee-for-service (FFS) Private Duty Nursing (PDN) for medically fragile children.

The announcement was made during DOH’s monthly Managed Care Policy and Planning meeting. (See related story in this week’s Situation Report for other updates from the meeting.)

HCA has long worked to improve the rate that Medicaid pays for private duty nursing, working with our association pediatric home care services providers who have informed our advocacy seeking functional, sustainable and necessary rate updates.

HCA welcomes the Department’s progress in this direction and will continue to consult with member providers on PDN rate adequacy.

Rate details

Beginning October 1, 2020, DOH will be moving from county-based fees to two regional fees. Eligibility has also been expanded to include all members up to the age of 23.

The Medically Fragile Children’s PDN program will now consist of two components with corresponding financial rate enhancements for provider participation beginning October 1, 2020.

Providers of pediatric continuous PDN services will receive an enhanced rate of 30 percent added to the approved standard hourly rate for participation in the PDN Medically Fragile Children Training and Experience component.

Also, in a separate component, fee-for-service Medicaid will pay an enhanced fee for those who enroll in the PDN Medically Fragile Children’s Provider Directory. The purpose of the directory is to ensure adequate access to PDN services. The enhanced fee will be implemented over a period of three years as follows:

  • October 1, 2020: 15 percent
  • April 1, 2021: 30 percent
  • April 1, 2020: 45 percent

Participation in the directory indicates the willingness to accept inquiries for providing care to medically fragile children. The directory, updated weekly, will be searchable by name, licensure, city and county.

Eligible providers for the above rate components include independently enrolled nurse providers (RNs and LPNs) as well as Licensed Home Care Services Agencies (LHCSAs) with nurses. Those who are eligible may choose to enroll at www.eMedNY.org.

During the meeting HCA asked about Certified Home Health Agencies (CHHAs) being eligible to participate and DOH said it will be looking into this matter and communicating back to HCA.

For further background, see the DOH slide presentation here.