Private Duty Nursing for Medically Fragile Children and Adults

Generated from the gc-benefits catalog. It lists what the owner record states. It is not an eligibility decision; confirm current rules with the program.

Private duty nursing services are nursing services for Medicaid members who require more individual and continuous nursing care than is available from a certified home health agency (CHHA). The intention of PDN services is to support - not replace - the skilled care provided to a member by parents, family, and other responsible caregivers. Commitment by the family and community are necessary to meet the member´s needs and to ensure the member can remain safely at home.

• Owner record: ny/private-duty-nursing
• Jurisdiction code: NY
• Frame: care_recipient
• Review by: 2026-11-11
• Also called: Private Duty Nursing (PDN); PDN; Medicaid Private Duty Nursing Services

Offering 1: private_duty_nursing

Private duty nursing provides more individual and continuous nursing care than a certified home health agency (CHHA) can provide. A CHHA generally provides nursing part-time or intermittently, fewer than two hours per service authorization. The service is not warranted for non-skilled tasks such as turning and positioning, ambulation, transferring, bathing, toileting, oral feeding, dressing, and household chores. Services may be provided by enrolled Licensed Home Care Agencies or independently practicing RNs or LPNs enrolled with New York State Medicaid. Nurses must have current New York State RN or LPN registration; an independently enrolled LPN must be overseen by a licensed physician.

• Availability (owner codes): {"checked": null, "intake": "unknown", "type": "unknown"}
• Amounts (as stated by the owner): []

Conditions:

• All of these:
• Stated condition, not checked automatically: "Medicaid members"
• Stated condition, not checked automatically: "Private duty nursing services are nursing services for Medicaid members who require more individual and continuous nursing care than is available from a certified home health agency (CHHA)."
• Stated condition, not checked automatically: "A Medicaid member may be appropriate for private duty nursing services if he or she requires nursing services that exceed the amount and scope of nursing services that a CHHA may provide."
• Stated condition, not checked automatically: "Private duty nursing services are not warranted for non-skilled tasks such as, but not limited to, turning and positioning, ambulation, transferring, bathing, toileting, oral feeding, dressing, and household chores."
• Stated condition, not checked automatically: "Commitment by the family and community are necessary to meet the member´s needs and to ensure the member can remain safely at home."

Access route 1.1

• Where: New York
• How: Use the Private Duty Nurse directory to find a nurse in your area. The directory lists enrolled New York State Medicaid fee-for-service private duty nursing providers; contact providers to confirm their current information. Prior approval is required before services can be provided. An enrolled servicing provider must submit the request under the direction of a Medicaid-enrolled physician or nurse practitioner. All third-party obligations must be exhausted before claims can be submitted to Medicaid.
• Url: https://health.ny.gov/health_care/medicaid/redesign/pdn_children/directory/index.htm
• Phone: null

Access route 1.2

• Where: PDN Directory questions
• How: If you have trouble finding a nurse, need more guidance or have any questions about the PDN Directory, please email [email protected].
• Url: https://health.ny.gov/health_care/medicaid/redesign/pdn_children/consumers/
• Phone: null

Evidence

• /name: "# Private Duty Nursing for Medically Fragile Children and Adults" (source, capture 52467e6b6eea1ccad82118e47b9b23afdee03f82f2ccf16628feb8d927564b61)
• /caregiving_effect: "Private duty nursing services are nursing services for Medicaid members who require more individual and continuous nursing care than is available from a certified home health agency (CHHA). A CHHA may provide nursing services only on a part-time or intermittent basis, generally fewer than two hours per service authorization. A Medicaid member may be appropriate for private duty nursing services if he or she requires nursing services that exceed the amount and scope of nursing services that a CHHA may provide. Private duty nursing services are not warranted for non-skilled tasks such as, but not limited to, turning and positioning, ambulation, transferring, bathing, toileting, oral feeding, dressing, and household chores. The intention of PDN services is to support - not replace - the skilled care provided to a member by parents, family, and other responsible caregivers. Commitment by the family and community are necessary to meet the member´s needs and to ensure the member can remain safely at home." (source, capture 2206391e11efe62210bf55f4efa8f6dff924aa9d8ec094c68d26810088c16402)
• /offerings/0/summary: "Private duty nursing services are nursing services for Medicaid members who require more individual and continuous nursing care than is available from a certified home health agency (CHHA). A CHHA may provide nursing services only on a part-time or intermittent basis, generally fewer than two hours per service authorization. A Medicaid member may be appropriate for private duty nursing services if he or she requires nursing services that exceed the amount and scope of nursing services that a CHHA may provide. Private duty nursing services are not warranted for non-skilled tasks such as, but not limited to, turning and positioning, ambulation, transferring, bathing, toileting, oral feeding, dressing, and household chores. The intention of PDN services is to support - not replace - the skilled care provided to a member by parents, family, and other responsible caregivers. Commitment by the family and community are necessary to meet the member´s needs and to ensure the member can remain safely at home." (source, capture 2206391e11efe62210bf55f4efa8f6dff924aa9d8ec094c68d26810088c16402)
• /offerings/0/summary: "Private duty nursing services may be provided by Licensed Home Care Agencies (LCHSAs) or independently practicing RNs or LPNs who are enrolled with New York State Medicaid." (source, capture 2206391e11efe62210bf55f4efa8f6dff924aa9d8ec094c68d26810088c16402)
• /offerings/0/summary: "All nurses providing PDN services must possess a current RN or LPN registration with the New York State Department of Education. Independent enrollment with Medicaid and any approval for PDN services does not constitute an exception to, or expansion of, any scope of practice defined by New York State Education Law. PDN services provided by an independently enrolled LPN must be overseen by a licensed physician. PDN providers, whether independent providers or licensed agencies, are not employees of the Department of Health." (source, capture 2206391e11efe62210bf55f4efa8f6dff924aa9d8ec094c68d26810088c16402)
• /offerings/0/rules: "Private duty nursing services are nursing services for Medicaid members who require more individual and continuous nursing care than is available from a certified home health agency (CHHA). A CHHA may provide nursing services only on a part-time or intermittent basis, generally fewer than two hours per service authorization. A Medicaid member may be appropriate for private duty nursing services if he or she requires nursing services that exceed the amount and scope of nursing services that a CHHA may provide. Private duty nursing services are not warranted for non-skilled tasks such as, but not limited to, turning and positioning, ambulation, transferring, bathing, toileting, oral feeding, dressing, and household chores. The intention of PDN services is to support - not replace - the skilled care provided to a member by parents, family, and other responsible caregivers. Commitment by the family and community are necessary to meet the member´s needs and to ensure the member can remain safely at home." (source, capture 2206391e11efe62210bf55f4efa8f6dff924aa9d8ec094c68d26810088c16402)
• /offerings/0/access/0/how: "This online directory provides a list of enrolled New York State Medicaid Program fee-for-service - private duty nursing providers who provide Medicaid-reimbursed services to medically fragile children and adults. The providers listed are not employees of the Department of Health. The Department of Health cannot recommend or refer you to a private duty nursing provider. This online directory provides a list of providers, and the information contained herein is updated periodically. However, some providers may have been added or removed from the list (and/or contact information may have changed) since this directory was last updated. The New York State Medicaid Program suggests that you contact the providers listed in this directory to confirm that the information remains current. Prior approval by the Department of Health is required before services can be provided." (source, capture 52467e6b6eea1ccad82118e47b9b23afdee03f82f2ccf16628feb8d927564b61)
• /offerings/0/access/0/how: "PDN services require prior approval and must be submitted by an enrolled servicing provider (LHCSA or independent RN or LPN) under the direction of a Medicaid enrolled physician or nurse practitioner. For further instruction on submitting a prior approval and documentation requirements, please refer to the Private Duty Nursing Policy Manual." (source, capture 2206391e11efe62210bf55f4efa8f6dff924aa9d8ec094c68d26810088c16402)
• /offerings/0/access/0/how: "Under federal law, the Medicaid program is the payer of last resort. All third-party obligations must be exhausted before claims can be submitted to Medicaid. It is the responsibility of the member (family) and provider to investigate and exhaust all other insurance sources prior to billing Medicaid." (source, capture 2206391e11efe62210bf55f4efa8f6dff924aa9d8ec094c68d26810088c16402)
• /offerings/0/access/0/url: "* Find a Private Duty Nurse (PDN) in Your Area\n* Investing in Medically Fragile Children and Adults: Information for Stakeholders on New York State´s Initiative\n* A Guide to Finding a Nurse\n* Information on Medicaid Health Homes care management services for children\n* Information for medically fragile children on the Children´s Health and Behavioral Health Medicaid System Transformation, or 1915(c) Children´s Waiver and 1115 Waiver amendments. The Children´s Waiver will restructure the health care delivery system for individuals under 21 that have behavioral health needs and/or complex medical conditions. \n * Department of Health website for 1915(c) Children´s Waiver and 1115 Waiver Amendments\n * Office of Mental Health website for Children´s Health and Behavioral Health System Transformation" (source, capture 52467e6b6eea1ccad82118e47b9b23afdee03f82f2ccf16628feb8d927564b61)
• /offerings/0/access/1/how: "* If you have trouble finding a nurse, need more guidance or have any questions about the PDN Directory, please email [email protected]" (source, capture 52467e6b6eea1ccad82118e47b9b23afdee03f82f2ccf16628feb8d927564b61)