To avoid delays in beneficiaries receiving needed private duty nursing services, NC Medicaid is temporarily approving prior authorizations that are in pending status for documentation of validation of primary insurance for 60 calendar days. This will allow for the delayed verification responses from individual third-party insurance providers to be uploaded to the prior authorizations in NCTracks. Details regarding documentation, supervisory visits and eligible remote technologies are included in this bulletin.
Topics Related to Private Duty Nursing (PDN) Providers
PACE organizations should continue to follow the guidance of the local, state and federal officials regarding COVID-19 and thoroughly document reasoning for making decisions which may fall outside of the PACE program model. This guidance supplements the Special Bulletin COVID-19 #27 released on March 30, 2020. The temporary flexibilities noted in Special Bulletin COVID-19 #27 and this Special Bulletin will end the earlier of the cancellation of the North Carolina state of emergency declaration or December 31, 2020.
Private Duty Nursing - beneficiaries under 21 years of age, Private Duty Nursing - all beneficiaries and Home Health – All Beneficiaries.
Effective March 1, 2020, Medicaid will begin issuing letters to PDN agencies addressing non-compliance with the timely submission of required documentation as indicated in the Request for Additional Information notice.
Unpaid medical bills and current medical expenses count toward NC Medicaid applicants’ deductibles. Private Duty Nursing (PDN) services qualify as a medical expense and may be used toward meeting this deductible.
The Verification of School Nursing Form – Attachment I (DMA-3171), and Instruction Sheet (DMA-3171-I) are now on the NC Medicaid PDN forms web page.
By Feb. 28, 2018, non-accredited nursing service providers previously providing services under the Community Alternatives Program for Children (CAP-C) waiver must obtain accreditation and meet all required occupational licensing entity regulations.