SPECIAL BULLETIN COVID-19 #57: Private Duty Nursing Flexibility Updates

Wednesday, April 22, 2020

Clinical Coverage Policy 3G-1, Private Duty Nursing for Beneficiaries Age 21 and Older and Clinical Coverage Policy 3G-2, Private Duty Nursing for Beneficiaries Under 21 Years of Age:

Section 7.3 requires the private duty nursing (PDN) provider to verify the beneficiary’s additional insurance coverage prior to initiating services and during delivery of PDN services.

To avoid delays in beneficiaries receiving needed PDN services, NC Medicaid is temporarily approving prior authorizations (PAs) that are in pending status for documentation of validation of primary insurance (PI) for 60 calendar days to allow for the delayed verification responses from individual third party insurance providers to be uploaded to the PA in NCTracks.

Section 7.2.1 requires documentation of supervisory visits according to agency policy and licensure rules.

During the period of the State of Emergency, Supervisory visits must be conducted, but may be conducted utilizing eligible technologies that allow the supervising RN to remotely communicate and evaluate services rendered.  Supervisory visits can be delivered via any HIPAA-compliant, secure technology with audio and video capabilities including (but not limited to) smart phones, tablets and computers.

If remote technology is used, it must be real-time communications and the platform is a type consistent with one described in the HHS Office for Civil Rights. The use of remote technology and patient consent should be properly documented in the participant’s medical record. 

These temporary changes are effective March 10, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when this policy is rescinded.

Questions regarding the temporary changes in this bulletin may be sent to Medicaid.COVID19@dhhs.nc.gov.  

CONTACT: GDIT, (800) 688-6696