Proposed Changes to Private Duty Nursing Services Clinical Policy

Near Relatives and Legally Responsible Persons May Deliver Skilled Nursing Service to a PDN-eligible Beneficiary.

Private Duty Nursing (PDN) Clinical Policy 3G-1 and 3G-2, Section 6.3 currently notes NC Medicaid shall not cover PDN if it is provided by the beneficiary’s near relative (spouse, child, parent, grandparent, grandchild, or sibling, including corresponding step and in-law relationships) or by an individual who serves as the beneficiary’s legally responsible person.

NC Medicaid researched the legality of a near relative or a legally responsible person providing skilled nursing services to PDN eligible beneficiaries and concluded it is permissible if the individual providing the skilled nursing service has a valid and current nursing license and is operating within their scope of practice.

As a result, and as a means of addressing North Carolina’s nursing shortage, NC Medicaid will modify the current PDN policy. The policy modification will permit provider agencies at their discretion to allow their employees who are the beneficiary’s near relative or individuals serving as a beneficiary’s legally responsible person to deliver PDN skilled nursing services to a PDN eligible beneficiary. In order to deliver the skilled nursing service, the near relative or legally responsible person must have a valid and current nursing license and must operate within their scope of practice.

To implement this change, a State Plan Amendment must be completed and approved by Centers for Medicare & Medicaid Services (CMS). In addition, both PDN Clinical Policy 3G-1 and 3G-2 must go through NC Medicaid’s formal promulgation process. Stakeholders will have the opportunity to review the changes made to both clinical policies and provide public comments related to the changes. Once approved, NC Medicaid will inform stakeholders of the effective date of the policy change.

Until the proposed change is approved, the restrictions noted in section 6.3 of the PDN Clinical Policy 3G-1 Private Duty Nursing for Beneficiaries Age 21 and Older and 3G-2 Private Duty Nursing for Beneficiaries Under 21 Years of Age continue to apply.


Medicaid Contact Center, 888-245-0179

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