This bulletin applies to NC Medicaid Direct.
NC Medicaid Direct is making a process change to allow previously approved shared Private Duty Nursing (PDN) hours to be redistributed among PDN service provider agencies without requiring a new PDN ordering provider signed Home Health Certification and Plan of Care Form (CMS-485) or order. This process change will be effective September 1, 2026. The redistribution does not change the total number of approved hours or the effective end date of the prior authorizations (PAs).
Process Change
The PDN Service provider that the beneficiary or their legal guardian contacts to redistribute hours shall submit the following:
The Shared Case Form indicating the need to redistribute approved PDN hours shall be signed and dated by a representative from each nursing service provider and beneficiary or their legal guardian. For redistributions only, the Shared Case Form does not have to be signed by the PDN ordering provider.
The PDN Service Provider(s) affected by the redistribution shall submit a PA along with the current signed CMS-485 and a copy of the corresponding Shared Case Form or a statement on company letterhead, signed and dated by a PDN agency representative, stating the new distribution of hours and effective begin date.
General Dynamics Information Technology (GDIT) may approve in NCTracks the redistribution with the requested effective date. PAs may be submitted prior to the redistribution effective date or up to five days after the effective redistribution date.
Contact
If you have questions, please contact the NCTracks Call Center at 800-688-6696.