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Private Duty Nursing Provider Qualifications

Provider Requirements and Service Limitations

From The July 2007 Florida Medicaid Provider Handbook

Private Duty Nursing- Requirements To Receive

Description

Private duty nursing services are prescribed by a physician and consist of
individual, continuous nursing care provided by registered or licensed practical
nurses. Nurses must provide private duty nursing services, in accordance with
Chapter 464, F.S.

Limitations

Private duty nursing services are available through the Medicaid Home Health
Program state plan services to children under the age of 21 with complex
medical needs. Licensed nursing is available to children and adults when
determined medically necessary by the Medicaid Home Health State Plan
Program and related to the care of a medical condition.
To be eligible for this service, a recipient must require active nursing
interventions on an ongoing basis. This service is provided on a one-to-one
basis to eligible recipients. If the service is provided with two or more recipients
present, the amount of time billed must be prorated between the numbers of
recipients receiving the service. This service may be provided concurrently (at
the same date and time) with another service. A nursing assessment may be
performed to determine the need for the service or to evaluate the recipient for
care plan development. Reimbursement for a nursing assessment is considered
two hours of service at the registered nurse rate. Only registered nurses may
perform an assessment. Nursing assessments should be updated annually or if
there is a significant change in the recipient's health status.
The DD waiver may pay only for those medically-necessary services not covered
by the Medicaid State Plan Home Health Program. A recipient shall receive no
more than 96 units of this service per day. A unit is defined as a 15-minute time
period or portion thereof.
Note: Refer to the Florida Medicaid Home Health Services Coverage and
Limitations Handbook for additional information on Medicaid state plan coverage.
The handbook is available on the Medicaid fiscal agent’s Web Portal at
http://mymedicaid-florida.com. Click on Public Information for Providers, then on
Provider Support, and then on Provider Handbooks. It is incorporated by
reference in 59G-4.130, F.A.C.

Documentation Requirements
Reimbursement* and monitoring documentation to be maintained by the
provider:
1. *Copy of claim(s) submitted for payment;
2. *Copy of nursing care plan;
3. *Copy of service log;
4. *Individual nursing assessment (must be completed at the time of the
first claim submission and annually thereafter);
5. Daily progress notes;
6. Original prescription for the service; and
7. List of duties to be performed by the nurse.
Nurses delivering this service as independent providers must provide proof
of meeting the educational requirements specified in Chapter 464.008(1),
F.S., for licensure as a registered professional nurse or a licensed
practical nurse, whichever is applicable. Nurses will also demonstrate
either verbally or in writing their knowledge, skills and ability to provide the
specific care required by the recipient, as well as a plan for the care that
they provide. This documentation must be provided to the waiver support
coordinator before rendering services.
Documentation to be submitted to the waiver support coordinator by the
provider:
1. Copy of service log, monthly;
2. Copy of nursing care plan at time of first claim submission and
annually thereafter;
3. Individual nursing assessment, at time of first claim submission and
annually thereafter; and
4. Copy of original prescription for the service.
*Indicates reimbursement documentation.
Place of Service Private duty nursing services shall be provided in the recipient’s own home
or family home.

Special Considerations

Private duty nursing services shall not be used for ongoing medical
services and oversight in a licensed residential facility.

Private Duty Nursing Provider Qualifications

Private Duty Nursing Provider Qualifications
Provider Qualifications
Providers of private duty nursing services shall be nurses registered or
licensed in accordance with Chapter 464, F.S.
Nurses may provide this service as employees of licensed home health,
hospice agencies or nurse registries licensed in accordance with Chapter
400, parts III or IV, F.S. They may also be enrolled as independent vendors
providing services under their own name and license.
Training
Requirements
Proof of training in the areas of Cardiopulmonary Resuscitation (CPR),
HIV/AIDS and infection control is required within 30 days of initially
providing private duty nursing services. Proof of annual or required updated
training shall be maintained on file for review. The provider is responsible
for all training requirements outlined in the Core Assurances.
Note: Refer to the Core Assurances in Appendix A for the provider training
requirements.