Investing in Medically Fragile Children and Adults

Information for Stakeholders on New York State´s Initiative

Private Duty Nursing (PDN) Services

  • Private duty nursing services (PDN) are nursing services for NYS Medicaid fee for service (FFS) members who require continuous skilled nursing care in a non-institutional setting
  • Medically fragile children are at risk of hospitalization or institutionalization but are capable of being cared for at home if provided with appropriate home care services

2022 Legislative Changes to Private Duty Nursing

  • Article VII Amendments to SSL 367r: Private duty nursing services worker recruitment and retention program for Medically Fragile Adults (MFA)
    • Authorizes the NYS Medicaid FFS program to reimburse noninstitutional continuous private duty nursing provided to medically fragile adults at the same enhanced fee as medically fragile children
      • PDNs providing services to medically fragile adults will be included in a newly expanded Private Duty Nursing Medically Fragile Children and Adult's Provider Directory

2020 Legislative Changes to Private Duty Nursing

  • Article VII Amendments to SSL 367r: Private duty nursing services worker recruitment and retention program for Medically Fragile Children (MFC)
    • Authorizes the NYS Medicaid FFS program to reimburse noninstitutional pediatric continuous private duty nursing provided to medically fragile children at an enhanced fee
      • PDNs will be included in a newly created Private Duty Nursing Medically Fragile Children´s Provider Directory (up to age 23)
  • The responsibility of setting PDN fees will be under the authority of the Commissioner of Health
    • Transition from county PDN fees to regional PDN fees

Medically Fragile Children and Adult (MFCA) PDN Program

  • Effective April 1, 2022, the PDN Medically Fragile Children´s Program expands to the Medically Fragile Children and Adult Program. The program consists of two components with corresponding financial enhancements for provider participation
    • PDN MFCA Training and Experience
    • PDN MFCA Provider Directory
  • Providers can choose to enroll in one or both components of the PDN Medically Fragile Children and Adult Program
  • Re-enrollment into each of these program components will be necessary every five years during a provider´s routine Provider Enrollment Revalidation Process
  • Eligible providers:
    • Licensed Home Care Services Agency (LHCSA)
    • Independently enrolled nurse providers (RNs and LPNs)

What is the Medically Fragile Children and Adult Provider Directory?


Medically Fragile Children and Adult Provider Directory

  • Lists private duty nurses and nursing agencies that serve Medicaid members receiving FFS private duty nursing services
  • PDNs are searchable by name, licensure, city, county
  • Directory will be updated on a weekly basis
  • A PDN listed in the directory indicates willingness to provide care to medically fragile children and adults. Enrolled PDNs are expected to respond to all inquiries received
  • Inquiries may be received from family members or representatives, discharge planners and case managers
  • Lists private duty nurses and nursing agencies that are enrolled in the Medically Fragile Children and Adult Directory
  • Available to the public

PDN MFCA Directory Fee Enhancements

  • PDNs participating in the MFCA Program will receive fee enhancements
    1. Medically Fragile Children and Adult Training and Experience Enhancement
      • Enrolled PDNs with training and/or experience in the care of medically fragile children and adults receive a 30% fee enhancement applied to the regional base fees during claims processing
    2. Medically Fragile Children and Adult Provider Directory Enhancement
      • PDNs enrolled in the Directory receive a 45% fee enhancement effective April 1, 2022 applied to the regional base fee.1
    3. If a provider will receive both enhancements, the payments will be stacked
    4. If applicable, the Directory enhancement is added after the Training and Experience Enhancement
    5. Enhancements are added at the time of claims processing

PDN Regions

  • Effective 10/1/20
  • Two regions:
    1. Downstate:
      • Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester Counties
    2. Upstate:
      • Albany, Allegany, Broom, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Clinton Columbia, Cortland, Delaware, Erie, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Montgomery, Niagara, Oneida, Onondaga, Ontario, Orleans, Oswego, Otsego, Rensselaer, St. Lawrence, Saratoga, Schenectady, Schoharie, Schuyler, Seneca, Steuben, Tioga, Tompkins, Warren, Washington, Wayne, Wyoming, Yates counties

Resources

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1. Previous Medically Fragile Children (members under 23) Provider Directory enhancements: 10/1/20 15%, 4/1/21 30%, 4/1/22 45%.  1