COVID-19 Guidance for Medicaid Providers

Guidance on Medicaid Changes to Private Duty Nursing (PDN) Policy

  • Guidance is also available in Portable Document Format (PDF)

March 28, 2020

Re: Medicaid Changes to Private Duty Nursing (PDN) Policy

Dear Private Duty Nursing (PDN) Ordering and Servicing Providers:

The New York State Department of Health (NYSDOH) is providing this guidance to Private Duty Nursing (PDN) ordering and servicing providers pertaining to the current novel coronavirus (COVID–19) outbreak. The guidance applies to Medicaid covered services, as described below, when delivered by enrolled PDN providers. This guidance is effective immediately and shall remain in effect for the remainder of the disaster emergency declared by Executive Order No. 202, or until the issuance of subsequent guidance by the NYSDOH prior to the expiration of such state disaster emergency declaration.


The health and safety of healthcare workers and our ability to provide and support patient care remain our top priorities. Recently, community–wide transmission of COVID–19 has occurred in the United States, including NYS, and the number of both Persons Under Investigation (PUIs) and confirmed cases is increasing. The situation with COVID–19 infections continues to evolve and is very rapidly changing. It is important for all Medicaid providers to keep apprised of current guidance by regularly visiting the Centers for Disease Control and Prevention (CDC) and NYSDOH websites, as well as the NYSDOH Health Commerce System (HCS), for the most up– to–date information for healthcare providers.

Policy Guidance for PDN Services

PDN Services Over 16 hours (Policy Manual 16.3 E)
The limitation on the number of hours that can be worked by a PDN has been raised to allow claims for shifts over 16 hours, when related to the COVID–19 state of emergency. Independent private duty nurses or nursing agencies with an active prior approval, who are required to work longer than 16 hours, may bill for over 16 hours. Daily nursing notes should include documentation that explains the reason(s) that working over 16 hours was required due to the state of emergency. Continuous 24 hours nursing care, by a single provider, is still prohibited.

PDN Administrative Approval – Reduced documentation (PDN Manual 6.0)

For PDN prior approval renewals, the necessary documentation for submission has been reduced to the physician orders. All other documentation is not required at this time. The ordering physician is encouraged to use telehealth for the completion of the required physician orders. To ensure there is no disruption in services, PDN renewals will be backdated to the end of the last PA, if needed.

Change Request for Addition of Non–School Hours (PDN Policy Manual Section 9.4)

The addition of non–school hours to an existing PA does not require a physician´s order. Nursing providers should submit a Change Request documenting the number of additional hours needed since the member is not attending school. These hours will be added to the prior approval (PA) in the date order that they are received.
Current Guidance on telehealth can be found here

The current PDN Policy Guidelines can be found here.


If you have questions on this guidance, please call 1–800–342–3005 or email

Questions for Medicaid Managed Care (MMC) Plans regarding this policy should be directed to the member´s MMC plan.