Investing in Medically Fragile Children

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Information for Stakeholders on New York State´s Initiative

September 2020

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

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´s PDN Program

  • The Medically Fragile Children´s Private Duty Nursing Program consists of two components with corresponding financial enhancements for provider participation
    • Private Duty Nursing Medically Fragile Children Training and Experience (expanded to include up to age 23)*
    • Private Duty Nursing (PDN) Medically Fragile Children´s (MFC) Provider Directory (up to age 23)
      • *Training and Experience enhancement to age 23 allows alignment of both components to service the entire span of the member´s eligibility in the Program
  • Providers can choose to enroll in one or both components of the Medically Fragile Children´s Private Duty Nursing 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´s Provider Directory?


Medically Fragile Children´s Provider Directory?

  • Lists private duty nurses and nurse agencies that serve Medicaid members, up to age 23, receiving FFS private duty nursing services
  • PDNs are searchable by name, licensure, city, county
  • Identifies providers who have enrolled in Medically Fragile Children Training and Experience component of the program
  • Directory will be updated on a weekly basis
  • A PDN listed in the directory indicates willingness to provide care to medically fragile children, and 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 nurse agencies that are enrolled in the Medically Fragile Children Directory
  • Search by name, licensure, city, county
  • Identifies providers enrolled in Medically Fragile Children Training and Experience
  • Updated on a weekly basis
  • Available to the general public

PDN MFC Directory Fee Enhancements

  • PDNs participating in the MFC Program will receive fee enhancements
    1. Medically Fragile Children Training and Experience
      • PDNs with training and/or experience in the care of medically fragile children receive a 30% fee enhancement
    2. Participation in PDN Medically Fragile Children´s Provider Directory
      • Fee enhancement percentages applied to regional base fees
        • October 1, 202015%
        • April 1, 2021 30%
        • April 1, 2022 45%
    • If provider receive both enhancements -payments are stacked
    • Directory enhancement is added after the current Training and Experience Enhancement

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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