Investing in Medically Fragile Children and Adults

Information for Providers 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 PDN Program

  • Effective April 1, 2022, the PDN Medically Fragile Children´s Program expanded to the Medically Fragile Children and Adult Program. The Program consists of two components with corresponding financial enhancements for provider participation
    1. Private Duty Nursing Medically Fragile Children and Adult Training and Experience
    2. Private Duty Nursing (PDN) Medically Fragile Children and Adult (MFCA) Provider Directory
  • Providers can choose to enroll in one or both components of the Medically Fragile Children and Adult 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:
    1. Licensed Home Care Services Agency (LHCSA)
    2. Independently enrolled nurse providers (RNs and LPNs)

What is the Medically Fragile Children and Adult (MFCA) Provider Directory?


Medically Fragile Children and Adults Provider Directory

  • Lists private duty nurses and nurse agencies that serve Medicaid members receiving FFS private duty nursing services
  • Searchable by name, licensure, city, county
  • Directory will be available to the public
  • Directory will be updated on a weekly basis
  • A PDN´s participation in the directory indicates the willingness to accept inquiries for providing care to medically fragile children and adults
  • Inquiries will be received from family members or representatives, discharge planners and case managers
  • Directory participants are expected to respond to all inquiries received
  • Active participation in the Directory is required for enhanced reimbursement
  • Listing in the Directory does not guarantee employment

Benefits of Participation


PDN MFCA Program Fee Enhancements

  • Fee enhancements applied for each component:
    1. Medically Fragile Children and Adult Training and Experience
      • Already an option for medically fragile children. Nurse/Agency enrolls in the program by attesting to medically fragile children and adult training and/or experience
      • 30% fee enhancement to be calculated at claims processing
    2. PDN Medically Fragile Children and Adult (MFCA) Provider Directory
      • 45% fee enhancement percentage applied to regional base fee at time of claims processing2
  • If provider is eligible for both enhancements – stacked payment upon claims processing
  • Directory enhancement will be added after the 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

PDN Base Fees

The current PDN fees are located in the PDN Manual located on eMedNY.org


Medically Fragile Children and Adult PDN Program
Provider Enrollment Process


Provider Enrollment Process

  • Access forms on eMedNY in the "Provider Enrollment" section
    • Forms are provider type specific:
      • Agency Providers: follow "Nurse Registry" instructions
      • Independent Providers: follow "Nurse (LPN/RN)" instructions
  • Providers may participate in one or both programs
  • Complete Section One for Certification of Nurse Training and Experience
    • Form no longer requires listing training or experience.
    • Documentation to support training and experience must be kept by the independent nurse/agency and presented to the Department on request
  • Complete Section Two for Private Duty Nursing Provider Directory
  • Sign and date certification(s)
  • Mail to eMedNY, PO Box 4610, Rensselaer NY 12144-4610

Provider Enrollment MFCA Form

Requirements & Additional Forms

✓ Proof of current license / registration
Examples:
  1. Copy of license with future expiration date,
  2. Copy of license registration/renewal, or
  3. Printout of your license status from the licensing agency´s website.
✓ Electronic Funds Transfer (EFT) Authorization - form #701101
(NOT REQUIRED for revalidation if EFT is already in place and no change is requested). If you answered "No" to the Enrollment Form´s Group question (Line 4 of page 2), EMEDNY -701101 is NOT required. Also not required for revalidation or reinstatement/reactivation.
✓ ETIN Certification Statement for New Enrollments - form #490602
(NOT REQUIRED for revalidation or reinstatement/reactivation). If you already have an existing ETIN that you wish to affiliate with, submit the Certification Statement for Existing ETINs (EMEDNY 490601) after you receive your Provider ID. This form is available on eMedNY under "Maintenance Forms".
✓ Medically Fragile Children and Adult Program - form #432301
To apply for the Medically Fragile Children and Adult PDN Enhancement, complete this form.
✓ Prior Conduct Questionnaire - form #431001
(If you answer "Yes" to questions 1-4 in section 6 of the enrollment application, you must complete this form).

OMIG Provider Compliance Certification - Confirmation notice for the OMIG Provider Compliance Program may be required. Visit OMIG to determine if the Applicant / Provider must comply. If yes, a copy of the confirmation notice (printed from the website) must be included with this application.


Resources

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2. Previous Directory enhancements for Medically Fragile Children (members under 23) 10/1/20 15%, 4/1/21 30%, 4/1/22 45%.  2