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Department of Human Services Department of Human Services  
 
Private Duty Nursing (PDN) Services

Revised: 09-26-2012


Private Duty Nursing (PDN) Services are nursing services ordered by a physician, for a recipient whose illness, injury, physical or mental condition requires more individual and continuous care by a Registered (RN) or Licensed Practical Nurse (LPN) than can be provided in a single or twice daily skilled nurse visit and requires greater skill than a Home Health Aide (HHA) or Personal Care Assistant (PCA) can provide.

PDN services:

• Are for recipients who need more individual and continuous skilled nursing care than provided in a skilled nurse visit
• Are for care outside the scope of services provided by a Home Health Aide/PCA
• Are provided under a plan of care or service plan approved by the physician
• Specify the level of care the nurse is qualified to provide
• Are ordered by the recipient’s physician
• May be used outside of the recipient’s home during hours when normal life activities take them outside of their home
• Must be provided by an RN or LPN
• May be provided by an RN or LPN with a hardship waiver who is one of the following: parent of a minor child, spouse or non-corporate legal guardian

Eligible Providers
• Medicare Certified Home Health Agency
• Class A licensed Private Duty Nurse Agency
• Independent Registered Nurse (RN)
• Independent Licensed Practical Nurse (LPN) with a class A license from MDH

PDN Relative Hardship Waiver
The PDN Relative Hardship Waiver allows certain relatives to receive reimbursement for providing services to an MA recipient. The relative must be currently licensed in the State of Minnesota as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) employed by a Private Duty Nursing Agency enrolled with MHCP and is:

• The parent of a recipient
• The spouse of a recipient or
• A non-corporate legal guardian of a recipient

In order to qualify for a PDN Relative Hardship Waiver, at least one of the following criteria must be met:

• The relative resigns from a full-time or part-time job to provide PDN for the recipient
• The relative goes from a full-time to a part-time job with less compensation to provide PDN for the recipient
• The relative takes a leave of absence without pay to provide PDN for the recipient
• Because of labor conditions, intermittent hours of care needed, or special language needs, the relative is needed in order to provide an adequate number of qualified PDNs to meet the recipient’s needs

In the case of a PDN Relative Hardship Waiver, the provider agency is responsible for:

• Receiving the request from the recipient/responsible party
• Obtaining the relative’s signature
• Completing the PDN Hardship Waiver Application request form (DHS-4109)
• Ensuring the accuracy of the information
• Submitting the PDN Hardship Waiver Application (DHS-4109) form along with supporting documentation to Disability Services Division (DSD)

Please note:

• Provision of paid service does not preclude the parent, spouse or guardian from his/her obligations for non-reimbursed family responsibilities of emergency backup caregiver and primary caregiver. The provision of these services is not legally required of the parent, spouse or legal guardian. Services provided by a parent, spouse or guardian cannot be used in lieu of nursing services covered and available under liable third-party payers including Medicare.
• Paid hours of service provided by the parent, spouse or guardian must be included in the recipient’s service plan. Hours authorized for the parent, spouse or guardian may not exceed 50% of the total approved nursing hours or 8 hours per day, whichever is less, up to a maximum of 40 hours per week.
• A parent or spouse may not be paid to provide PDN if they fail to pass a criminal background check or if the home health agency, the waiver case manager or the physician, determine that the care provided by the parent, spouse or guardian is unsafe.
• The review process is 30 days. Written notice will be issued upon a decision. The provider must keep this notice in the recipient’s file. The hardship waiver will be approved from the date received forward. If the hardship waiver is denied an explanation will be provided.
• PDN services may not be reimbursed if the nurse is the foster care provider of a person who is under the age of 18 years.

Eligible Recipients
Recipients must be eligible under one of the following programs:

Medical Assistance (MA)
MinnesotaCare: Expanded Benefit Set (pregnant women and children under age 21)
Waiver and Alternative Care

Authorization Requirements
Assessment Requirements
PDN nursing care is based on an assessment of the recipient’s medical/health care needs. This service includes ongoing professional nursing observation, monitoring, intervention, and evaluation. This level of care provides continuity, intensity, and the length of time required to maintain or restore optimal health. Professional nursing is defined in the MN Nurse Practice Act.

To request PDN services, complete the MA Private Duty Nursing Assessment (DHS-4071A) form following the process described in the updated MA Private Duty Nursing Assessment Instructions (DHS-4071B) and the PDN Decision Tree (DHS-4071C).

• All PDN services require prior authorization. Refer to the Service Agreement Quick Reference Guide (PDF) for the complete process
• PDN services require a physician order prior to initiating service
• Review/approval of the service plan by the recipient’s physician every 60 days

Covered Services
PDN services can be classified regular or complex.

Regular PDN Care
Regular PDN care is provided to a recipient who is not ventilator dependent, and does not require an intensive level of care.

• Perform regular PDN assessments and interventions for recipients who are considered stable but have episodes of instability not immediately life threatening.
• Perform nursing observation, monitoring and assessment to determine appropriate interventions to maintain or improve the recipient’s health status.

PDN services are for recipients who need more individual and continuous skilled nursing care than can be provided in a skilled nurse visit. Services must:

• Be outside the scope of services that can be provided by a Home Health Aide or PCA
• Be provided according to the recipient’s plan of care
• Be approved by the recipient’s physician
• Be provided in the recipient’s home, or outside the home if normal life activities take them outside the home (must be in the care plan)

Complex PDN Care
Complex PDN care is provided to recipients who are either ventilator-dependent or who require an “intensive level of care.”

Ventilator Dependent
A recipient is considered ventilator dependent when:

• Mechanical ventilation for life support is needed for at least six hours per day
• The person is expected will be/was dependent for at least 30 consecutive days

Intensive Level of Care
A recipient’s medical needs meet intensive level of care when the doctor’s orders require complex nursing assessments and interventions in response to life-threatening episodes of instability. The interventions are immediately needed based on either anticipated or unanticipated changes in the recipient’s health status.


Non-Covered Services
• PDN visits for the sole purpose of providing household tasks, transportation, companionship, or socialization
• Services that are not medically necessary
• Services that are not ordered by a physician
• Services provided in a hospital, nursing facility (NF), or intermediate care facility (ICF)

Billing
Complex Reimbursement Rates
A complex care reimbursement rate is only available when the recipient is receiving 1:1 PDN services. A complex care rate is not available when the recipient is receiving shared (1:2) PDN services. This means a recipient can share PDN services if they are authorized complex care, but the agency will only receive the complex rate during the hours the recipient is receiving the 1:1 services.

Shared PDN Option
This option allows two recipients to share PDN services in the same setting at the same time from the same private duty nurse. All regulations pertaining to private duty nursing services also apply to the Shared Care Option. A setting includes:

• The home/licensed foster care home of one of the recipients
• Outside the home/foster care home when normal life activities take recipients outside the home
• A child care program licensed under MS 245A, or operated by a local school district/private school
• An adult day care service licensed under MS 245A

Shared PDN cannot be provided to two recipients in separate apartments in the same building. PDN cannot replace or supplement required staff at a licensed facility.

Required Documentation
Include a copy of each of the following in the recipient’s chart when service is shared PDN:

• A signed consent form by each recipient/legal representative
• Permission for the agency to schedule shared care up to the maximum hours chosen by the recipient
• Any use of services outside the recipient’s home
• Permission to place the recipient’s name in the chart of the other shared recipient
• How the needs of both recipients are appropriately and safely being met
• Where the shared services will be provided
• Ongoing monitoring and evaluation of the shared services by the PDN
• Emergency response back up plans to the recipient’s illness/absence or PDN’s illness/absence
• Additional training, if needed, for the PDN to provide care to two recipients
• The names of each recipient receiving shared PDN services
• The starting and ending times the recipients received shared PDN
• Routine nursing documentation such as changes in the recipient’s condition/any problems due to sharing services

Changing or Discontinuing Shared PDN
The recipient or legal representative must notify the provider in writing if the recipient chooses to make a change in their shared care. Changes include:

• The number of authorized units the recipient wishes to share
• Discontinuing participation in shared care
• Changing providers

The written revocation or change must be maintained in the recipient’s file. For additional information, refer to the Quick Reference Tool.


Definitions
Plan of Care - PCA: See Service Plan.

Private-Duty Nursing Agency: An agency holding a Class A Home Care license and is enrolled with the Department of Human Services to provide private duty nursing services.

Service Plan – PCA: (Also called PCA plan of care.)A written description of the services needed by the recipient based on the assessment. The service plan must include a description of the home care services, the frequency and duration of services, recipient’s functional level, medications, treatments and the expected outcomes and goals.


Legal References
42 CFR 440.80 (Private Duty Nursing Services)
MS 256B.0625
subd 7 (Private Duty Nursing)
MS 256B.0651
(Home care services)
MS 256B.0654
(Private Duty Nursing)
MN Rule 9505.0360
(Private Duty Nursing Services)


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