The Agency for Health Care Administration is in the process of amending current language in the Florida Medicaid Home Health Coverage and Limitations Handbook and the Florida Medicaid Prescribed Pediatric Extended Care (PPEC) Coverage and Limitations Handbook to more accurately describe the process for evaluating parental responsibility when reviewing requests for both private duty nursing and PPEC services for children under the age of 21.
Effective immediately, when determining the need for Private Duty Nursing (PDN) services, the Agency will not require that parents participate to the fullest extent possible in performing skilled interventions that normally could only be provided by a licensed nurse. The following language should be applied when determining parental responsibility in evaluating the need for PDN services:
If the parents or legal guardians are willing and capable of providing more than activities of daily living (ADL) and instrumental activities of daily living (IADL) care, PDN services can be authorized to supplement the care provided by those parents or legal guardians.
Medicaid can reimburse PDN services rendered to a recipient whose parent or legal guardian is not available or able to provide ADL and IADL care. Supporting documentation must accompany the prior authorization request in order to substantiate a parent or legal guardian’s inability to participate in the care of the recipient (i.e., work or school schedules and medical documentation). If a parent or legal guardian is unable to provide a documented work schedule, a statement attesting to the work schedule must be presented to eQHealth Solutions when requesting authorization.
If you have any questions, please contact your local Medicaid area office.