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Do I Qualify for Private Duty Nursing Services?
Private duty nursing services are available to any person who requires
skilled nursing care, when these services are ordered by a physician.
The primary
barrier encountered by those who require services, is often cost. The
requirements for third party reimbursement differ depending on the
source. Some private insurance companies cover the cost of private duty
nursing. Many patients also qualify for a number of state and federally
funded programs.
Medicaid is
available for private duty nursing, when the patient requires at least 8
hours a day of skilled nursing. Each request for authorization is
reviewed by the Bureau of Health and Family Services and a determination
is made based on the Bureau’s criteria for eligibility. Although many
people qualify for Medicaid on the basis of disability or income, there
are other programs, such as the Katie Beckett program that make one
eligible for Medicaid.
After Medicaid is
granted, the patient must also meet the requirements for skilled
nursing. A request for prior authorization is sent to the state, in the
patient’s behalf, by the provider. It may take as long as 6 weeks for a
reply. In some circumstances, services can begin before prior
authorization is approved.
What if I Already have Nursing Services
from a Home Care Agency but Need Additional Care?
Independent nurses often case share with
agencies to meet the patient’s staffing needs. Each
provider is allotted a certain number of hours.
Services do not overlap. Each provider keeps their own
doctor’s orders and patient record. There is both an
independent and an agency case manager, who coordinate
the patient’s care.
Initiating Services
PHP will assist families in finding
independent nurses through our job board and networking,
but we are not an employment agency. We do not endorse
the providers to whom patients are referred. Applicants
are screened, interviewed and hired by the patient or
family of the patient. An RN referred to as the “case
coordinator” performs an initial assessment, develops a
plan of care based on the doctor’s orders, submits
requests for prior authorization as indicated, and sets
up a patient record.
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