DOH Announces Private Duty Nursing Rate Enhancement Process for Serving Medically Fragile Children and Adults
Effective April 1, 2022, the New York State Fee-for-Service (FFS) Medicaid Private Duty Nursing (PDN) Medically Fragile Children’s Program transitioned to the Medically Fragile Children and Adult (MFCA) Program. FFS Medicaid will offer PDN fee enhancements to all enrolled Medicaid PDN providers (enrolled Licensed Home Care Services Agencies (LHCSAs) and independent Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)) who enroll in one or both components of the MFCA Program. The Department of Health (DOH) advisory is available here.
The two components will consist of the MFCA Training and Experience component and the MFCA Provider Directory component. Enrollment is voluntary, and PDN providers may choose to participate in one or both components to receive the corresponding enhanced fee(s):
Component 1: FFS PDN MFCA Training and Experience (no member age limit)
- Already an option for PDN providers serving medically fragile children
- A PDN provider must enroll in the program by attesting to having completed training and/or experience to care for children and adults in the PDN community
- 30 percent fee enhancement to be calculated at the time of claims processing
- Enrolled providers must indicate a Service Authorization (SA) Code of 7 on their claims
- Providers already enrolled in the Medically Fragile Children’s Training and Experience component will not need to re-enroll until they need to revalidate. Revalidation occurs every five years.
Component 2: FFS PDN MFCA Provider Directory (no member age limit)
- Already an option for PDN providers serving medically fragile children
- A PDN provider must enroll to be listed in the online, searchable PDN Directory. Participation in the Directory indicates the willingness to accept inquiries for providing care to PDN members in the community, which may come from members, family members, member representatives, discharge planners, or case managers. PDN providers are expected to respond to all inquiries.
- 45 percent fee enhancement to be calculated at the time of claims processing
- For providers enrolling in both components, this fee enhancement is applied after the application of (in addition to) the Training and Experience fee adjustment
- Enrolled providers do not need to indicate an SA code on their claims for the Directory component