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 Private
Duty Nursing (PDN) Brochure
Wisconsin Department of Health and Family Services
Division of Health Care Financing, POH 1122, April 1999
A Guide for Wisconsin Medicaid Recipients and Their Families
Brochure - PDF
 bout Wisconsin Medicaid Private Duty Nursing
Wisconsin Medicaid covers private duty nursing (PDN) for recipients with
medical conditions that require eight or more hours of skilled nursing care in a 24-hour
period.
- PDN supplements the care families and other health
professionals are able to provide in the home.
- PDN services are generally provided in a recipient's home. However,
PDN may also be provided outside the home if the recipient's normal activities, like
school or work, require him/her to leave home.
- Recipients may use their authorized daily hours of PDN care
flexibly over periods of time up to 8 weeks in length.
- The number of PDN hours covered daily is based on medical need and
must be prior authorized by Wisconsin Medicaid medical consultants.
- Only Medicaid-certified home health agencies or independent nurses may
provide Medicaid PDN.
 uiding Recipients Through the Process
If it appears that you, the Medicaid recipient, may qualify for PDN
services, the PDN provider will work with you and your physician to help you get the care
you need.
If you do not require eight or more hours of skilled nursing care in a
day, the PDN provider can refer you to providers of part-time intermittent skilled nursing
care.
Plan of Treatment
The PDN provider will work with you and your physician to develop a Plan
of Treatment, sometimes called a Plan of Care. A Plan of Treatment includes:
- A medical assessment.
- Medication and treatment orders.
- Treatment goals.
- Methods of care to be used.
- Plan for care coordination by nurses and other health professionals.
Family Support
The PDN provider will ask questions about your family support needs,
including:
- Your family's ability to provide medical care.
- Daily schedules - including hours of work, school, sleep, and care for
other family dependents.
Request for Prior Authorization
Based on the Plan of Treatment and the family support information, the
provider will:
- Prepare a written prior authorization request.
- Obtain a signed statement from you or a responsible family member
saying that you or he/she has read both the Plan of Treatment and the prior
authorization request.
- Submit the Prior Authorization Request and the Plan of Treatment to
the Medicaid medical consultants who will review the request.
Approval of PDN
Medicaid medical consultants will review a request for prior
authorization of PDN services within two weeks after it is received.
- If the information is not complete, the prior authorization
request
will be returned to the provider.
- If the information is complete, the request will be approved,
modified, or denied.
- If the request is modified or denied, you will receive a letter
explaining the reason for the decision and what further steps you may take.
Questions and Answers About PDN
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