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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
 uestions and Answers About PDN
Is it possible to appeal a prior authorization decision?
- You may appeal a prior authorization decision by requesting a fair
hearing before an independent administrative hearing officer.
- Before beginning the appeal process, you should discuss the decision
with your provider to make sure that the provider submitted all the necessary information
in the prior authorization request.
- If additional information or corrections are needed, the provider may
submit the prior authorization request for reconsideration.
What if changes occur in your needs or the family's ability to provide
care after the PDN services are approved?
- If changes occur, inform your PDN provider, who will then notify your
physician and Wisconsin Medicaid.
- The Plan of Treatment can by modified and the
prior authorization request may be
amended with the approval of the Medicaid consultants.
- The Plan of Treatment must be re-evaluated and signed by your
physician every 62 days, even if no changes occur.
Are there limits on how many hours of PDN care a recipient may
receive?
Yes. PDN only covers the time spent by a licensed nurse performing
skilled nursing tasks. If additional health care is authorized, family and PDN care may be
supplemented by home health aides and personal care workers. Together, you, your family,
and the PDN provider(s) should discuss how these hours will be coordinated.
Can PDN recipients use their authorized hours flexibly?
Yes. You may use your authorized PDN hours flexibly over periods of time
up to eight weeks in length. If you choose flexible scheduling, the provider(s) will
indicate this preference in the prior authorization request or in an amendment to the
existing prior authorization.
Flexible use of PDN hours allows most recipients to accommodate changes
in family schedules, unscheduled provider absences, hospitalizations, or other unforeseen
needs.
What if a provider cannot meet a recipient's need for flexible hours?
If an agency or individual provider is unable to meet your needs for
flexibility, you may wish to work with additional PDN providers to ensure coverage of all
the PDN hours authorized. Provider should include a provision regarding flexible time in
your service agreement with them.
Where can recipients get more information or voice any concerns they
may have about their PDN care?
You can contact Medicaid Recipient Services by calling (800) 362-3002
toll-free or (608) 221-5720. Medicaid Recipient Services can:
- Answer questions about Medicaid coverage.
- Refer you to Medicaid-certified providers in your area.
- Refer you to state agencies that regulate the performance of home
health care professionals.
Previous page of PDN brochure.
PDF of
PDN brochure.
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