D.Service Standards – Private Duty Nursing

Issue Date: 3/27/07 / Rev Date: 08/31/11
Service Name / Private Duty Nursing
Service Definition / Individual and continuous care (in contrast to part time or intermittent care) provided by licensed nurses within the scope of state law. These services are provided to an individual in their home.
Service Code / *T1000 Private duty/Independent nursing service(s); licensed, up to 15 minutes
*Please use:TD modifier to indicate an RN;
TE modifier to indicate an LPN
Units / Up to 15 minutes
Service Delivery Options /  Traditional/Agency-Based
 Self-Determination
I.MINIMUM STANDARDS FOR TRADITIONAL/AGENCY-BASED

A.All nurses providing Private Duty Nursing (PDN) to MI Choice participants must meet licensure requirements and practice the standards found under MCL 333.17201-17242, and maintain a current State of Michigan nursing license.

B.This service may include medication administration as defined under MCL 333.7103(1).

C.The vendor shall maintain close contact with the AAA 1-B and the participant’s Care Manager to promptly report changes in each participant’s condition and/or treatment needs upon observation of such changes.
D.Through a person-centered planning process, the waiver agent shall determine the length and duration of services provided.
E.The vendor shall send case notes to the care manager on a regular basis to update the supports coordinator on the condition of the participant.
F.The AAA 1-B is required to obtain prior authorization from MDCH for PDN services provided to participants aged 18-21. Normally, the Medicaid state plan covers PDN services for participants in this age group.
G.Services paid for with MI Choice funds shall not duplicate nor replace services available through Michigan Medicaid state plan. Vendors can find state plan coverage online in the Medicaid Provider Manual at
II.PROGRAM REQUIREMENTS
  1. The AAA 1-B shall explore and utilize all other sources of funding before using MI Choice funds for PDN services.

III.VENDOR RECORDS

  1. Vendors MUST maintain copies of the physician’s orders in each participant’s record. This is in addition to other required information that must be maintained in participant records.
  1. MINIMUM STANDARDS FOR SELF-DETERMINED SERVICE DELIVERY
  1. Each chosen provider must minimally comply with section C of the “General Operating Standards for MI Choice Waiver Service Providers.”
  2. When authorizing Private Duty Nursing for participants choosing the self-determination option, vendors must comply with the Minimum Standards for Traditional Service Delivery specified above.

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