Private Duty Nursing for Children FAQs

Eligibility and Limitations

To qualify for Private Duty Nursing (PDN) services, the participant must:

  • Be eligible for MO HealthNet benefits;
  • Be under the age of 21; and
  • Have a medical problem which requires at least a four-hour block of nursing care per day that exceeds the family’s ability to care for the child without help.

PDN services cannot be provided when the participant:

  • Does not need skilled nursing services;
  • Is in a hospital or nursing facility; or
  • Is over the age of 21.
Plan of Care

The Plan of Care (POC) is the participant’s ordered medical treatment plan. PDN services must be ordered in the POC and be under the guidance of the participant’s physician. The ordering practitioner must review the POC at least every 60 days.

Bureau of Special Health Care Needs

Services must be prior authorized by the Department of Health and Senior Services, Bureau of Special Health Care Needs (DHSS/BSHCN). A BSHCN nurse will do an assessment to determine the need for PDN services, as well as the frequency (how often), amount (how much) and duration (how long).

Each participant will be assigned a BSHCN Service Coordinator. The Service Coordinator will:

  • Contact the participant/responsible party to schedule and complete an assessment of needs;
  • Create a plan that identifies goals, services, funding sources and outcomes needed to reach goals;
  • Create an authorization or a change in prior authorization for private duty nursing services;
  • Assist with contacting private duty nursing agencies, scheduling services and coordinating care;
  • Make referrals to other programs or agencies as needed for services and to meet goals;
  • Visit the home at least every 3 months to discuss services, review the plan of care, and make any needed changes to the plan of care; and
  • Be a point of contact to address any questions and concerns.

The Service Coordinator may authorize additional hours to be used to allow flexibility, for example: for nurses to go with the participant/family to healthcare appointments, to allow the parent/responsible party to work more hours, or to allow flexibility when multiple agencies are involved.

Change in Prior Authorization

An approved prior authorization for PDN may be changed when needed to meet the needs of the participant. The participant/responsible party or the provider may contact the BSHCN Service Coordinator to make a change in the prior authorization. For example, if two agencies are involved, each agency is authorized for the amount of service units it expects to provide. If one agency does not have a nurse to provide the amount of services expected, unused service units may be moved to the other agency if they have a nurse available. Changes to a prior authorization should be requested as far in advance as possible, such as when the nurse is scheduled for a vacation or doctor’s appointment, which is known in advance. When an emergency situation arises and a change cannot be made in advance, the BSHCN Service Coordinator should be contacted as soon as possible, not later than within 72 hours.

Flexibility in Scheduling PDN Services

The service coordinator will work with the participant/responsible party so the authorization allows maximum flexibility when approved hours are scheduled. The needs of the participant and family will be considered including work/sleep schedules, health needs, other family members, and other household responsibilities.

Choice of Providers

The parent/responsible party may choose the provider of services for the participant, and will be given a list of providers in their area. One or more than one provider may be chosen. Services from a provider may be declined. The parent/responsible party may request help from the Service Coordinator in calling the providers. Services will be delivered based on availability of provider agency staff.

Family Members/Legal Guardians as PDNs

A family member or legal guardian is allowed to provide PDN services if they are a licensed registered nurse (RN) or a licensed practical nurse (LPN) employed by a PDN agency that is enrolled with MO HealthNet.

Primary Caregiver

PDN services can be provided in the participant’s home. There must be a primary caregiver (parent or other responsible party) who is able and willing to assist in the participant’s care. Primary caregivers are not allowed to be away from the home for an extended period of time and expect the PDN agency to be 100% responsible for the participant. PDN services are to support the care of the participant, not replace the duties of the primary caregiver.

PDN Provider Agency

The PDN provider agency will:

  • Communicate directly with the participant/responsible party;
  • Do an assessment and develop a plan of care;
  • Provide a bill of rights and grievance procedure; and
  • Work with the participant/responsible party to schedule and provide the nurse to perform nursing services as indicated in the plan of care.
Receiving Services Outside of the Home

When a participant is receiving PDN services in their home, they may also use those services outside their home if their normal life activities require it, including at day care and school. The nurse may accompany the participant into the community, but may not drive.

School-Based Private Duty Nursing

Some school-aged participants have an Individualized Education Plan (IEP) through their school district that identifies PDN services as a necessary support for learning. If that is the case, PDN services will be offered through the school district while the participant attends school.

State Fair Hearing Rights

A participant/responsible party has the right to ask for a State Fair Hearing any time services are denied, reduced or terminated. A letter will be provided with these rights. If a letter is not received, contact the Constituent Services Unit at 1-800-392-2161.

Who to Contact:

Bureau of Special Health Care Needs
Missouri Department of Health and Senior Services
PO Box 570
Jefferson City, MO 65102-0570

Telephone (Central Office): 573-751-6246 or (toll-free) 800-451-0669
Fax: 573-751-6237

Find your county on the Regional Offices map to determine which regional office helps people in your area.

Participants enrolled in Managed Care should contact their Managed Care Plan for prior authorization of PDN services.