Private Duty Nursing (PDN) Prior Authorization Adjustment Including Urgent Or Emergency Situations
There are times when one PDN agency cannot staff all the PDN services authorized for a participant. The Bureau of Special Health Care Needs (BSHCN) service coordinator may approve services to multiple provider agencies or a different agency to meet the participant's needs. The services must be prior authorized for each provider agency, with a specific number of units authorized to each agency based on the anticipated services each agency will provide. The participant may then utilize multiple PDN provider agencies to assist them in receiving the authorized units of PDN services. The authorized units can be adjusted and/or moved to another agency if an agency cannot staff their authorized units, but another agency can.
Provider agencies are encouraged to coordinate with each other to staff all authorized units of PDN services. Agency providers should contact the appropriate Bureau of Special Health Care Needs at BSHCN Regional Office to adjust the authorization. If an unforeseen, urgent or emergency situation arises resulting in a need to adjust the authorization, BSHCN should be contacted within 72 hours after the event.
For additional information, reference MO HealthNet Provider Bulletin, Volume 46 Number 57 dated May 6, 2024.