432301 2026

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4.4 out of 5

170 votes

The document outlines the New York State Medicaid program's policy to provide an enhanced reimbursement rate of 30% for non-institutional pediatric continuous private duty nursing services for medically fragile children. It specifies eligibility criteria for Licensed Home Care Services Agencies (LHCSA) and independently enrolled nurses, requiring them to certify their training and experience in caring for this population. The document also includes billing instructions and emphasizes the importance of maintaining documentation for inspection.

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Click ‘Get Form’ to open the 432301 document in the editor.
Begin by entering your agency name and NYS license number in the designated fields. Ensure accuracy as this information is crucial for processing.
Provide your Medicaid Provider Identification Number and National Provider Identifier (NPI) in the respective sections. This identification is necessary for reimbursement purposes.
For Licensed Home Care Services Agencies (LHCSA), check the appropriate box to certify that your nurses are trained and experienced in caring for medically fragile pediatric patients. Include a signature from an authorized officer.
If you are an independently enrolled nurse, fill out your name, NYS license number, Medicaid Provider ID, and NPI. Specify your training details and completion dates in the provided fields.
Finally, review all entries for completeness and accuracy before submitting the form through eMedNY to ensure timely processing of your enhanced rate authorization.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (163 Votes)
2020	4.4 Satisfied (170 Votes)
2016	4.2 Satisfied (130 Votes)
2010	4 Satisfied (56 Votes)

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