432301 2026

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The Private Duty Nursing Program for Medically Fragile Children offers enhanced reimbursement rates for providers delivering continuous nursing services to pediatric patients. Providers can enroll in two components, requiring certification of training and experience to qualify for a 30% rate increase. Additionally, participation in a public provider directory is encouraged to ensure service availability. Providers must complete specific forms and submit them through eMedNY to receive the enhanced rates and be listed in the directory.

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Click ‘Get Form’ to open the 432301 document in the editor.
Begin with Section One, where you will enter the Nurse’s Name, NYS License Number, Medicaid Provider Identification Number (if applicable), and National Provider Identifier (NPI). Ensure all information is accurate as it is crucial for reimbursement.
In Section One, certify your training and experience by signing the form. This certification is essential for receiving the enhanced Medicaid reimbursement rate.
Proceed to Section Two if you wish to enroll in the PDN Provider Directory. Fill in your contact email address and phone number, ensuring they are correct for future communications.
Sign Section Two to confirm your participation in the directory. This step is vital as it indicates your willingness to accept inquiries for providing care.
Once completed, submit the form through eMedNY as instructed at the end of the document.

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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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