Private Duty Nursing - Ohio Department of Medicaid 2025

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  1. Click ‘Get Form’ to open the Private Duty Nursing Services Request form in the editor.
  2. Begin by filling out the Consumer Information section. Enter the first name, middle initial, last name, and Medicaid number (12 digits). Include your phone number and, if applicable, the name and phone number of an authorized representative.
  3. Indicate the effective date requested and select the waiver type. If you are using an ODA-administered waiver, ensure that your case manager submits this form.
  4. In the Provider Information section, provide your agency's name, Ohio Medicaid provider number (7 digits), National Provider Identifier (NPI) number, and the ordering physician’s details including their NPI number.
  5. Complete any additional required fields and review all information for accuracy before signing. Ensure that you understand the privacy implications regarding Protected Health Information.
  6. Finally, submit your completed form through our platform for a seamless process.

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Medicare doesnt typically cover caregivers who help you with the activities of daily living unless this type of care is necessary for a short time while you recover from an illness or injury. For instance, it wont pay for services like cleaning, shopping, or laundry, which are typically part of custodial care.
Private duty nurses provide long-term, comprehensive hourly nursing care and are skilled in managing medical equipment and technology. A patient will have a nurse in the home anywhere from 4 to 24 hours per day.
Another popular way to pay for PDN care is through Medicaid, the joint federal and state program that assists lower-income individuals with healthcare. In-home care and skilled nursing are generally covered under Medicaid.
Under Medicares rules, you qualify for home health services if you need intermittent skilled nursing care. Medicare will continue to cover these services as long as they are deemed medically necessary and you meet the criteria for being homebound.
Medicare Part A does not cover most nursing home care. Medicare Part A may help cover some medical services in a nursing home under certain conditions. If you need skilled nursing care, such as changing sterile dressings, Medicare Part A may help cover some costs.
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For Medicare to cover in-home nursing services, the care must meet specific criteria. The patient must be homebound, require part-time or intermittent skilled nursing care, and have a physicians certification for these services. Medicare also requires that care be delivered by a Medicare-certified home health agency.
While Medicare covers many aspects of home healthcare, private duty nursing often falls outside its scope. The continuous and long-term nature of private duty nursing exceeds Medicares definition of intermittent care. As a result, families seeking private duty nursing may need to explore alternative funding sources.
While both services offer professional medical care, they cater to distinct patient needs. Private duty nursing focuses on long-term, continuous care for individuals with complex medical needs. Skilled nursing, in contrast, offers short-term, intermittent care that targets recovery or specific health goals.

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