Emedny 432301 2026

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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 nurses' 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 emedny 432301 in the editor.
Begin by selecting the appropriate box indicating whether you are a Licensed Home Care Services Agency (LHCSA) or an independently enrolled nurse. Fill in your agency name and NYS license number if applicable.
Enter your Medicaid Provider Identification Number and National Provider Identifier (NPI) in the designated fields.
For LHCSA providers, certify that the nurses providing services are trained and experienced for medically fragile pediatric patients. Ensure that documentation is maintained for inspection.
If you are an independently enrolled nurse, provide your name, NYS license number, Medicaid Provider Identification Number, and NPI. Specify your training details and completion dates.
Sign and date the form at the bottom to complete your certification before submitting it to Computer Sciences Corporation.

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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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