When nursing care is needed for more than can be provided in an intermittent home health visit and the patient and their family prefer to receive care at home rather than a hospital, a private duty nurse may be the answer. The nurse provides the skilled care necessary for maintaining their quality of life, prepares nutritious meals, bathes the patient, and cleans their immediate surroundings to promote a healthy environment. Services include:
- Private Duty Nursing Visits
- Private Duty Aide
Eligibility Requirements
Medicaid Child Waiver private duty nursing must be pre-authorized by the Missouri Department of Health Bureau for Special Healthcare Needs Healthy Children and Youth Program. Medicaid Waiver will not purchase private duty nursing for patients while in the hospital. Private Insurance eligibility requirements vary by benefit package.
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Private Duty Nurse
RNs and LPNs provide skilled and non-skilled services for one patient over a pre-set time called a “shift”. The amount of hours provided depends on the needs of the patient, with a minimum requirement of 4 hours. Services are usually provided in a private home. Skilled Services may include administration of IVs and other medicines, treatments such as nebulizer treatments, ventilator care, and suctioning; assessment of vital signs and body systems; dressing changes and wound assessment; gastric tube feedings; etc. Non-skilled services may include bathing and dressing; food preparation and feeding; cleaning of the patient’s room and equipment; laundry; linen changes; etc.
Eligibility Requirements
Medicaid Child Waiver private duty nursing must be pre-authorized by the Missouri Department of Health Bureau for Special Healthcare Needs Healthy Children and Youth Program. Medicaid Waiver will not purchase private duty nursing for patients while in the hospital. Private Insurance eligibility requirements vary by benefit package.
Payment Methods
Private Insurance, Medicaid Child Waiver, and Private Funds are used to purchase private-duty nursing services.
Private Duty Aide
Aides provide non-skilled services for one patient over a pre-set time called a “shift”. The hours approved depend on the needs of the patient. Services are provided in the private home. Non-skilled services may include bathing and dressing; food preparation and feeding; cleaning the patient’s room and equipment; laundry; linen changes; etc.
Fees to Participate
Hourly costs are contracted according to 1) the specific needs of the individual; 2) the duration of service to be provided, and 3) the hours of the day, i.e. evening and night shift hours may warrant a premium.
Eligibility Requirements
Medicaid Child Waiver Private Duty Aide Service must be pre-authorized by the Missouri Department of Health Bureau for Special Healthcare Needs, Healthy Children and Youth (HCY) Program. Medicaid Waiver will not purchase Private Duty services for patients while in the hospital. Private Insurance eligibility requirements vary by benefit package and generally are used only in situations where doing so proves a cost savings to the insurance company by replacing more expensive hospital or nursing home care.
Payment Methods
Medicaid Child Waiver, some Private Insurance, and Private Funds are used to purchase Private Duty Aide Services.