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December 2016 Texas Medicaid Provider Procedures Manual

Home Health Nursing and Private Duty Nursing Services Handbook : 4 Private Duty Nursing (PDN) Services - CCP : 4.1 * Services, Benefits, Limitations, and Prior Authorization : 4.1.4 Authorization Requirements : 4.1.4.8 * Client Receives both PDN and PPECC and Shifts Services from One to the Other

4.1.4.8
A client receiving both PDN and PPECC services may choose to shift approved hours from one ongoing skilled nursing provider to another.
The receiving provider (PDN or PPECC provider who will gain hours in the shift) must submit all required documentation for a revision.
The sending provider (PDN or PPECC provider who will lose hours in the shift) will receive a notice from HHSC’s Claims Administrator with revised (decreased) hours and the effective date of the reduction. The sending provider does not need to take any action unless there is a change in the client’s medical needs, and additional ongoing skilled nursing hours are medically necessary. If there is a medical need for additional ongoing skilled nursing hours, the sending provider may submit a revision request.
The total combined hours between PDN and PPECC services are not expected to increase without client medical necessity for additional hours (e.g., change in client condition or authorized hours are not commensurate with the client’s medical needs).

Texas Medicaid & Healthcare Partnership
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