Medicaid Benefits: Private Duty Nursing Services

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2018

Location	Benefit Covered	Coverage Code	Copayment Required?	Limits on Services	Prior Approval Required	Reimbursement Methodology
United States	Yes - 25 No - 21 NR - 5	2018 data limited to CN	Yes - 3	Yes - 19	Included in "Limits on Services" for 2018	Not included in 2018 survey
Alabama	No				-	-
Alaska	Yes	CN	Depends on income	Prior authorization required	-	-
Arizona	Yes	CN	No	ALTCS Only	-	-
Arkansas	Yes	CN	NR	NR	-	-
California	No				-	-
Colorado	Yes	CN	No	Services subject to prior authorization. Clients ages 21 and older limited to 16 hours per day	-	-
Connecticut	No				-	-
Delaware	Yes	CN	No	Prior authorization required	-	-
District of Columbia	Yes	CN	No	Requires PA for service to be reimbursable	-	-
Florida	No				-	-
Georgia	Yes	CN	Yes - Not Specified	Yes - Not Specified	-	-
Hawaii	No				-	-
Idaho	No				-	-
Illinois	NR	NR	NR	NR	-	-
Indiana	Yes	CN	No	Limited to ventilator dependent beneficiaries only.	-	-
Iowa	NR	NR	NR	NR	-	-
Kansas	No				-	-
Kentucky	Yes	CN	No	2000 hours per year	-	-
Louisiana	No				-	-
Maine	Yes	CN	$.50 to $3/day depending on payment amount, up to $30/month	No	-	-
Maryland	No				-	-
Massachusetts	Yes	CN	No	No	-	-
Michigan	No				-	-
Minnesota	Yes	CN	No	No	-	-
Mississippi	No				-	-
Missouri	No				-	-
Montana	No				-	-
Nebraska	Yes	CN	No	Postpartum visits for teaching and training are limited to two sessions	-	-
Nevada	Yes	CN	No	Prior authorization required	-	-
New Hampshire	NR	NR	NR	NR	-	-
New Jersey	Yes	CN	No	Limited to MLTSS and DDD population	-	-
New Mexico	No				-	-
New York	NR	NR	NR	NR	-	-
North Carolina	Yes	CN	No	NR	-	-
North Dakota	Yes	CN	No	4 hours per day	-	-
Ohio	Yes	CN	No	More than four hours (max of 12) hours per visit; requires prior authorization	-	-
Oklahoma	No				-	-
Oregon	Yes	CN	No	NR	-	-
Pennsylvania	No				-	-
Rhode Island	Yes	CN	No	At home only	-	-
South Carolina	NR	NR	NR	NR	-	-
South Dakota	No				-	-
Tennessee	Yes	CN	No	Limited to services that support the use of ventilator equipment or other life-sustaining technology when constant nursing supervision and monitoring are required.	-	-
Texas	No				-	-
Utah	No				-	-
Vermont	Yes	CN	No	Prior authorization required	-	-
Virginia	No				-	-
Washington	Yes	CN	No	PA; requires 16 hours of skilled nursing care per day	-	-
West Virginia	Yes	CN	No	PA required for start of services & every 60 days	-	-
Wisconsin	Yes	CN	No	Prior authorization required	-	-
Wyoming	No				-	-

2012

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 23 No - 33		Yes - 1 No - 22
Alabama	No
Alaska	No
American Samoa	No
Arizona	Yes	CN & MN			Yes	Fee for service
Arkansas	Yes	CN & MN		Limited to ventilator dependent beneficiaries and those with functioning tracheostomy requiring suctioning and oxygen supplementation, $80 maximum payment for medical supplies/month	Yes	Fee for service
California	No
Colorado	Yes	CN		Limited to technology-dependent beneficiaries,16 hours/day	Yes	Fee for service
Connecticut	No
Delaware	Yes	CN		28 hours/week	Yes	Fee for service with capped payment/week
District of Columbia	Yes	CN & MN			Yes	Fee for service using Medicare limits
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	No
Illinois	No
Indiana	Yes	CN		Limited to ventilator dependent beneficiaries only	Yes	Fee for service
Iowa	No
Kansas	No
Kentucky	No
Louisiana	No
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $50/month	Beneficiaries must meet specified level of care criteria	Yes	Fee for service with annual payment ceiling based on LOC
Maryland	No
Massachusetts	Yes	CN & MN		112 hours/week	Yes	Fee for service
Michigan	No
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	No
Montana	No
Nebraska	Yes	CN & MN		Daily cost limit for skilled nursing	Initiation of care	Fee for service
Nevada	Yes	CN		Approved hours of care dependent on medical necessity	Yes	Fee for service
New Hampshire	Yes	CN & MN		8 hours/day	Yes	Fee for service
New Jersey	No
New Mexico	No
New York	Yes	CN & MN		Limited to situations where home health agency care is not available or cost effective	Yes	Fee for service
North Carolina	Yes	CN & MN		Approved hours based on care plan and medical need, not covered during same hours as home health or personal care	Yes	Fee for service
North Dakota	Yes	CN & MN				Fee for service
Northern Mariana Islands	No
Ohio	Yes	CN			Yes	Fee for service
Oklahoma	No
Oregon	Yes	A - See state-specific FN		Services limited to funded conditions on the priority list	Yes	Negotiated rates
Pennsylvania	No
Puerto Rico	No
Rhode Island	Yes	See state-specific FN		LTC clinical and financial eligibility criteria must be met		Fee for service
South Carolina	No
South Dakota	No
Tennessee	Yes	A, B & C - See state-specific FN		Limited to services that support use of ventilator equipment or other life-sustaining technology when constant nursing supervision and monitoring are required		See state-specific FN
Texas	No
Utah	Yes	A - See state-specific FN		Limited to ventilator dependent beneficiaries only		Fee for service
Vermont	Yes	A - See state-specific FN		Limited to technology-dependent beneficiaries		Fee for service
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN		Must meet specified medical need criteria	Yes	Fee for service
West Virginia	No
Wisconsin	Yes	CN & MN			Yes	2-tiered hourly rate based on level of care (RN or LPN)
Wyoming	No

2010

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 24 No - 32		Yes - 1 No - 23
Alabama	No
Alaska	No
American Samoa	No
Arizona	Yes	CN & MN			Yes	Fee for service
Arkansas	Yes	CN & MN		Limited to ventilator dependent beneficiaries and those with functioning tracheostomy requiring suctioning and oxygen supplementation, $80 maximum payment for medical supplies/month	Yes	Fee for service
California	No
Colorado	Yes	CN		Limited to technology-dependent beneficiaries,16 hours/day	Yes	Fee for service
Connecticut	No
Delaware	Yes	CN		28 hours/week	Yes	Fee for service with capped payment/week
District of Columbia	Yes	CN & MN			Yes	Fee for service using Medicare limits
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	No
Illinois	No
Indiana	Yes	CN		Limited to ventilator dependent beneficiaries only	Yes	Fee for service
Iowa	No
Kansas	No
Kentucky	No
Louisiana	No
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $50/month	Beneficiaries must meet specified level of care criteria	Yes	Fee for service with annual payment ceiling based on LOC
Maryland	No
Massachusetts	Yes	CN & MN		112 hours/week	Yes	Fee for service
Michigan	No
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	No
Montana	Yes	A - See state-specific FN			Yes	Fee for service
Nebraska	Yes	CN & MN		Daily cost limit for skilled nursing	Initiation of care	Fee for service
Nevada	Yes	CN		Approved hours of care dependent on medical necessity	Yes	Fee for service
New Hampshire	Yes	CN & MN		8 hours/day	Yes	Fee for service
New Jersey	No
New Mexico	No
New York	Yes	CN & MN		Limited to situations where home health agency care is not available or cost effective	Yes	Fee for service
North Carolina	Yes	CN & MN		Approved hours based on care plan and medical need, not covered during same hours as home health or personal care	Yes	Fee for service
North Dakota	Yes	CN & MN				Fee for service
Northern Mariana Islands	No
Ohio	Yes	CN			Yes	Fee for service
Oklahoma	No
Oregon	Yes	A - See state-specific FN		Services limited to funded conditions on the priority list	Yes	Negotiated rates
Pennsylvania	No
Puerto Rico	No
Rhode Island	Yes	See state-specific FN		LTC clinical and financial eligibility criteria must be met		Fee for service
South Carolina	No
South Dakota	No
Tennessee	Yes	A & B - See state-specific FN		Limited to services that support use of ventilator equipment or other life-sustaining technology when constant nursing supervision and monitoring are required		See state-specific FN
Texas	No
Utah	Yes	A - See state-specific FN		Limited to ventilator dependent beneficiaries only		Fee for service
Vermont	Yes	A - See state-specific FN		Limited to technology-dependent beneficiaries		Fee for service
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN		Must meet specified medical need criteria	Yes	Fee for service
West Virginia	No
Wisconsin	Yes	CN & MN			Yes	2-tiered hourly rate based on level of care (RN or LPN)
Wyoming	No

2008

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 24 No - 32		Yes - 1 No - 23
Alabama	No
Alaska	No
American Samoa	Yes	See territory-specific FN		Limited to post-hospital care only
Arizona	Yes	CN & MN			Yes	Fee for service
Arkansas	Yes	CN & MN		Limited to ventilator dependent beneficiaries and those with functioning tracheostomy requiring suctioning and oxygen supplementation, $80 maximum payment for medical supplies/month	Yes	Fee for service
California	No
Colorado	Yes	CN		Limited to technology-dependent beneficiaries,16 hours/day	Yes	Fee for service
Connecticut	No
Delaware	Yes	CN		28 hours/week	Yes	Fee for service with capped payment/week
District of Columbia	Yes	CN & MN			Yes	Fee for service using Medicare limits
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	No
Illinois	No
Indiana	Yes	CN		Limited to ventilator dependent beneficiaries only	Yes	Fee for service
Iowa	No
Kansas	No
Kentucky	No
Louisiana	No
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $50/month	Beneficiaries must meet specified level of care criteria	Yes	Fee for service with annual payment ceiling based on LOC
Maryland	No
Massachusetts	Yes	CN & MN		112 hours/week	Yes	Fee for service
Michigan	No
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	No
Montana	Yes	A - See state-specific FN			Yes	Fee for service
Nebraska	Yes	CN & MN				Fee for service
Nevada	Yes	CN		Approved hours of care dependent on medical necessity	Yes	Fee for service
New Hampshire	Yes	CN & MN		8 hours/day	Yes	Fee for service
New Jersey	No
New Mexico	No
New York	Yes	CN & MN		Limited to situations where home health agency care is not available or not cost effective	Yes	Fee for service
North Carolina	Yes	CN & MN		Approved hours based on care plan and medical need, not covered during same hours as home health or personal care	Yes	Fee for service
North Dakota	Yes	CN & MN				Fee for service
Northern Mariana Islands	No
Ohio	Yes	CN			Yes	Fee for service
Oklahoma	No
Oregon	Yes	A - See state-specific FN			Yes	Fee for service
Pennsylvania	No
Puerto Rico	No
Rhode Island	No
South Carolina	No
South Dakota	No
Tennessee	Yes	A & B - See state-specific FN		Limited to services that support use of ventilator equipment or other life-sustaining technology when constant nursing supervision and monitoring are required
Texas	No
Utah	Yes	A - See state-specific FN		Limited to ventilator dependent beneficiaries only		Fee for service
Vermont	Yes	A - See state-specific FN		Limited to technology-dependent beneficiaries		Fee for service
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN		Must meet specified medical need criteria	Yes	Fee for service
West Virginia	No
Wisconsin	Yes	CN & MN			Yes	2-tiered hourly rate based on level of care (RN or LPN)
Wyoming	No

2006

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 24 No - 32		Yes - 1 No - 23
Alabama	No
Alaska	No
American Samoa	Yes	See territory-specific FN		Limited to post-hospital care only
Arizona	Yes	CN & MN			Yes	Fee for service
Arkansas	Yes	CN & MN		Limited to ventilator dependent beneficiaries and those with functioning tracheostomy requiring suctioning and oxygen supplementation, $80 maximum payment for medical supplies/month	Yes	Fee for service
California	No
Colorado	Yes	CN		Limited to technology-dependent beneficiaries,16 hours/day	Yes	Fee for service
Connecticut	No
Delaware	Yes	CN		28 hours/week	Yes	Fee for service with capped payment/week
District of Columbia	Yes	CN & MN			Yes	Fee for service using Medicare limits
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	No
Illinois	No
Indiana	Yes	CN		Limited to ventilator dependent beneficiaries only	Yes	Fee for service
Iowa	No
Kansas	No
Kentucky	No
Louisiana	No
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $50/month	Beneficiaries must meet specified level of care criteria	Yes	Fee for service with annual payment ceiling based on LOC
Maryland	No
Massachusetts	Yes	CN & MN		112 hours/week	Yes	Fee for service
Michigan	No
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	No
Montana	Yes	A - See state-specific FN			Yes	Fee for service
Nebraska	Yes	CN & MN				Fee for service
Nevada	Yes	CN		Approved hours of care dependent on medical necessity	Yes	Fee for service
New Hampshire	Yes	CN & MN			Yes	Fee for service
New Jersey	No
New Mexico	No
New York	Yes	CN & MN		Limited to situations where home health agency care is not available or not cost effective	Yes	Fee for service
North Carolina	Yes	CN & MN		Not covered during same hours as home health or personal care	Yes	Fee for service
North Dakota	Yes	CN & MN				Fee for service
Northern Mariana Islands	No
Ohio	Yes	CN			Yes	Fee for service
Oklahoma	No
Oregon	Yes	A - See state-specific FN			Yes	Fee for service
Pennsylvania	No
Puerto Rico	No
Rhode Island	No
South Carolina	No
South Dakota	No
Tennessee	Yes	A & B - See state-specific FN
Texas	No
Utah	Yes	A - See state-specific FN		Limited to ventilator dependent beneficiaries only		Fee for service
Vermont	Yes	A - See state-specific FN		Limited to technology-dependent beneficiaries		Fee for service
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN		Must meet specified medical need criteria		Fee for service
West Virginia	No
Wisconsin	Yes	CN & MN			Yes	2-tiered hourly rate based on level of care (RN or LPN)
Wyoming	No

2004

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 24 No - 32		Yes - 1 No - 23
Alabama	No
Alaska	No
American Samoa	Yes	See territory-specific FN		Limited to post-hospital care only
Arizona	Yes	CN & MN			Yes	Fee for service
Arkansas	Yes	CN & MN		Limited to ventilator dependent beneficiaries and those with functioning tracheostomy requiring suctioning and oxygen supplementation, $80 maximum payment for medical supplies/month	Yes	Fee for service
California	No
Colorado	Yes	CN		Limited to technology-dependent beneficiaries,16 hours/day	Yes	Fee for service
Connecticut	No
Delaware	Yes	CN			Yes	Fee for service with capped payment/week
District of Columbia	Yes	CN & MN			Yes	Fee for service using Medicare limits
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	No
Illinois	No
Indiana	Yes	CN		Limited to ventilator dependent beneficiaries only	Yes	Fee for service
Iowa	No
Kansas	No
Kentucky	No
Louisiana	No
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $50/month	Beneficiaries must meet specified level of care criteria	Yes	Fee for service with annual payment ceiling based on LOC
Maryland	No
Massachusetts	Yes	CN & MN		112 hours/week	Yes	Fee for service
Michigan	No
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	No
Montana	Yes	A - See state-specific FN			Yes	Fee for service
Nebraska	Yes	CN & MN				Fee for service
Nevada	Yes	CN		Approved hours of care dependent upon need	Yes	Fee for service
New Hampshire	Yes	CN & MN			Yes	Fee for service
New Jersey	No
New Mexico	No
New York	Yes	CN & MN		Limited to situations where home health agency care is not available or not cost effective	Yes	Fee for service
North Carolina	Yes	CN & MN		Not covered during same hours as home health or personal care	Yes	Fee for service
North Dakota	Yes	CN & MN				Fee for service
Northern Mariana Islands	No
Ohio	Yes	CN			Yes	Fee for service
Oklahoma	No
Oregon	Yes	A - See state-specific FN			Yes	Fee for service
Pennsylvania	No
Puerto Rico	No
Rhode Island	No
South Carolina	No
South Dakota	No
Tennessee	Yes	A & B - See state-specific FN
Texas	No
Utah	Yes	A - See state-specific FN		Limited to ventilator dependent beneficiaries only		Fee for service
Vermont	Yes	A - See state-specific FN		Limited to technology-dependent beneficiaries		Fee for service
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN		Must meet specified medical need criteria		Fee for service
West Virginia	No
Wisconsin	Yes	CN & MN			Yes	2-tiered hourly rate based on level of care (RN or LPN)
Wyoming	No

2003

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 24 No - 32		Yes - 1 No - 23
Alabama	No
Alaska	No
American Samoa	Yes	See territory-specific FN		Limited to post-hospital care only
Arizona	Yes	CN & MN			Yes	Fee for service
Arkansas	Yes	CN & MN		Limited to ventilator dependent beneficiaries and those with functioning tracheostomy requiring suctioning and oxygen supplementation, $80 maximum payment for medical supplies/month	Yes	Fee for service
California	No
Colorado	Yes	CN		Limited to technology-dependent beneficiaries, 20 hours/day	Yes	Fee for service
Connecticut	No
Delaware	Yes	CN			Yes	Fee for service with capped payment/week
District of Columbia	Yes	CN & MN			Yes	Fee for service using Medicare limits
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	No
Illinois	No
Indiana	Yes	CN		Limited to ventilator dependent beneficiaries only	Yes	Fee for service
Iowa	No
Kansas	No
Kentucky	No
Louisiana	No
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $50/month	Beneficiaries must meet specified level of care criteria	Yes	Fee for service with annual payment ceiling based on LOC
Maryland	No
Massachusetts	Yes	CN & MN		112 hours/week	Yes	Fee for service
Michigan	No
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	No
Montana	Yes	CN & MN			Yes	Fee for service
Nebraska	Yes	CN & MN				Fee for service
Nevada	No
New Hampshire	Yes	CN & MN			Yes	Fee for service
New Jersey	No
New Mexico	No
New York	Yes	CN & MN		Limited to situations where home health agency care is not available or not cost effective	Yes	Fee for service
North Carolina	Yes	CN & MN		Not covered during same hours as home health or personal care	Yes	Fee for service
North Dakota	Yes	CN & MN				Fee for service
Northern Mariana Islands	No
Ohio	Yes	CN			Yes	Fee for service
Oklahoma	No
Oregon	Yes	CN & MN			Yes	Fee for service
Pennsylvania	No
Puerto Rico	No
Rhode Island	No
South Carolina	No
South Dakota	No
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN			Yes	Fee for service
Utah	Yes	A - See state specific FN		Limited to ventilator dependent beneficiaries only		Fee for service
Vermont	Yes	A - See state-specific FN		Limited to technology-dependent beneficiaries		Fee for service
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN				Fee for service
West Virginia	No
Wisconsin	Yes	CN & MN			Yes	2-tiered hourly rate based on level of care (RN or LPN)
Wyoming	No

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Medicaid Benefits: Private Duty Nursing Services

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