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Private Duty Nursing (PDN) & Family Home Health Aide (FHHA) Services Policy for Medically Fragile Children

Date: 02/07/25

Sunshine Health wants to make Private Duty Nursing (PDN) and Family Home Health Aides (FHHA) providers aware of published policy changes made by the Agency for Health Care Administration (AHCA).

  • Policy Purpose: Intended for use by providers that render PDN and FHHA services to eligible Florida Medicaid recipients.

Who can receive these services?

  • Florida Medicaid recipients under 21 years of age requiring medically necessary PDN and/or FHHA services.

Private Duty Nursing Services

  • Licensed practical nurses (LPN) and registered nurses (RN)

PDN Services

  • Up to 24 hours of PDN services per day, per recipient
  • PDN services should be provided by a Related Provider, Legal Guardian or Caretaker Relative Florida Medicaid may cover an enrolled home health agency provider for up to 40 hours per week, for PDN services, per related provider, legal guardian, or caretaker relative who has a valid RN or LPN license in the state of Florida and who is employed by the home health agency.

Home Health Prescription Orders

  • The health plan will accept both Advanced Practice Nurses (APRN) and Physician Assistance (PA) ordering and writing of prescriptions and signatures. For more information, please visit the HB 935 Home Health Care Services Bill.

Family Home Health Aide Services

Family Home Health Aides who meet and maintain requirements to provide services and who are employed by home health agencies.

How Services Should be Provided

  • Up to 8 hours of Family Home Health Aide services per day, per recipient under the age of 21 years receiving PDN services, when the recipient is under the care of a physician and has an order for PDN and Training (80 hours)
    • Skills Training (30 hours)
    • Clinical Competency Training and Validation (16 hours)

Frequently Asked Questions (FAQ)

  • What is the Home Health Aide for Medically Fragile Children Program and where can I find more information on this service?
    • The Home Health Aide for Medically Fragile Children Program was established in House Bill 391 (PDF), which was passed in 2023 by the Florida Legislature and codified in Section 400.4765, Florida Statutes (F.S.).
    • The Agency for Health Care Administration’s (Agency) Division of Medicaid updated Rule 59G-4.261, Florida Administrative Code (F.A.C.), the Private Duty Nursing (PDN) Services Coverage Policy to include a new rule title and a new service called “Family Home Health Aide Services” adding this Medicaid covered service.
  • How does a family participate?
    • First, an eligible family member must contact a participating home health agency to take the required training course. This is an 86-hour course that has specific requirements identified in the regulations.
    • The family member must complete the required training and be employed by a home health agency for Florida Medicaid to reimburse for Family Home Health Aide services. The terms of this employment is negotiated between the family member and the home health agency.
  • Who is in charge of choosing and conducting the required training?
    • Section 400.4765, F.S. and Rule 59A-8.0099, F.A.C. provide the specific training program requirements for home health aides for medically fragile children. The training program was developed by the Agency, in consultation with the Board of Nursing. The home health agency oversees developing and providing the training for their home health agency based on the rule.
  • Why are families required to take training courses that do not apply to their medically fragile child(ren)? For example, why are families required to be trained on tracheostomy and ventilator practices when this may not pertain to their medically fragile child?
    • Section 400.4765, F.S., requires the training to be a standardized program and addresses the most common conditions and tasks associated with a medically fragile child.
  • Will the training for Home Health Aide for Medically Fragile Children Program be transferable between each Florida home health agency? Will the parent/caregiver be required to take additional training if employed by a different home health agency?
    • The home health agency would determine if they accept the training documentation from another agency or require additional training and validation prior to employment.
  • Do the contracts need to be updated?
    • Not currently. The health plan is following the Medicaid Fee Schedule for service codes and reimbursement.

For important income information for participating families, read AHCA’s Home Health Aide for Medically Fragile Children Program FAQ (PDF).

Specific Criteria or Exclusions

  • Family Home Health Aide services are intended to be provided in conjunction with, but may not duplicate, authorized PDN hours. Services must be overseen by a nonrelated provider, non-legal guardian, or non-caretaker relative RN who is employed by a home health agency and authorized to provide PDN services in accordance with this policy.
  • Do not duplicate another service.
  • Private Duty Nursing services & Family Home Health Aide services shall not be provided by the same related provider, legal guardian, or caretaker relative.
  • Private duty nursing services & family home health aide services shall not be provided concurrently.

Authorization Process

Providers must obtain authorization from Sunshine Health.

  • Providers can expect services authorized on a month-by-month basis up to 180 days.
    • Note: Case Management will not authorize these services. Providers must submit an authorization request for a member to obtain PDN services.

Documentation for Authorization Request

Providers must maintain the following in the recipient’s file:

  1. Assessments
  2. Written orders for both PDN and FHHA from the prescriber
  3. A plan of care (POC)

Electronic Visit Verification (EVV)

  • Family Home Health Aides should utilize the HHAeXchange and/or third-party EVV platform when providing members with care.
  • Providers must ensure authorization is obtained from Sunshine Health first, prior to verifying that the HHHAeXchange Client Portal reflects the authorized services.

To view recent Provider EVV Town Hall recordings where this topic is discussed, please visit Provider Training and scroll down to the Provider Town Hall section.

Initial and Subsequent Recertification Assessments

  • The initial assessment and all subsequent POC recertification assessments for PDN and FHHA services, must be completed by an RN who is employed by the home health agency provider and who is not a related provider, legal guardian, caretaker relative, or member of the recipient’s household.

When PDN and FHHA services are authorized, providers must ensure the following

  1. Cumulative hours for PDN and FHHA services do not exceed 24 hours a day.
  2. PDN and FHHA services do not occur concurrently.

Home Health Agency’s Responsibility

Home Health Agencies are responsible for completing the following activities which are part of Family Home Health Aide services.

  • Confirming family caregiver eligibility.
    • Identified Home Health Agency completes attestation with Department of Children and Families (DCF) and obtains case number.
  • Ensure family caregivers complete the approved training program with appropriate documentation maintained.
    • Home Health Agencies, through confirmation of family caregiver eligibility, must obtain documentation reflecting guardianship and/or parental relationship to the member.
  • Services rendered by the FHHA are appropriately supervised.
  • Obtaining proper documentation from ordering physicians, including the plan of care (POC).

Medicaid Service Policy and Fee Schedules

Service Code Bundling

  • Service Code Bundle: S9123
    • Allowed Service Codes: S9123, S9123TT, S9123TTUF, S9123UF, S9124, S9124TT, S9124TTUF, S9124UF, S9122SK, S9122SKTT, S9122SKUF, S9122SKTTUF

Note: Utilization Management will be bundling and authorizing the requested allowed service codes under S9123. Even though the allowed service codes will be bundled within the authorization, providers should bill the claim with the actual procedure performed.

To review the full policy, please visit

To view all service-specific policies, visit Adopted Rules – Services Specific Policies.

Questions?

Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:

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