Covered and Noncovered Services : Covered Services and Requirements

Hours of Care That Qualify as Private Duty Nursing Services

Wisconsin Medicaid requires that the POC include the actual amount of time to be spent on medically necessary direct cares requiring the skills of a licensed nurse as stated in Wis. Admin. Code § DHS 107.12(1)(f).

A member qualifies for PDN if they require eight or more hours of direct skilled nursing services daily. Add up the total hours of direct skilled nursing care provided by all caregivers, including home health agencies, nurses, and skilled cares provided by family or friends. If the total time required daily for these cares is equivalent to eight hours or more, the member is eligible for PDN.

For this purpose, covered skilled nursing tasks may include:

• Application of dressings involving prescription medications and aseptic techniques.
• Gastrostomy feedings (include the time needed to begin, disconnect, and flush—not the entire time the feeding is dispensing).
• Injections.
• Insertion and sterile irrigation of catheters.
• Nasopharyngeal and tracheostomy suctioning.
• Treatment of extensive decubitus ulcers or other widespread skin disorders.