If you are a an independent RN/LPN or work for an agency and provide PDN services to the members that have PDN benefit available, then this blog post is for you!

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As per NYS Medicaid- starting for DOS 7/1/26 and thereafter there 2 new forms that will be required in addition to other needed documentation.

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1.Rendering/Billing Provider- Member Demographic Information form :

• Form must be dated no later than 90 days before the start day of the prior approval
• Must be completed by billing provid we of the patient case/care manager
• This form must be submitted for any new cases or for 12-month documentation renewals
• This form includes the home attestation, member school information, non school day information, school day nursing info, and day program info.

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2. Trained Caregiver Form:

• Form must be dated no later than 90 days before the start day of the prior approval
• At least 1 adult trained Caregiver has to be identified for each member
• This form must be submitted for any new cases or for 12-month documentation renewals
• The new format includes: training attestation, member household info, living situation, employment info, and college status

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In addition the Trained Caregiver needs to provide the following info:

• If the caregiver is working- an employer signed employment verification with work schedule
• If a caregiver is in college- a college signed, on a college letterhead – college schedule

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For full information and to download the new forms, please visit https://www.emedny.org/ProviderManuals/NursingServices/ 

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Find this information useful? Follow my blog for more!

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