The Agency for Health Care Administration (AHCA) has introduced a new pathway to Medicaid enrollment for home health agencies exclusively offering Private Duty Nursing (PDN) services to participants under 21, aligning with directives from the Florida Legislature.

Effective immediately, home health agencies seeking to solely provide PDN services can enroll as a Provider Type 65 (Home Health Services) with Specialty Type 221 (Private Duty Nursing). Home health agencies opting for Specialty Type 221 enrollment are exempt from meeting Medicare certification requirements or their accreditation equivalents.

During the 2023 Florida Legislative Session, HCAF effectively advocated for the passage of SB 2510. This bill aimed to revise the Medicaid provider enrollment policy, sparing PDN providers from unnecessary requirements, and reducing costs and bureaucracy.

To enroll as a Provider Type 65 with Specialty Type 221, home health agencies must:

1. Possess an active home health agency license permitting the provision of skilled care services, including nursing care at minimum, issued by AHCA, or
2. Obtain a new license as a home health agency to deliver skilled care services. Per Florida Statutes, 400.471(2)(g), the provider must undergo the initial licensure survey from an approved accrediting organization as defined in 59-A8.002(1) F.A.C.

Providers enrolling as Specialty Type 221 must also fulfill the requirements outlined for all provider types in Rule 59G-1.060, Provider Enrollment Policy, section 9.2, Appendix B: General Document Requirements, and any other applicable Medicaid enrollment criteria.

Home health agencies enrolled as Specialty Type 221 can bill solely for authorized services listed on the PDN fee schedule. They are ineligible to bill from either the Home Health Visit Services or Personal Care Services fee schedules. To bill for these services, the provider must enroll with Florida Medicaid following Rule 59G-1.060, Provider Enrollment Policy.

Home health agencies enrolled as Specialty Type 221 remain subject to unannounced surveys conducted by AHCA to assess compliance with relevant state regulations for home health agencies, regardless of accreditation status.

For assistance or inquiries regarding the Medicaid Provider Enrollment Application, enrollment forms, supporting documentation, or claims processing, please contact the Medicaid Provider Enrollment Call Center at (800) 289-7799 (option 4).