MedicaidCoverageHigh impact
MMP 25-45: Updates to the Private Duty Nursing Benefit for Early and Periodic Screening, Diagnosis and Treatment
Michigan Medicaid - MDHHS·MI · Pediatrics·Specialty Services
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
Michigan Medicaid removes the 16-hour daily limit for Private Duty Nursing services for children under 21, allowing unlimited medically necessary PDN hours with proper prior authorization and documentation. The policy also eliminates requirements for primary caregivers to provide 8 hours of daily care.
Action Required
Before November 1, 2025: Billing team must update prior authorization processes for Private Duty Nursing services for Michigan Medicaid beneficiaries under 21. Update systems to remove 16-hour daily limits and ensure form MSA-0732 is used for all PA requests. Train staff on new documentation requirements that distinguish skilled nursing care from unskilled support and document caregiver availability. Coordinate with providers to ensure proper medical justification for requested hours is documented.