Updated Private Duty Nursing Regulations and Forms

By June 5, 2026: Billing team must implement the following mandatory changes: (1) Obtain and begin using the revised DMAS-62 Medical Necessity Assessment and Private Duty Nursing Service Authorization Form for ALL private duty nursing service requests submitted on or after June 5, 2026. (2) Update internal workflows to route PDN authorization requests through the correct channel based on member enrollment: Atrezzo portal (https://atrezzo.acentra.com) for non-waiver FFS members, Waiver Management System (WaMS) for 1915(c) Developmental Disability waiver-enrolled members, or directly to the member's assigned MCO for Cardinal Care managed care members. (3) Ensure all submitted requests include completed DMAS-62 form plus supporting clinical documentation using the new Medical Needs Assessment algorithm. (4) Verify provider enrollment status in PRSS (Provider Services Solution) for all service locations before June 5, 2026, as claims will be denied to providers not currently enrolled. (5) Attend one of the June 12 or June 18, 2026 webinars to review DMAS-62 updates. (6) Consult the transition guidance FAQ at https://vamedicaid.dmas.virginia.gov/sites/default/files/2026-06/2026_05_DMAS62_FAQ.pdf for additional implementation details. CONSEQUENCES: Claims submitted with old forms or to incorrect submission channels will be denied; claims from unenrolled providers will not be paid under federal rules.