MedicaidAdministrativeMedium impact
Process Change for NC Medicaid Direct Private Duty Nursing Authorizations
NC Medicaid - NCDHHS·NC·Managed Care
Effective date
Sep 1, 2026
We identified it
Sep 9, 2026
Summary
NC Medicaid Direct is streamlining Private Duty Nursing (PDN) hour redistribution among service provider agencies. Previously approved shared PDN hours can now be redistributed without requiring a new provider-signed CMS-485 form or order—only the current signed CMS-485, Shared Case Form (DHB-3512), and a PA submission are needed. Total approved hours and authorization end dates remain unchanged.
Action Required
By August 31, 2026: Billing and authorization teams must update internal workflows and staff training to reflect the new PDN redistribution process. Specifically: (1) Instruct billing staff that PDN hour redistributions no longer require a new provider-signed CMS-485 or order; (2) Update authorization submission requirements to accept redistributions with only the current signed CMS-485, Shared Case Form (DHB-3512) signed by all affected agencies and the beneficiary/guardian, and the PA; (3) Note that the Shared Case Form does not require PDN ordering provider signature for redistributions only; (4) Clarify that PAs may be submitted prior to or up to 5 days after the redistribution effective date; (5) Update templates and checklists to reflect the new documentation requirements. Communicate these changes to all providers and nursing agencies in your network. Failure to follow the new process may result in authorization delays or denials.