Home‑care providers urge review of new private‑duty nursing policy; warn service cuts risk institutionalization

Providers of private‑duty nursing told the Senate Appropriations — Human Resources Division that a new Medicaid assessment tool and policy implemented this year is reducing authorized hours for medically fragile children and adults, and they asked the committee to require an independent review to confirm compliance with federal rules.

Beverly Unrath, owner of Dakota Home Care, said the state’s new private duty nursing policy and assessment tools led to reductions in approved hours that she said do not reflect medical necessity. Unrath requested that HB 10-12 be amended to (1) require the Department of Health and Human Services to submit the revised policy for independent review against CMS guidance, EPSDT (Early and Periodic Screening, Diagnostic and Treatment), and the Olmstead directive on providing services in the least restrictive setting; (2) require stakeholder engagement in the revision process; and (3) require a report back to the Legislature.

Nurse case manager Amber Cook provided a redacted clinical letter from a pediatric intensivist describing a child with complex medical needs (ventilator and tracheostomy dependent, multiple ICU admissions) and argued that large hour cuts would likely increase hospitalizations, raise costs and undermine safety. Unrath said some families have seen reductions of 25–60% in approved hours under the new tool and that reductions are pressuring families to quit work, forgo sleep or consider institutional care.

Committee members expressed interest in gathering additional information from Medicaid and said staff would follow up. Unrath and providers stressed that the request was not for a general appropriation but for policy review and stakeholder engagement to ensure compliance with federal standards and to avoid unintended institutionalization and higher system costs.