Be in the Know:
Private Duty Nursing (PDN) and Prescribed Pediatric Extended Care Centers (PPECCs)
Our vision is for optimal health and quality of life for all children and youth with special health-care needs and their families.U.S. Department of Health and Human Services, 2020
- Nationwide, nearly 19 percent of children 17 years and younger (13.8 million) have a special health-care need
- In Texas, 17.4 percent of children 17 years and younger (1.2 million) have a special health-care need
- Nationwide, an estimated 3.2 percent of youth with special health-care needs — or one in every 31— have complex medical conditions
Sources: National Survey of Children’s Health, 2018-2019 & Pediatrics (2018)
Children and adolescents with complex medical conditions such as congenital heart diseases, genetic conditions, cystic fibrosis, cancer and other conditions may require constant nursing care. They also may need medical equipment such as wheelchairs, oxygen concentrators, gastrostomy tubes and medication ports.
“These children and their families often navigate multiple health care providers and are consistently at high-risk for emergency department visits and hospitalizations” (Children's Hospital of Philadelphia, PolicyLab, 2019).
Children and adolescents with complex medical conditions who live at home may require Medicaid-covered home health skilled nursing or home health aide visits to assist with personal care and medical needs.
In Texas, two additional key Medicaid services also are available to youth with complex medical conditions who live in the community:
- Private duty nursing (PDN)
- Prescribed Pediatric Extended Care Centers (PPECCs)
PDN and PPECC are Texas Health Steps benefits for children and adolescents ages birth through 20 years who meet medical necessity criteria and require individualized, continuous, skilled health care beyond the level of a home health skilled nursing or home health aide visit.
Both of these services could be provided to a youth on the same day. However, individuals cannot receive PDN services during the hours they are in a PPECC, which is a licensed, non-residential care center. For example, a child may receive PDN services in the mornings at home before going to the PPECC and again in the evening or at night after coming home from the PPECC.
Review the following case study for an example of how PDN and PPECC services may be appropriate for a young patient with complex medical needs.
Why It Matters
As a Texas Health Steps provider, you play a vital role in assisting children and adolescents who have medically complex conditions with accessing ongoing therapeutic and nursing care. Youth with complex needs have a choice of PDN, a PPECC, or a combination of both PDN and a PPECC for ongoing skilled nursing. PDN and PPECCs are designed to help youth with complex medical needs live as independently as possible in the community. Your knowledge of these programs and ability to assist families can make a difference in a child or adolescent’s quality of life.
Allshouse, C., Comeau, M., Rodgers, R., & Wells, N. (2018). Families of Children With Medical Complexity: A View From the Front Lines. Pediatrics, 141(Supplement 3), S195-S201.
Children’s Hospital of Philadelphia, PolicyLab. (2019). Meeting the Needs of Children with Complex Medical Needs in a Changing Health Care System.
Texas Department of State Health Services. (2019). Children and Youth with Special Health Care Needs 2018 Outreach Survey Report.
Texas Health and Human Services Commission. (2021). Prescribed Pediatric Extended Care Centers (PPECCs).
Texas Medicaid & Healthcare Partnership. (2021). Texas Medicaid Provider Procedures Manual.
Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, 2.14. Prescribed Pediatric Extended Care Centers.
Texas Medicaid Provider Procedures Manual, Home Health Nursing and Private Duty Nursing Services Handbook.
U.S. Department of Health and Human Services, Health Resources & Services Administration. (2020). Children and Youth with Special Health Care Needs.