Skilled Home Private Duty Nursing Care

Private duty home nursing (for plans that include PDN benefits) is medically necessary only when ordered by the treating physician and the member is homebound with skilled needs that exceed intermittent care, placement is solely to meet those skilled needs (not for family convenience), at least one caregiver is willing/able to assume care when the nurse is absent, and continuous home nursing for ventilator patients is allowed up to 3 weeks post-discharge (longer only if the patient is unstable and requires frequent ventilator adjustments). Services safely performed by nonclinical persons, nursing placed for caregiver convenience (including to allow work/school), caregiver refusal/unwillingness, and transportation to day care are excluded.

"Subject to applicable benefit plan terms and limitations, Aetna considers home nursing care medically necessary when recommended by the member's primary care and/or treating physician and all of th..."