Written by a parent, not a doctor. Nothing here is medical advice.

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North Dakota program

Nursing care at home

Skilled nursing care at home paid by North Dakota Medicaid when your child medically needs it.

What it is

Skilled nursing care at home paid by North Dakota Medicaid when your child medically needs it.

Going home can require more than a parent can safely provide alone. The care team documents the nursing tasks and hours your child needs. Acentra reviews the request for North Dakota Medicaid.

Eligibility rules
  • Medicaid enrollment, a signed care plan and medical evidence of skilled nursing needs are required.
  • The nursing agency submits SFN 224 and SFN 197 through Acentra’s Atrezzo portal.
What you get
  • Medicaid may cover approved nursing or home-health care. Any monthly client share still needs checking.
  • Private duty nursing and home health when the care meets Medicaid rules.
What the help includes
  • For children under 21, EPSDT requires medically necessary treatment within federal Medicaid benefit categories. It does not promise every requested service.
  • Private Duty Nursing approvals last up to 60 days. Ordinary Home Health has a 50-visits-per-calendar-year threshold without prior authorization. Additional medically necessary visits need review rather than automatic refusal, including under EPSDT for children under 21. Approval does not guarantee staffing.
If you decide to apply
  1. Ask the discharge planner which nursing agency will request the hours and whether the request is urgent.
  2. Have the discharge plan, equipment and medicine list ready for the agency and care team.

Discharge planner or nursing agency; Acentra review line, 844-396-9569 · Official page ↗

After you ask
  • The authorization identifies hours and dates. The clinician can seek reconsideration within 30 days with additional medical evidence, but the family’s fair-hearing deadline is separate and does not stop while that request is reviewed. The denial or reduction notice needs checking for urgent review, continued services and possible repayment.
  • The Medicaid notice and EPSDT details explain the separate family hearing route.
Good to know

Private Duty Nursing approvals last up to 60 days. Home-health visits have different rules. Approval does not guarantee available nurses.

Other details
  • The agency submits the request, rather than the family. A decision about medical necessity is separate from finding staff to cover the hours.
Official sources
Ask your social worker

“Does our child need skilled nursing at home, and what would that help cover? Could you help arrange the assessment and request if it would make home safer?”

Why I’m asking: I want to understand which care needs a nurse and what help we could actually receive.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask who is filing and when, and keep the denial letter if one comes.

Your social worker

The nursing agency files SFN 224 and SFN 197 with the plan of care and the records.

The care team

The team signs the plan of care and writes why the hours are needed.

Who decides
Acentra, on behalf of North Dakota Medicaid.
Ask your social worker
“Which nursing agency is filing for hours at home, has it gone in as urgent, and what date did it go?”

How to apply

First step: Ask the discharge planner this week which nursing agency is filing, and ask for the request to go in as urgent.

  1. Ask the discharge planner which nursing agency is filing and on what day.
  2. Ask for the request to be marked urgent if discharge depends on it.
  3. If it is denied, ask the provider to send more medical evidence within 30 days.

Official application / program page ↗

Where it starts: A nursing agency files; ask the discharge planner which one and whether it is marked urgent.

What to gather

  • The discharge plan
  • The list of equipment and medicines going home with you

How long: Seven calendar days for a standard request, 72 hours for an urgent one.

What a yes looks like

An approval naming the hours a week and the dates, up to 60 days.

What a no looks like, and the next move

A denial notice explains the family’s hearing route, generally 30 calendar days from mailing for fee-for-service services. Provider reconsideration has a separate 30-day period and does not stop the hearing clock. Keeping existing services requires action before the effective change date and may create repayment exposure.

Watch out

  • The nursing agency files, not you. Find out which one and when.
  • An approval lasts 60 days, so someone has to file again before it runs out.
  • A no can be reconsidered within 30 days if the provider sends more evidence.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Skilled nursing hours at home, decided within seven calendar days, or 72 hours when the request is urgent.

  • $7 — Standard authorisation decision time
  • $72 — Urgent authorisation decision time
  • $60 — Length of one approval

Covers: Private duty nursing hours at home · Home health · Medically necessary care for a child under 21 within federal Medicaid benefit categories, even if the state does not cover that service for adults

Legal protection: A provider can request reconsideration within 30 days with more medical evidence. This does not replace or extend the family’s separate hearing deadline.

What it costs the family: A Medicaid-assigned client share can still apply. The eligibility notice and covered service determine family liability.

The eligibility facts, as published

Age
under 21 for the EPSDT treatment duty
Coverage
North Dakota Medicaid
Medical
a signed plan of care and medical records supporting skilled nursing
Forms
SFN 224 and SFN 197, filed by the nursing agency

The trap: The agency asks, not you. Ask the discharge planner which nursing agency is filing, and ask them to mark it urgent if discharge is waiting on it: urgent is 72 hours, standard is seven days.

Where I read this

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