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Form Update for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) - Private Duty Nursing (DMAS-62)
Dept. of Medical Assistance Services (DMAS) has announced updated regulation for Private Duty Nursing for EPSDT participants. As children and youth, under 21 years of age, receiving Private Duty Nursing (PDN) via the Community Living (CL) & Family and Individual Supports (FIS) waivers must comply with EPSDT requirements, effective March 26, 2026 all EPSDT - Private Duty Nursing service authorization requests should include the updated 2025 version of the DMAS-62 (link below) per the Virginia Register of Regulations (Feb. 9, 2026).
DMAS-62 Form
The updated regulations include the following requirements regarding the DMAS-62 related to service authorization.
12VAC30-50-132 Private duty nursing services under early and periodic screening, diagnostic, and treatment
E. Service limits.
Private duty nursing services are limited to the hours of skilled nursing care and medically-necessary supervision as specified in the Plan of Care signed by the child's physician (per §§ 54.1-2957 and 54.1-2957.02 of the Code of Virginia, signature by a nurse practitioner is acceptable in certain circumstances) and limited to the number of hours approved by DMAS or the DMAS contractor through the DMAS service authorization form (DMAS-62). Authorization of the number of medically necessary hours is based on assessing an individual's medical and support needs related to respiratory function, cardiovascular access and medications, wound care, feeding, central nervous system function, assessments that require the skills of a medical professional, toileting, and any other additional medical or support needs that require the skills of a licensed clinician. These medical and support needs are encompassed in the DMAS-62, and the number of hours approved will be based on medical needs final score, as detailed in the DMAS-62. Individuals younger than 21 years of age qualifying under EPSDT shall receive the services described in excess of any State Plan limit, up to 24 hours per day, if services are determined to be medically necessary to correct, ameliorate, or maintain the member's health condition and are prior authorized by the DMAS or the DMAS contractor (DBHDS).
If you have any questions on submissions of the DMAS-62 for a DD Waiver service authorization request, please contact Sam Pinero, Waiver Operations Manager, or Julie Zeh, Nursing Service Authorization Consultant.
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