The Ghost Network Behind Pediatric Home Nursing: When Authorized Hours Go Unfilled

Podcast: Value Based Care Advisory (VBCA) Podcast · Carenodes

Opublikowano: 2026-08-01

Episode Summary A pediatric patient in a New Jersey hospital is medically ready for discharge — equipment arranged, family ready, nursing hours authorized by the health plan. The only missing piece: an actual nurse. This episode uses that scenario to examine the structural gap between authorized private duty nursing (PDN) hours and filled hours in Medicaid managed care, why standard provider directories overstate real pediatric home health capacity, and what CMS's 2024 Medicaid managed care access rule signals for how plans will need to prove — not just claim — network adequacy going forward. "When the network looks broad on paper...