I work for a pediatric home health company and when we have to submit for auth for DD waiver we have been running into many problems. First the Part V is really more tailored to the Care attendants and not nursing. Everything we put into the Part V can be found in the year long 485 we submit, which should be sufficient enough. We have also had an issue with the RN/LPN auth and having to break down the hours of when we use either one and give a justification for why they have both or just an RN. Sometimes we have an RN in the home because that is what we could find the child and I don't feel it should be up to you what type of nurse is ok to place in a home for a child. Also no other insurance, including DMAS which is what we were told DD waiver is supposed to be following, requires that we break down the hours between RN and LPN. We get the full amount of hours for either or. This is helpful if the RN is out for whatever reason because then we can just place an LPN if available. With DD waiver this is not an option and so the child ends up without coverage, which really isn't fair to the child or family. We have also had issues with submitting the schedules since we can't see what the attendant care company submitted and sometimes that means we submit for the same hours due to our nurses having flexible shifts and the care attendant covering when the nurse can't. In the past we would submit the general schedule that our nurse works and put a comment in that it varies and when nursing coverage is not available then care attendant is used. We have also had issues with being told different things as to what the SA's want to see on each form we submit which results in multiple changes and fixes that then result in us not having auth for months at a time for our patients which can then interrupt their nursing services as well. We also have an issue with increasing hours when needed which then results in us losing nursing coverage for the patient because the nurse goes elsewhere. Other Insurance companies give us a pool of hours to use and DD waiver only gives us what we currently use even if the child qualifies for way more. The DD waiver process has just become overall very frustrating and time consuming which really just ends up hurting the patient and families.