NURSING FACILITY SERVICES PROVIDER IN ILLINOIS

PROVIDING COMPREHENSIVE 24-HOUR MEDICAL, REHABILITATION, AND PERSONAL CARE IN A SKILLED NURSING ENVIRONMENT

Nursing Facility Services in Illinois offer 24-hour skilled nursing care, rehabilitation, and personal care to individuals with significant medical, functional, or cognitive needs. These services are primarily authorized under Illinois’ Medicaid State Plan and Medicaid Waiver programs, ensuring individuals receive high-quality care in a licensed institutional setting while maximizing health outcomes and dignity.

1. GOVERNING AGENCIES

Agency: Illinois Department of Healthcare and Family Services (HFS)

Role: Administers Medicaid funding, oversees nursing facility certification and reimbursement rates

Agency: Illinois Department of Public Health (IDPH)

Role: Licenses nursing facilities, conducts inspections, enforces state and federal health and safety regulations, and certifies compliance for Medicaid and Medicare participation

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight to ensure that nursing facilities comply with Medicaid and Medicare regulations, including quality, safety, and participant rights

2. NURSING FACILITY SERVICE OVERVIEW

Nursing Facility Services deliver comprehensive, interdisciplinary care in a structured environment, supporting residents with complex medical needs who cannot be safely cared for in the community.

Approved providers deliver:

• 24-hour skilled nursing services

• Assistance with Activities of Daily Living (ADLs) such as bathing, dressing, toileting, eating, and mobility

• Rehabilitation therapies (physical, occupational, and speech therapy)

• Medication administration and management

• Chronic disease management (e.g., diabetes, cardiac care)

• Wound care, IV therapy, and post-surgical recovery care

• Nutritional services, meal planning, and special diets

• Behavioral health support and dementia care

• Social services, discharge planning, and family engagement

All care must align with the resident’s comprehensive Individualized Care Plan and federal Nursing Facility regulations under 42 CFR Part 483.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business entity with the Illinois Secretary of State

• Obtain EIN from the IRS and NPI (Type 2)

• Apply for and obtain Nursing Home License through Illinois Department of Public Health (IDPH)

• Enroll as a Medicaid and Medicare provider via the Illinois Medicaid Provider Enrollment Portal (IMPACT system) and CMS Medicare Enrollment (PECOS)

• Maintain sufficient general liability, malpractice, and professional liability insurance

• Develop comprehensive facility policies covering nursing care, resident rights, emergency procedures, infection control, staffing, and quality assurance

• Ensure facility design, staffing, and operations meet Life Safety Code and health standards

4. IDPH AND HFS PROVIDER ENROLLMENT PROCESS

Initial Application and Pre-Licensure Review:

• Submit a Letter of Intent and complete a Certificate of Need (CON) process if establishing a new facility

• Apply for Nursing Home License with required documentation including facility plans, staffing plans, operating budgets, and policies

Licensure and Certification Surveys:

• IDPH conducts a pre-licensure inspection to verify physical plant standards, life safety code compliance, and operational readiness

• CMS and/or IDPH conduct certification surveys to approve facilities for Medicaid and Medicare reimbursement

Enrollment and Medicaid/Medicare Billing Authorization:

• Following licensure and survey approval, enroll in the Illinois IMPACT system and CMS PECOS to bill Medicaid and Medicare

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business Registration (Illinois Secretary of State)

• IRS EIN confirmation letter

• NPI confirmation

• IDPH-issued Nursing Facility License

• Certificate of Need (CON) approval (for new construction or major renovations)

• Proof of insurance coverage (general, professional, malpractice)

• Comprehensive Nursing Facility Policy & Procedure Manual including:

  • Admission, discharge, and transfer policies

  • Nursing and clinical service protocols

  • Medication management, pharmacy coordination, and documentation procedures

  • Emergency preparedness and infection control plans

  • Resident rights, abuse prevention, grievance handling

  • Staffing policies including credentials, background checks, and training

  • Quality assurance, audit readiness, and billing compliance documentation

6. STAFFING REQUIREMENTS

Role: Nursing Home Administrator

Requirements: Licensed Nursing Home Administrator (LNHA) through IDFPR; background clearance

Role: Director of Nursing (DON)

Requirements: Registered Nurse (RN) with management experience in long-term care settings; background clearance

Role: Licensed Nursing Staff (RN, LPN)

Requirements: Active Illinois nursing license; CPR certification; ongoing competency assessments

Role: Certified Nursing Assistants (CNAs)

Requirements: Illinois CNA certification; background clearance; health screenings

All staff must complete:

• Abuse, neglect, and exploitation prevention training

• Infection control and emergency response training

• Person-centered care and dementia care training (where applicable)

• HIPAA compliance and resident rights training

• Annual in-service education and continuing professional development

7. MEDICAID WAIVER PROGRAMS AND STATE PLAN COVERAGE

Nursing Facility Services are primarily funded through:

• Illinois Medicaid State Plan Nursing Facility Benefit: For residents who meet nursing home level-of-care criteria

• Supportive Living Program (SLP) Waiver: Alternative for individuals who can live semi-independently but need supportive services

• Medicare Post-Acute Skilled Nursing Services: For short-term rehabilitation following hospitalization (first 100 days coverage under Medicare Part A)

Approved providers deliver:

• Short-term rehabilitation and post-acute care

• Long-term skilled nursing care for chronic conditions

• Specialized dementia care units (where applicable)

• Hospice coordination and end-of-life care services

8. TIMELINE TO LAUNCH

Phase: Business Formation, Planning, and Certificate of Need (CON) Process

Timeline: 3–6 months

Phase: Facility Construction/Preparation and Staffing

Timeline: 6–12 months

Phase: IDPH Licensure Application and Pre-Licensure Survey

Timeline: 2–4 months

Phase: CMS Certification and Medicaid/Medicare Enrollment

Timeline: 3–6 months

Phase: Billing System Configuration and Service Launch

Timeline: 1–2 months

9. CONTACT INFORMATION

Illinois Department of Healthcare and Family Services (HFS)

Website: https://www.hfs.illinois.gov/

Illinois Department of Public Health (IDPH) — Nursing Home Licensure

Website: https://dph.illinois.gov/topics-services/health-care-regulation/nursing-homes.html

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — ILLINOIS NURSING FACILITY SERVICES PROVIDER

WCG assists skilled nursing facilities, long-term care operators, and healthcare entrepreneurs in launching Medicaid and Medicare-certified Nursing Facility Services in Illinois.​​​​

Scope of Work:

• Business formation, Certificate of Need (CON) assistance, and licensure support

• Medicaid and Medicare provider enrollment guidance

• Development of Nursing Facility Policy & Procedure Manual

• Staff credentialing templates, clinical documentation systems, and patient care forms

• Medicaid and Medicare billing system setup and claims management

• Website, domain, and professional branding setup

• Survey preparation, quality assurance systems, and compliance monitoring tools

• Resident satisfaction programs and healthcare provider partnership development strategies

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