SKILLED NURSING SERVICES PROVIDER IN ARIZONA

Fatumata Kaba
5 days ago
4 min read

DELIVERING PROFESSIONAL MEDICAL CARE TO SUPPORT HEALTH, SAFETY, AND INDEPENDENCE IN HOME AND COMMUNITY SETTINGS

Skilled Nursing Services in Arizona deliver medically necessary care provided by licensed nurses to individuals with chronic conditions, disabilities, or significant health needs. These services are authorized under Arizona’s Home and Community-Based Services (HCBS) Medicaid Waiver programs and the Arizona Long Term Care System (ALTCS), aiming to maintain health and prevent unnecessary hospitalization or institutionalization.

1. GOVERNING AGENCIES

Agency: Arizona Health Care Cost Containment System (AHCCCS)

Role: Oversees Medicaid enrollment, service authorization, and reimbursement for Skilled Nursing Services

Agency: Arizona Department of Economic Security (DES) – Division of Developmental Disabilities (DDD) (for DDD members)

Role: Coordinates skilled nursing supports for individuals with developmental disabilities

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring that skilled nursing services comply with Medicaid HCBS guidelines

2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services provide clinical interventions based on physician orders, designed to address specific health conditions and promote individual health, wellness, and stability.

Approved providers may deliver:

Medication administration and complex medication management
Wound care and treatment of pressure ulcers
Tracheostomy care and ventilator support
Catheter care and management
Gastrostomy (G-tube) care and enteral nutrition
Diabetes management, including insulin administration
Chronic disease monitoring and clinical assessments
Training caregivers on health support procedures
Coordination with physicians, therapists, and case managers

Services must be provided by licensed nurses (Registered Nurses [RNs] or Licensed Practical Nurses [LPNs]) and comply with an individualized person-centered service plan.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Arizona Corporation Commission
Obtain EIN from the IRS and NPI (Type 2)
Employ licensed RNs and/or LPNs with active Arizona Board of Nursing licenses
Secure malpractice insurance and liability coverage
Develop clinical protocols and policies aligned with Arizona nursing standards
Ensure compliance with HIPAA and Medicaid documentation standards

4. AHCCCS/DDD PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Request Skilled Nursing Provider application materials from AHCCCS or DDD
(Recommended) Attend Medicaid or HCBS provider orientation sessions

Application and Documentation Submission:

Submit business documents, staffing rosters, clinical service descriptions, and liability insurance proof
Provide sample nursing care plans, incident reporting protocols, and emergency procedures
Submit background checks and licensing verification for all clinical staff

Program Readiness Review:

AHCCCS and/or DDD review staffing qualifications, policies, and operational readiness
May require demonstration of clinical documentation systems and quality assurance processes

Approval & Medicaid Enrollment:

Upon approval, complete Medicaid enrollment with AHCCCS
Contract with Medicaid Managed Care Organizations (MCOs) and/or DDD for service delivery
Configure billing systems and Medicaid claims processes

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License
IRS EIN confirmation
NPI confirmation
RN and/or LPN licensure verification
Liability insurance and malpractice coverage proof
Policy & Procedure Manual including:
- Participant intake and clinical assessment protocols
- Skilled service documentation procedures
- Medication administration policies
- Emergency medical response and reporting procedures
- Resident/client rights, HIPAA privacy compliance, and informed consent policies
- Staff background checks, credentials, and continuing education records
- Incident tracking, infection control policies, and quality assurance systems
- Medicaid billing, service authorization, and claim tracking systems

6. STAFFING REQUIREMENTS

Role: Nursing Supervisor (RN)Requirements: Active Arizona RN license, supervisory experience in clinical care settings, Medicaid familiarity

Role: Skilled Nurse (RN or LPN)Requirements: Current Arizona nursing license, CPR certification, background check clearance

All staff must complete:

Medicaid HCBS and DDD service documentation training
Emergency preparedness and infection control training
Annual continuing education and skills competency assessments
Training in person-centered planning and client rights protection

7. MEDICAID WAIVER SERVICES

The following Arizona Medicaid Waivers authorize Skilled Nursing Services:

Arizona Long Term Care System (ALTCS) – Elderly and Physically Disabled (EPD) Program
ALTCS – Developmental Disabilities (DD) Program
HCBS Waivers under AHCCCS and DDD programs

Approved providers may deliver:

In-home or facility-based skilled nursing interventions
Clinical assessments and ongoing health monitoring
Training for family members and caregivers
Participation in interdisciplinary care team meetings and service plan updates

8. TIMELINE TO LAUNCH

Phase: Business Formation and Initial Setup

Timeline: 2–3 weeks

Phase: AHCCCS/DDD Application and Readiness Review

Timeline: 60–90 days

Phase: Staff Hiring, Training, and Clinical Protocol Finalization

Timeline: 30–45 days

Phase: MCO Contracting and Medicaid Claims Configuration

Timeline: 45–60 days

9. CONTACT INFORMATION

Arizona Health Care Cost Containment System (AHCCCS)

Website: https://www.azahcccs.gov/

Arizona Department of Economic Security – Division of Developmental Disabilities (DDD)

Website: https://des.az.gov/services/disabilities/developmental-disabilities

Arizona Medicaid Provider Enrollment Portal

Website: https://www.azahcccs.gov/PlansProviders/NewProviders/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — ARIZONA SKILLED NURSING PROVIDER

WCG supports healthcare entrepreneurs, clinicians, and home health agencies in launching Medicaid-compliant Skilled Nursing Services under Arizona’s HCBS Waiver programs and ALTCS.

Scope of Work: