SKILLED NURSING SERVICES PROVIDER IN CALIFORNIA

DELIVERING LICENSED MEDICAL CARE IN THE HOME TO PROMOTE STABILITY, RECOVERY, AND QUALITY OF LIFE FOR INDIVIDUALS WITH COMPLEX HEALTH NEEDS

Skilled Nursing Services in California provides licensed, physician-directed medical care in the home for individuals with ongoing medical needs. These services are available under Medi-Cal (California Medicaid) through both State Plan benefits and Home and Community-Based Services (HCBS) Waivers, such as the Nursing Facility/Acute Hospital (NF/AH) Waiver. They are regulated by the California Department of Health Care Services (DHCS) and the California Department of Public Health (CDPH).

1. GOVERNING AGENCIES

Agency: California Department of Health Care Services (DHCS)

Role: Administers Medi-Cal and HCBS waiver funding for skilled nursing services

Agency: California Department of Public Health (CDPH)

Role: Licenses Home Health Agencies (HHAs) and oversees compliance with Title 22 regulations

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight and ensures HCBS and skilled nursing standards are met

2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services involve direct care delivered by a Registered Nurse (RN) or Licensed Vocational Nurse (LVN) in the home under a physician’s written order. These services are for individuals with complex medical needs who require regular clinical support to prevent institutionalization.

Approved providers may deliver:

• Medication administration and IV therapy

• Wound care, catheter care, and tracheostomy management

• Feeding tube maintenance and monitoring

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

• Skilled assessments and nursing notes

• Coordination with primary care physicians and interdisciplinary teams

• Emergency planning and health education for caregivers

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the California Secretary of State

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

• Apply for a Home Health Agency (HHA) license through CDPH

• Complete Medi-Cal enrollment for reimbursement of in-home skilled nursing

• Comply with federal Conditions of Participation if also Medicare-certified

• Carry liability insurance and workers’ compensation

• Implement HIPAA-compliant clinical documentation systems

4. PROVIDER ENROLLMENT PROCESS

Step 1: Register your agency and obtain NPI

Step 2: Apply for Home Health Agency licensure through CDPH’s Centralized Applications Unit (CAU)

• Submit business plan, staffing model, policies, and undergo a site survey

Step 3: Enroll as a Medi-Cal provider through the Provider Application and Validation for Enrollment (PAVE) portal

Step 4: Apply to provide services under HCBS Waivers (such as NF/AH Waiver) if eligible

Step 5: Begin accepting referrals from physicians, case managers, or waiver agencies

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or business registration

• IRS EIN Letter

• NPI confirmation

• CDPH HHA license and Medicare certification (if applicable)

• Medi-Cal provider number and waiver program approval

• Policy & procedure manual including:

  • Nursing care plans and physician order tracking

  • Medication administration records and treatment logs

  • Infection control and emergency preparedness

  • Incident reporting and quality assurance protocols

  • HIPAA compliance and patient privacy standards

  • Staff credentialing, training, and clinical supervision

  • Documentation for Medi-Cal and CMS audits

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements:

• California RN license

• Experience in home health or acute care preferred

• CPR certification, background check, and TB clearance

Role: Licensed Vocational Nurse (LVN)

Requirements:

• California LVN license

• Works under RN supervision

• Medication administration and clinical care experience

Role: Clinical Supervisor / Director of Patient Care Services (DPCS)

Requirements:

• Active California RN license

• Two or more years of clinical experience, including at least one year in home health supervision

Training Requirements for All Staff:

• HIPAA and patient confidentiality

• Documentation and billing compliance

• Infection control and emergency response

• Cultural competence and patient communication

• Annual skills verification and CEU tracking

7. MEDICAID WAIVER SERVICES

Skilled Nursing is reimbursed through:

• California Medi-Cal (State Plan benefit)

• Home and Community-Based Services Waivers, such as:

  • NF/AH Waiver

  • Home and Community-Based Alternatives (HCBA) Waiver

Approved providers may deliver:

• Short- or long-term nursing care based on medical necessity

• Care planning in coordination with waiver case managers

• Documentation for Level of Care reviews and ongoing eligibility

• In-home skilled services to avoid hospitalization or nursing facility placement

8. TIMELINE TO LAUNCH

Phase: Business Formation

Timeline: 1–2 weeks

Phase: CDPH Licensing Process

Timeline: 3–6 months

Phase: Medi-Cal Enrollment

Timeline: 60–90 days

Phase: Waiver Program Application (optional)

Timeline: 30–60 days

Phase: Staffing and Referral Activation

Timeline: Ongoing

9. CONTACT INFORMATION

California Department of Public Health (CDPH) – Licensing and Certification

Phone: (916) 558-1784

Website: https://www.cdph.ca.gov

California Department of Health Care Services (DHCS)

Phone: (800) 541-5555

Website: https://www.dhcs.ca.gov

Medi-Cal Provider Enrollment (PAVE)

Website: https://pave.dhcs.ca.gov

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — CALIFORNIA SKILLED NURSING SERVICES PROVIDER

We help licensed healthcare professionals and home health agencies launch compliant Skilled Nursing Services programs under Medi-Cal and HCBS waiver programs in California.

Scope of Work:

• Business registration (LLC, EIN, NPI)

• CDPH Home Health Agency licensing support

• Medi-Cal and waiver provider enrollment guidance

• Policy & procedure manual for nursing care, compliance, and documentation

• Templates for care plans, physician orders, treatment logs, and incident reports

• Website, domain, and email setup

• Staff credentialing trackers and CEU monitoring tools

• Client intake packet, consent forms, and HIPAA documents

• Audit preparation systems and waiver readiness tools

• Referral networking with hospitals, physicians, and managed care plans

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.