SKILLED NURSING SERVICES PROVIDER IN FLORIDA

Fatumata Kaba
5 days ago
4 min read

DELIVERING HIGH-QUALITY MEDICAL CARE IN HOME AND COMMUNITY SETTINGS TO SUPPORT HEALTH, SAFETY, AND INDEPENDENCE

Skilled Nursing Services in Florida provide essential clinical care to individuals with chronic health conditions, disabilities, or recovery needs. These services are authorized under Florida’s Medicaid and Home and Community-Based Services (HCBS) waiver programs, allowing individuals to receive professional nursing care while remaining safely in their homes and communities.

1. GOVERNING AGENCIES

Agency: Florida Agency for Health Care Administration (AHCA)

Role: Licenses Home Health Agencies, oversees Medicaid provider enrollment, and monitors Skilled Nursing Services delivery

Agency: Florida Department of Health (DOH)

Role: Regulates nursing licensure and clinical practice standards

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring compliance with Medicaid and Medicare standards for home-based clinical services

2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services involve clinical interventions provided under physician orders, tailored to the individual’s specific medical needs.

Approved providers may deliver:

Medication administration and complex medication management
Wound care and pressure ulcer treatment
Tracheostomy care and ventilator support
Catheter care and maintenance
Diabetes management, including insulin injections
Gastrostomy (G-tube) feeding and maintenance
Respiratory therapies (e.g., nebulizer treatments, oxygen monitoring)
Chronic condition monitoring and clinical assessments
Caregiver education and training on medical needs

All services must follow an individualized plan of care and meet Medicaid clinical documentation standards.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Florida Division of Corporations (Sunbiz)
Obtain EIN from the IRS and NPI (Type 2)
Obtain a Home Health Agency License from AHCA (mandatory if providing in-home skilled nursing)
Secure general liability, professional malpractice, and worker’s compensation insurance
Develop clinical policies and emergency preparedness protocols compliant with Florida statutes
Employ appropriately licensed Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)

4. AHCA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Submit application for Home Health Agency licensure to AHCA
Complete fingerprint-based background screenings for owners, administrators, and clinical staff
Pass AHCA’s initial licensure inspection

Application and Documentation Submission:

Submit business organizational documents, insurance certificates, staff licensure verification, and operational policies
Provide clinical protocols, incident reporting policies, and patient intake forms

Program Readiness Review:

AHCA reviews clinical service delivery readiness, including emergency preparedness, infection control, and HIPAA compliance

Medicaid Enrollment:

After obtaining licensure, enroll as a Florida Medicaid provider via the Florida Medicaid Provider Enrollment Portal
Configure billing systems for Skilled Nursing Services codes

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (from Sunbiz)
IRS EIN confirmation
NPI confirmation
Home Health Agency License
Liability and professional malpractice insurance certificates
AHCA-Compliant Policy & Procedure Manual including:
- Participant intake, nursing assessment, and plan of care development
- Medication administration, wound care, respiratory support, and tracheostomy care protocols
- Emergency preparedness, infection control, and incident management policies
- HIPAA compliance and client rights protection
- Staff background checks, licensure records, and training logs
- Clinical documentation and Medicaid billing systems

6. STAFFING REQUIREMENTS

Role: Administrator

Requirements: Experience managing health care operations; background screening clearance

Role: Director of Nursing (DON)

Requirements: Active Florida RN license; at least two years of nursing experience, with one year in home health or a related field; background screening clearance

Role: Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)

Requirements: Active Florida nursing licenses; CPR certification; background screening clearance

All staff must complete:

Emergency preparedness, infection control, and abuse prevention training
HIPAA confidentiality and patient rights training
Clinical competency assessments
Annual continuing education and licensure renewal

7. MEDICAID WAIVER SERVICES

The following Florida Medicaid programs authorize Skilled Nursing Services:

Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Program
Medicaid Fee-for-Service Program (for medically necessary skilled nursing ordered by a physician)
iBudget Florida Waiver (only for limited skilled nursing supports related to developmental disabilities)

Approved providers may deliver: