SKILLED NURSING SERVICES PROVIDER IN GEORGIA

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

Skilled Nursing Services in Georgia provide medically necessary nursing care to individuals with chronic conditions, disabilities, or complex health needs. These services are authorized under Georgia’s Medicaid Home and Community-Based Services (HCBS) waiver programs and Medicaid State Plan programs, enabling participants to receive high-quality clinical care while remaining in their homes and communities.

1. GOVERNING AGENCIES

Agency: Georgia Department of Community Health (DCH)

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

Agency: Georgia Board of Nursing

Role: Regulates licensure and practice standards for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring Skilled Nursing Services meet Medicaid and Medicare home health and HCBS standards

2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services involve clinical assessments, medical treatments, and health monitoring performed under the direction of a licensed healthcare provider.

Approved providers may deliver:

• Medication administration, complex medication management, and IV therapy

• Wound care, dressing changes, and pressure sore management

• Tracheostomy care, ventilator support, and respiratory therapies

• Gastrostomy (G-tube) feeding and related interventions

• Diabetic management and insulin injections

• Catheter care and urinary system management

• Chronic disease monitoring and health education

• Emergency intervention planning and caregiver education

All services must be physician-ordered, documented in the participant’s plan of care, and delivered by appropriately licensed nursing professionals.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Georgia Secretary of State

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

• Obtain a Home Health Agency License (if operating a full agency) through DCH’s Healthcare Facility Regulation Division (HFRD) or operate under a nurse delegation model (for certain waiver services)

• Ensure nurses hold active Georgia RN or LPN licensure

• Maintain professional liability insurance and general liability insurance

• Develop clinical care policies aligned with Georgia Medicaid and Medicare standards

4. DCH PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Skilled Nursing Services provider application through the Georgia Medicaid Management Information System (GAMMIS)

• If operating a Home Health Agency, obtain licensing through DCH HFRD first

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance documentation, staff credentialing, and clinical service policies

• Provide sample care plans, emergency protocols, and medication management documentation templates

Program Readiness Review:

• DCH reviews readiness for clinical service delivery, Medicaid documentation standards, and participant safety compliance

• Facility inspections may be required for agency-based models

Approval & Medicaid Enrollment:

• After licensing (if applicable) and documentation approval, finalize Medicaid enrollment in GAMMIS

• Set up billing codes specific to Skilled Nursing Services under State Plan and HCBS programs

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Georgia Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Home Health Agency License (if required)

• Proof of professional and general liability insurance

• Georgia Nursing Licenses for all clinical staff

• DCH-Compliant Policy & Procedure Manual including:

  • Participant intake, nursing assessment, and individualized care plan development

  • Medication administration, respiratory support, and wound care protocols

  • Incident reporting, infection control, and emergency preparedness procedures

  • Client rights, HIPAA compliance, and grievance resolution policies

  • Staff credentialing, competency verification, and continuing education records

  • Medicaid billing, authorization tracking, and clinical documentation systems

6. STAFFING REQUIREMENTS

Role: Director of Nursing / Clinical Supervisor

Requirements: Active Georgia RN license; at least two years of nursing experience, preferably in home health or complex care settings; background screening clearance

Role: Registered Nurses (RNs)Requirements: Active Georgia nursing license; CPR certification; background screening clearance

Role: Licensed Practical Nurses (LPNs)

Requirements: Active Georgia nursing license; CPR certification; background screening clearance

All staff must complete:

• HIPAA confidentiality, participant rights, and abuse prevention training

• Emergency response, infection control, and incident reporting training

• Clinical competency assessments and annual skill evaluations

• Continuing education to maintain nursing licensure and Medicaid compliance

7. MEDICAID WAIVER SERVICES

The following Georgia Medicaid Waivers and Programs authorize Skilled Nursing Services:

• Comprehensive Supports Waiver Program (COMP)

• New Options Waiver Program (NOW)

• Independent Care Waiver Program (ICWP)

• Georgia Pediatric Program (GAPP)

• Medicaid State Plan (Home Health Services)

Approved providers may deliver:

• Intermittent or continuous nursing care

• In-home medical assessments and interventions

• Caregiver education and health-related training

• Transition nursing support during hospital discharges

8. TIMELINE TO LAUNCH

Phase: Business Formation and Licensing Setup

Timeline: 2–3 weeks

Phase: Home Health Agency Licensing (if applicable) and Readiness Review

Timeline: 90–120 days

Phase: Staff Hiring, Credentialing, and Clinical System Development

Timeline: 30–45 days

Phase: Medicaid Enrollment and Billing System Setup

Timeline: 45–60 days

9. CONTACT INFORMATION

Georgia Department of Community Health (DCH)

Website: https://dch.georgia.gov/

Georgia Medicaid Management Information System (GAMMIS)

Website: https://www.mmis.georgia.gov/

Georgia Board of Nursing

Website: https://sos.ga.gov/

Georgia Healthcare Facility Regulation Division (HFRD)

Website: https://dch.georgia.gov/divisionsoffices/hfrd

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

WCG supports healthcare agencies and clinical service providers in launching Medicaid-compliant Skilled Nursing Services under Georgia’s HCBS Waivers and State Plan programs.

Scope of Work:

• Business registration and EIN/NPI setup

• Home Health Agency licensing support and Medicaid enrollment assistance

• Development of Skilled Nursing Services Policy & Procedure Manual

• Staff credentialing templates and clinical documentation systems

• Medicaid billing setup and claims configuration

• Website, domain, and email setup

• Participant intake, clinical assessment, and individualized plan templates

• Emergency preparedness, infection control, and quality assurance systems

• Community networking and discharge planning partnerships

Continue To Our Client Portal To Get Started

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