SKILLED NURSING SERVICES PROVIDER IN HAWAII

Fatumata Kaba
1 day ago
4 min read

DELIVERING MEDICALLY NECESSARY, PROFESSIONAL NURSING CARE TO INDIVIDUALS IN THEIR HOMES AND COMMUNITIES

Skilled Nursing Services in Hawaii provide clinical nursing care to individuals with chronic illnesses, disabilities, or post-acute medical needs. These services are authorized under Hawaii’s Medicaid State Plan, Home and Community-Based Services (HCBS) waiver programs, and Medicare, helping individuals maintain optimal health and remain safely at home or in community settings.

1. GOVERNING AGENCIES

Agency: Hawaii Department of Human Services (DHS) — Med-QUEST Division

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

Agency: Hawaii Department of Health (DOH) — Office of Health Care Assurance (OHCA)

Role: Licenses and monitors home health agencies and skilled nursing providers

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Skilled Nursing Services meet Medicaid and Medicare standards

2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services involve medically necessary nursing care provided by licensed nurses to manage health conditions, prevent complications, and promote recovery or stability.

Approved providers may deliver:

Health assessments and monitoring of vital signs and clinical status
Medication administration (including injections, IV therapy)
Wound care and management of pressure injuries
Disease-specific management (e.g., diabetes care, respiratory support)
Catheter care, tube feeding, and ostomy care
Health education for participants and caregivers
Coordination with physicians and interdisciplinary care teams

Services may be intermittent, part-time, or extended depending on the participant’s needs as documented in their Individualized Service Plan (ISP) or Plan of Care (POC).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Hawaii Department of Commerce and Consumer Affairs (DCCA)
Obtain EIN from the IRS and NPI (Type 2)
Obtain Home Health Agency License or Skilled Nursing Agency License through DOH's Office of Health Care Assurance (if operating as an agency)
Employ licensed Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) under appropriate supervision
Maintain general liability, professional liability, and malpractice insurance
Enroll as a Medicaid provider with Hawaii’s Med-QUEST Division

4. MED-QUEST/DHS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Submit Provider Enrollment Application for Skilled Nursing Services through Hawaii Med-QUEST
If operating a facility-based agency, submit a license application to the DOH’s Office of Health Care Assurance

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, nursing staff credentialing, insurance certificates, clinical protocols, and quality assurance plans
Provide sample care plans, nursing service logs, and emergency response protocols

Program Readiness Review:

DHS and DOH review provider readiness, including nursing protocols, participant safety systems, and Medicaid billing compliance

Approval & Medicaid Enrollment:

Upon approval, configure billing codes for Skilled Nursing Services (e.g., per visit, per hour, continuous care models)

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (Hawaii DCCA)
IRS EIN confirmation
NPI confirmation
Home Health Agency or Skilled Nursing Facility License (if required)
Proof of general, professional, and malpractice insurance
HCBS-Compliant and Skilled Nursing-Compliant Policy & Procedure Manual including:
- Participant intake, nursing assessment, and care planning protocols
- Skilled nursing intervention and monitoring procedures
- Medication administration, wound care, and emergency response protocols
- HIPAA confidentiality, participant rights, and grievance handling policies
- Staff credentialing, background screening, and ongoing competency verification
- Medicaid billing, service authorization tracking, and quality assurance systems

6. STAFFING REQUIREMENTS

Role: Director of Nursing / Clinical Supervisor

Requirements: Active Hawaii RN license; supervisory experience in skilled care preferred; background screening clearance

Role: Registered Nurses (RNs)

Requirements: Active Hawaii RN license; CPR certification; experience in community or home-based care; background screening clearance

Role: Licensed Practical Nurses (LPNs)

Requirements: Active Hawaii LPN license; experience with skilled nursing procedures; background screening clearance

All staff must complete:

HIPAA confidentiality, participant rights, and abuse prevention training
Emergency preparedness and infection control training
Clinical documentation and Medicaid compliance training
Annual competency assessments and continuing nursing education

7. MEDICAID WAIVER PROGRAMS

The following Hawaii Medicaid Waivers authorize Skilled Nursing Services:

Developmental Disabilities/Intellectual Disabilities (DD/ID) Waiver (where medically necessary)
Community Care Services (CCS) Program
Medicaid State Plan Home Health Benefit
QUEST Integration Managed Care Program

Approved providers may deliver:

Skilled nursing visits
Ongoing health monitoring and medical management
Extended skilled nursing care for medically fragile participants

8. TIMELINE TO LAUNCH

Phase: Business Formation and Licensing Application

Timeline: 1–2 months

Phase: Facility Readiness (if required) and Staff Hiring

Timeline: 2–4 months

Phase: Med-QUEST and DOH Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing Setup and Claims Testing

Timeline: 30–45 days

9. CONTACT INFORMATION

Hawaii Department of Human Services (DHS) — Med-QUEST Division

Website: https://medquest.hawaii.gov/

Hawaii Department of Health (DOH) — Office of Health Care Assurance (OHCA)

Website: https://health.hawaii.gov/ohca/

Centers for Medicare & Medicaid Services (CMS)

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

SKILLED NURSING SERVICES PROVIDER IN HAWAII

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

WCG supports nursing agencies, home health providers, and healthcare entrepreneurs in launching Medicaid-compliant Skilled Nursing Services under Hawaii’s HCBS waiver programs and Medicaid State Plan.

Scope of Work: