SKILLED NURSING SERVICES PROVIDER IN MAINE

Fatumata Kaba
Aug 12
4 min read

DELIVERING CLINICAL CARE AT HOME TO ENHANCE SAFETY, RECOVERY, AND INDEPENDENCE FOR INDIVIDUALS WITH COMPLEX MEDICAL NEEDS

Skilled Nursing Services in Maine provide in-home clinical care to individuals recovering from illness, managing chronic conditions, or requiring ongoing medical oversight. These services are critical for reducing hospital readmissions, enhancing comfort, and promoting wellness in a familiar setting. They are authorized and reimbursed through MaineCare (Medicaid), Medicare, private insurance, and HCBS Waivers (primarily Sections 19, 21, and 96).

1. GOVERNING AGENCIES

Agency: Maine Department of Health and Human Services (DHHS)

Role: Oversees statewide regulation of home health and skilled nursing services

Agency: Division of Licensing and Certification (DLC)

Role: Issues Home Health Agency (HHA) and Private Duty Nursing licenses

Agency: Office of MaineCare Services (OMS)

Role: Administers Medicaid provider enrollment and reimbursement under Sections 19, 21, 96, and 40

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures compliance with federal standards for clinical care and HCBS Waivers

2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services are medically necessary interventions provided by licensed nurses, often within the individual's home. These services may include:

Medication management and injections
Wound care and post-surgical support
Catheter care, ostomy care, and tracheostomy management
Disease monitoring and chronic condition support (e.g., diabetes, COPD)
Health assessments and vital sign monitoring
Coordination with physicians and therapists
Emergency planning and caregiver education

Services must be ordered by a licensed physician and outlined in a Plan of Care or Person-Centered Plan (PCP).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Maine Secretary of State
Obtain EIN and Type 2 NPI
Apply for Home Health Agency (HHA) or Private Duty Nursing license via the Division of Licensing and Certification (DLC)
Submit operations manuals, RN/clinical staffing plan, and infection control policy
Obtain Medicare and/or MaineCare enrollment approval
Secure liability and professional insurance coverage

4. MAINECARE ENROLLMENT & SERVICE APPROVAL

Step 1: Business & Policy Setup

Create operational manuals for nursing services
Develop quality assurance, supervision, and infection control plans

Step 2: Apply for HHA or PDN License

Submit application to DLC with service model and location details
Pass survey inspection (if applicable)

Step 3: Enroll with MaineCare

Apply via Health PAS Online
Choose applicable service sections:
- Section 96 – Private Duty Nursing
- Section 40 – Home Health Services
- Section 19 or 21 – Waiver-related nursing for eligible populations

Step 4: Service Launch

Begin accepting referrals from physicians, hospitals, and case managers
Deliver care according to Plan of Care and submit documentation for billing

5. REQUIRED DOCUMENTATION

Articles of Incorporation or LLC registration
IRS EIN and NPI confirmation
State-issued HHA or PDN license
Approved MaineCare or Medicare enrollment
Policy & procedure manual including:
- Nursing care plans and physician orders
- Medication logs and wound care documentation
- HIPAA and emergency response protocols
- Client rights and service agreements
- Infection prevention and control manual
- Staff training logs, RN supervision records, and incident reports

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements: Active Maine RN license, CPR certification, 1+ year of clinical experience

Role: Licensed Practical Nurse (LPN)

Requirements: Supervised by an RN, licensed in Maine, trained in delegated tasks

Role: Clinical Supervisor / Director of Nursing (DON)

Requirements: RN with management experience, responsible for oversight, care coordination, and regulatory compliance

Training Requirements for All Clinical Staff:

HIPAA and patient confidentiality
Infection control and universal precautions
Medication administration protocols
Emergency response and safety procedures
Continuing education per licensing board requirements

7. MEDICAID WAIVER SERVICES

Skilled Nursing Services are reimbursed under:

Section 96: Private Duty Nursing Services
Section 40: Home Health Services
Section 19 & 21: Waivers for Adults with Disabilities and the Elderly
Medicare: Post-hospital care (Part A) and long-term support (Part B) if certified

Authorized services include:

Hourly RN or LPN support (including 24-hour care if needed)
Intermittent skilled nursing visits
Training for caregivers and family members
Care documentation and communication with PCPs

8. TIMELINE TO LAUNCH

Phase: Business Registration

Timeline: 1–2 weeks

Phase: Policy & Procedure Manual Development

Timeline: 2–3 weeks

Phase: Licensure Application (HHA or PDN)

Timeline: 30–90 days

Phase: MaineCare Enrollment & Clinical Onboarding

Timeline: 4–6 weeks

Phase: Referral Activation and Care Delivery

Timeline: Ongoing

9. CONTACT INFORMATION

Division of Licensing and Certification (DLC)

Website: https://www.maine.gov/dhhs/dlc

Phone: (207) 287-9300

Office of MaineCare Services

Email: provider-enrollment@mainecare.maine.gov

Website: https://www.maine.gov/dhhs/oms

Health PAS Online Portal (MaineCare Provider Portal)

Website: https://mainecare.maine.gov

Maine State Board of Nursing

Website: https://www.maine.gov/boardofnursing

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — MAINE SKILLED NURSING PROVIDER LAUNCH

We partner with registered nurses and healthcare entrepreneurs to launch fully licensed, compliant, and Medicaid-enrolled skilled nursing agencies across Maine.

Scope of Work: