SKILLED NURSING SERVICES PROVIDER IN MASSACHUSETTS

Fatumata Kaba
Aug 8, 2025
4 min read

DELIVERING LICENSED MEDICAL CARE IN THE HOME OR COMMUNITY FOR INDIVIDUALS WITH COMPLEX HEALTH NEEDS

Skilled Nursing Services in Massachusetts are provided by licensed nurses to individuals who require ongoing medical care due to chronic illnesses, disabilities, or post-hospitalization recovery. These services are a key component of MassHealth’s Medicaid benefits and are also authorized under Home and Community-Based Services (HCBS) waivers, the Home Health Program, and the Money Follows the Person (MFP) initiative.

1. GOVERNING AGENCIES

Agency: MassHealth (Massachusetts Medicaid)

Role: Approves and reimburses skilled nursing services under state plan and HCBS waivers

Agency: Department of Public Health (DPH), Division of Health Care Facility Licensure and Certification

Role: Licenses home health agencies and ensures clinical compliance with state and federal standards

Agency: Executive Office of Health and Human Services (EOHHS)

Role: Oversees long-term services and supports (LTSS), including waiver-based nursing

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight and funding for Medicaid-covered nursing services under 1915(c) waivers

2. SKILLED NURSING SERVICE OVERVIEW

Skilled nursing services involve medically necessary, clinical care provided in the individual’s home or community setting by licensed nurses (RN/LPN) under physician orders.

Services may include:

Medication administration and IV therapy
Wound care and post-surgical dressing changes
Catheter care, ostomy maintenance, and tube feeding
Monitoring of chronic conditions (e.g., diabetes, CHF, COPD)
Health assessments and vital signs monitoring
Client and caregiver training
Coordination with physicians and other care team members

All services must be ordered by a physician and documented in a Plan of Care (POC) or Individual Service Plan (ISP).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Massachusetts Secretary of the Commonwealth
Obtain IRS EIN and Type 2 NPI
Obtain a Home Health Agency license from DPH
Carry professional liability and malpractice insurance
Hire licensed RNs and LPNs with current Massachusetts Board of Registration in Nursing credentials
Develop clinical policies in compliance with CMS Conditions of Participation (CoPs)

If providing waiver-based skilled nursing:

You must be credentialed through DDS, MFP, or other waiver authorities and comply with additional program-specific requirements.

4. PROVIDER ENROLLMENT PROCESS

Step 1: Obtain DPH Home Health Agency License

Apply through the DPH Licensure Portal

Step 2: Enroll with MassHealth as a Skilled Nursing Provider

Apply via Provider Online Service Center (POSC)

Step 3: Apply to HCBS Waiver Programs (DDS, ABI, MFP)

Submit staffing plans, clinical protocols, and service descriptions

Step 4: Prepare for DPH Survey and CMS Conditions of Participation

Implement Quality Assurance Performance Improvement (QAPI) and clinical oversight systems

5. REQUIRED DOCUMENTATION

Articles of Incorporation or business registration
IRS EIN and NPI confirmation
Proof of DPH home health agency licensure
Malpractice and general liability insurance
Skilled Nursing Services Policy & Procedure Manual, including:
- Physician order templates and care plan forms
- Clinical progress notes and medication administration records (MARs)
- Infection control protocols and emergency procedures
- Nurse supervision logs and training records
- HIPAA and documentation compliance checklists
- Quality assurance and client outcome tracking
- Billing and time documentation forms

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements: Valid Massachusetts RN license; CPR certification; clinical experience; CORI background check

Role: Licensed Practical Nurse (LPN)

Requirements: MA LPN license; supervised by RN; experience with in-home care preferred

Role: Director of Nursing (for agencies)

Requirements: RN license with leadership experience; oversees clinical policies, QAPI, and supervision

Required Trainings:

HIPAA and infection control
Emergency preparedness
Abuse/neglect prevention and mandatory reporting
Electronic visit verification (EVV) systems (if required)
CMS Conditions of Participation and clinical documentation

7. MASSHEALTH PROGRAMS THAT COVER SKILLED NURSING

Skilled Nursing is reimbursed under:

MassHealth Home Health Program (State Plan Services)
ABI Waivers (Acquired Brain Injury)
MFP Waivers (Residential and Community Living)
DDS Waivers (for clients with developmental disabilities)
Children’s Behavioral Health Initiative (CBHI) — for eligible youth with complex needs

Providers may bill for:

Intermittent or hourly skilled nursing
RN supervisory visits
Complex case management and physician coordination
Shift nursing (for medically fragile individuals)

8. TIMELINE TO LAUNCH

Phase: Business Registration and Insurance Setup

Timeline: 2–3 weeks

Phase: DPH Home Health License Application and Survey

Timeline: 2–4 months

Phase: MassHealth and Waiver Enrollment

Timeline: 1–2 months

Phase: Clinical Policy Manual and Staff Credentialing

Timeline: 1 month

Phase: Start of Services Upon Authorization

Timeline: Ongoing — based on physician referrals and waiver team approvals

9. CONTACT INFORMATION

MassHealth Provider Enrollment Portal

https://www.mass.gov/orgs/masshealth

Department of Public Health (DPH) — Home Health Licensure

https://www.mass.gov/guides/home-health-agency-licensure

Department of Developmental Services (DDS)

https://www.mass.gov/orgs/department-of-developmental-services

Massachusetts Board of Registration in Nursing

https://www.mass.gov/orgs/board-of-registration-in-nursing

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

WCG supports nurse entrepreneurs, medical professionals, and home health organizations in launching licensed, Medicaid-approved skilled nursing services across Massachusetts.

Scope of Work: