SKILLED NURSING SERVICES PROVIDER IN NEW YORK

Fatumata Kaba
Sep 4
4 min read

DELIVERING COMPREHENSIVE AND HIGH-QUALITY SKILLED NURSING CARE FOR INDIVIDUALS IN HOME AND COMMUNITY SETTINGS

Skilled Nursing Services in New York support individuals with complex medical needs by providing clinical care, health monitoring, and rehabilitative services in home and community environments. These services are essential for individuals requiring long-term medical support, post-hospitalization care, or ongoing management of chronic conditions. Skilled Nursing Services are authorized under New York Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: New York State Department of Health (NYSDOH)

Role: Administers Medicaid waiver funding for Skilled Nursing Services and oversees provider enrollment, service authorization, and reimbursement.

Agency: New York State Office for People With Developmental Disabilities (OPWDD)

Role: Provides oversight for skilled nursing services targeting individuals with developmental disabilities.

Agency: New York State Office of Mental Health (OMH)

Role: Ensures compliance with mental and behavioral health regulations within skilled nursing care.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Offers federal oversight to ensure Medicaid-funded Skilled Nursing Services meet quality standards, patient safety, and person-centered care practices.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing Services include the delivery of clinical care by licensed healthcare professionals, focusing on health maintenance, rehabilitation, and preventive care.

Approved providers may deliver:

Wound Care: Monitoring and managing wound healing, including pressure ulcers and surgical sites.
Medication Administration: Ensuring safe and accurate medication delivery, including injections and infusions.
Chronic Disease Management: Providing ongoing care for conditions such as diabetes, hypertension, and respiratory disorders.
Health Assessments: Conducting comprehensive physical exams and health evaluations.
Rehabilitative Nursing: Supporting mobility, physical therapy, and post-operative recovery.
Patient and Family Education: Teaching self-care techniques and health management strategies.
Vital Sign Monitoring: Tracking blood pressure, glucose levels, heart rate, and respiratory function.
Care Coordination: Collaborating with healthcare teams to maintain continuity of care.
End-of-Life Care: Offering palliative and hospice care, ensuring patient comfort and dignity.
Documentation: Maintaining accurate health records and care plans.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business entity with the New York Department of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Skilled Nursing provider via the New York Medicaid Provider Enrollment Portal (eMedNY).
Maintain general and professional liability insurance.
Develop policies for clinical care, medication management, and patient safety.
Ensure nursing staff complete required background checks, health screenings, and licensure verifications.

4. NEW YORK PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application via the eMedNY Portal for Skilled Nursing Services under HCBS waivers.

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, clinical policies, and staff licensure documentation.

Program Readiness Review:

NYSDOH, OPWDD, and OMH evaluate provider readiness, including clinical protocols, patient safety measures, and staff qualifications.

Approval & Medicaid Enrollment:

Upon approval, providers are authorized to bill Medicaid for Skilled Nursing Services using designated billing codes.

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (New York Department of State)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Skilled Nursing Policy & Procedure Manual, including:
- Clinical care protocols and medication management
- Infection control measures and hygiene standards
- Staff credentialing and training records
- Documentation standards for care and Medicaid billing
- HIPAA compliance, patient rights, and safety protocols
- Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Nursing Director

Requirements: Registered Nurse (RN) license, Bachelor’s or Master’s in Nursing; experience in clinical supervision.

Role: Skilled Nurses (RNs and LPNs)

Requirements: Active state license, clinical experience in home health care or long-term care; CPR and BLS certifications.

Role: Nursing Assistants

Requirements: Certified Nursing Assistant (CNA) certification; experience in patient care and safety.

All staff must complete:

Training in infection control, medication administration, and chronic disease management
HIPAA compliance and patient rights education
Annual competency evaluations
Safety and emergency response training
Documentation and care coordination best practices