SKILLED NURSING SERVICES PROVIDER IN OKLAHOMA

Fatumata Kaba
Sep 8
4 min read

DELIVERING MEDICALLY NECESSARY NURSING CARE TO SUPPORT HEALTH, SAFETY, AND COMMUNITY LIVING

Skilled Nursing Services in Oklahoma provide essential medical care to individuals with complex health needs who require nursing oversight in home or community-based settings. These services help individuals avoid institutional care by managing chronic conditions, providing post-acute care, and supporting long-term health goals. Skilled Nursing Services are authorized under Oklahoma Medicaid (SoonerCare) and several Home and Community-Based Services (HCBS) Waiver programs, including the Medically Fragile Waiver, ADvantage Waiver, and DDS Waivers.

1. GOVERNING AGENCIES

Agency: Oklahoma Health Care Authority (OHCA)

Role: Administers SoonerCare, oversees Medicaid provider enrollment, and processes reimbursement for skilled nursing services.

Agency: Oklahoma Department of Human Services (OKDHS) – Aging Services & DDS

Role: Coordinates waiver-based skilled nursing services for specific populations.

Agency: Oklahoma Board of Nursing (OBN)**

Role: Regulates licensure and scope of practice for registered nurses (RNs) and licensed practical nurses (LPNs).

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Ensures that skilled nursing services delivered through Medicaid meet federal standards for quality and medical necessity.

2. SKILLED NURSING SERVICES OVERVIEW

These services include direct nursing care provided under physician orders to manage medical conditions, prevent health deterioration, and deliver clinically necessary supports.

Approved providers may deliver:

Wound Care & Dressing Changes
Medication Administration & IV Therapy
Chronic Disease Monitoring (e.g., diabetes, hypertension)
Enteral Feeding & Catheter Management
Ostomy Care
Respiratory Care & Tracheostomy Support
Nursing Assessments & Health Education
Supervision of Certified Nursing Aides (if applicable)
Care Plan Documentation, Monitoring, and Reassessment
Crisis Stabilization in Home Settings

All care is delivered under a nursing plan developed in collaboration with the individual’s care team and primary physician.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your agency with the Oklahoma Secretary of State.
Obtain EIN from the IRS and NPI (Type 2 for agency, Type 1 for nurses).
Apply for OHCA Medicaid enrollment as a Skilled Nursing provider.
If operating as a home health agency, obtain Home Care licensure from the Oklahoma State Department of Health (OSDH).
Ensure all nurses are licensed and in good standing with the Oklahoma Board of Nursing (OBN).
Maintain general, professional, and malpractice insurance.
Develop a Skilled Nursing Services Policy & Procedure Manual.

4. OKLAHOMA PROVIDER ENROLLMENT PROCESS

Step 1: Business formation and legal compliance

Step 2: Apply for OSDH licensure (if offering broader home health services)

Step 3: Enroll with OHCA via the SoonerCare Provider Portal

Step 4: Submit credentials, including staff licensure, policy manuals, and documentation templates

Step 5: Upon approval, begin delivering services based on waiver program authorizations

5. REQUIRED DOCUMENTATION

Articles of Incorporation and Business License
IRS EIN and NPI registration
Insurance certificates (general, professional, workers’ comp)
Oklahoma Board of Nursing license verification for staff
Skilled Nursing Policy & Procedure Manual including:
- Plan of care development and documentation protocols
- Medication management and infection control procedures
- RN/LPN supervision guidelines and delegation standards
- HIPAA compliance and participant rights
- Emergency response, safety, and quality assurance tracking
- Medicaid billing templates and shift notes

6. STAFFING REQUIREMENTS

Role: Director of Nursing / Clinical Supervisor

Requirements: Active Oklahoma RN license; experience in home- or community-based nursing supervision.

Role: Registered Nurses (RNs)

Requirements: Oklahoma RN license; responsible for assessments, care planning, and direct skilled interventions.

Role: Licensed Practical Nurses (LPNs)**

Requirements: Oklahoma LPN license; may provide care under RN supervision.

Role: Certified Nursing Assistants (optional)**

Requirements: CNA certification; tasks must be delegated and supervised by a nurse in accordance with state regulations.

All staff must complete:

HIPAA and documentation training
Annual skills competency checks
Emergency preparedness and infection control modules
Background checks and health screenings per OSDH or waiver requirements

7. MEDICAID WAIVER PROGRAMS

Skilled Nursing Services are available under:

Medically Fragile Waiver – intensive skilled care at home
ADvantage Waiver – limited skilled nursing support as part of the care plan
DDS Waivers (Community, IHSW) – for individuals with medical/behavioral complexities
Living Choice Program – supports individuals transitioning from institutions
SoonerCare State Plan – home health or intermittent skilled nursing for qualifying conditions