SKILLED NURSING SERVICES PROVIDER IN PENNSYLVANIA

Fatumata Kaba
Oct 8
4 min read

DELIVERING MEDICALLY NECESSARY CARE AT HOME TO PROMOTE HEALTH, RECOVERY, AND INDEPENDENCE

Skilled Nursing Services in Pennsylvania are Medicaid-funded, medically necessary services delivered by licensed nurses to individuals with complex health needs. These services are designed to prevent or delay institutionalization by providing clinical interventions in the individual’s home or community setting. Skilled nursing is covered under the Pennsylvania Medicaid State Plan, Home and Community-Based Services (HCBS) waivers, and Community HealthChoices (CHC) Managed Care Organizations (MCOs).

1. GOVERNING AGENCIES

Agency: Pennsylvania Department of Health (DOH) – Division of Home Health

Role: Licenses home health agencies that deliver skilled nursing care.

Agency: Pennsylvania Department of Human Services (DHS) – Office of Long-Term Living (OLTL)

Role: Oversees HCBS waiver programs that fund skilled nursing for aging and physically disabled populations.

Agency: Community HealthChoices (CHC) MCOs

Role: Authorize and reimburse for skilled nursing under managed Medicaid.

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

Role: Provides federal guidance and oversight for Medicaid and Medicare-funded skilled services.

Agency: Pennsylvania Department of State

Role: Registers healthcare entities and ensures nurse licensure compliance.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing Services are prescribed by a physician and delivered by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) under physician oversight.

Approved providers may deliver:

Medication Administration: Injections, IV therapy, and oral medication management.
Wound Care: Dressing changes, pressure sore management, and surgical site care.
Chronic Condition Monitoring: Diabetes, cardiac, respiratory, or neurological support.
Post-Acute Care: Follow-up after hospital discharge or surgery.
Care Plan Development: RN-supervised care planning in coordination with the primary physician.
Training for Family/Caregivers: Teaching medication administration, monitoring signs/symptoms.
Documentation: Skilled nursing notes, medication logs, care plan updates, and billing forms.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Pennsylvania Department of State.
Obtain an EIN and Type 2 NPI.
Apply for a Home Health Agency License through the PA Department of Health (if operating a home health model).
Enroll with PROMISe™ as a Medicaid skilled nursing provider.
Contract with CHC MCOs for waiver-eligible populations.
Maintain malpractice, liability, and workers’ compensation insurance.
Develop a Skilled Nursing Services Policy & Procedure Manual in alignment with DOH and CMS guidelines.

4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS

Step 1: Form legal entity and obtain EIN, NPI, and required insurance.

Step 2: Apply for a Home Health Agency License via DOH (if applicable).

Step 3: Enroll with PROMISe™ under provider type for skilled nursing.

Step 4: Contract with CHC MCOs (UPMC, Keystone First, PA Health & Wellness).

Step 5: Submit staff credentials, licensure, and policy documentation.

Step 6: Begin receiving authorizations and referrals upon approval.

5. REQUIRED DOCUMENTATION

Business registration and Articles of Incorporation
EIN and NPI confirmation
Home Health License (if applicable)
Nursing staff licensure and credentials
Insurance certificates (malpractice, general liability, workers’ comp)
Skilled Nursing Policy & Procedure Manual including:
- Plan of care development and clinical supervision
- Medication administration and documentation protocols
- Infection control and emergency response plans
- HIPAA compliance and patient rights
- RN and LPN supervisory requirements
- Visit note templates and electronic documentation standards
- Medicaid billing and chart audit readiness materials

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements: Active PA license; responsible for assessments, care planning, direct care, and LPN supervision.

Role: Licensed Practical Nurse (LPN)

Requirements: Active PA license; provides care under RN supervision.

Role: Clinical Supervisor / Director of Nursing

Requirements: Oversees nursing compliance, staff evaluations, and quality assurance.

All nursing staff must complete:

CPR/First Aid certification
HIPAA and abuse prevention training
Infection control and medication administration refreshers
Continuing education per PA Board of Nursing requirements
Electronic documentation and charting training

7. MEDICAID WAIVER PROGRAMS

Skilled Nursing Services are reimbursable through:

Medicaid State Plan Home Health Benefit – Physician-ordered nursing under medical necessity.
CHC Waiver (OLTL):
- Skilled nursing included in service plan authorized by CHC MCOs
Aging, Independence, and OBRA Waivers (OLTL):
- Nursing care to maintain or improve health at home
Children’s Waivers (if pediatric):
- For medically complex children (via PH-95 or MA eligibility)

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Manual Development

Timeline: 1–2 months

Phase: DOH Licensing & PROMISe™ Enrollment

Timeline: 2–4 months

Phase: MCO Contracting & Staff Credentialing

Timeline: 1–2 months

Phase: Referral Development & Service Launch

Timeline: Begins upon approval and readiness certification

9. CONTACT INFORMATION

PA Department of Health – Home Health Licensing

Website: https://www.health.pa.gov

PA DHS – Office of Long-Term Living (OLTL)

Website: https://www.dhs.pa.gov

PROMISe™ Provider Portal

Website: https://promise.dpw.state.pa.us

Community HealthChoices MCOs:

UPMC CHC – https://www.upmchealthplan.com
PA Health & Wellness – https://www.pahealthwellness.com
Keystone First CHC – https://www.keystonefirstchc.com

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

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

WCG supports healthcare agencies with launching, staffing, and maintaining high-quality skilled nursing operations in full compliance with PA Medicaid and licensing requirements.

Scope of Work: