SKILLED NURSING SERVICES PROVIDER IN RHODE ISLAND

Fatumata Kaba
Oct 9
4 min read

DELIVERING MEDICALLY NECESSARY, LICENSED NURSING SUPPORT TO INDIVIDUALS WITH COMPLEX HEALTH NEEDS IN HOME AND COMMUNITY SETTINGS

Skilled Nursing Services in Rhode Island are Medicaid-reimbursed healthcare supports provided by licensed nurses to individuals with medical conditions requiring clinical oversight. These services are available under the Rhode Island Medicaid State Plan, 1115 Global Waiver, and various Home and Community-Based Services (HCBS) programs, including services for medically fragile children (Katie Beckett/TEFRA) and adults with disabilities.

1. GOVERNING AGENCIES

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

Role: Oversees Medicaid eligibility, reimbursement, and clinical service authorization.

Agency: Rhode Island Department of Health (RIDOH)

Role: Licenses home care and nursing service agencies; regulates professional nursing standards.

Agency: Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH)**

Role: Approves nursing services for IDD waiver participants (if applicable).

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

Role: Ensures federal compliance with Medicaid and HCBS nursing regulations.

2. SKILLED NURSING SERVICES OVERVIEW

These services are medically necessary and must be ordered by a physician or licensed healthcare provider. They are provided in the client’s home or other approved community-based settings.

Approved providers may deliver:

Medication Administration: Injections, IVs, and complex medication regimens.
Wound Care: Dressing changes, infection control, and post-surgical follow-up.
Chronic Disease Monitoring: Diabetes management, seizure tracking, respiratory support.
Catheter & Ostomy Care: Maintenance, education, and complication prevention.
Vital Sign Monitoring: Blood pressure, blood glucose, heart rate, respiratory function.
Education & Coordination: Client/family training, collaboration with primary care and specialists.
Shift Nursing (RN/LPN): Hourly or continuous care for high-needs individuals (e.g., ventilator-dependent).
Clinical Documentation: Progress notes, medication records, and care plan updates.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Form a home nursing agency or enroll as an independent RN/LPN provider (if eligible).
Register your business with the Rhode Island Secretary of State.
Obtain EIN and Type 2 NPI.
Apply for licensure through RIDOH as a Home Nursing Care Provider or Home Care Provider (based on services).
Secure liability and professional malpractice insurance.
Develop a Skilled Nursing Services Policy & Procedure Manual detailing nursing scope, documentation, and infection control.

4. RHODE ISLAND PROVIDER ENROLLMENT PROCESS

Step 1: Establish your legal entity, secure licensure through RIDOH, and obtain required insurance.

Step 2: Enroll with Medicaid through the RI provider portal under the appropriate provider type (e.g., RN, home care agency).

Step 3: If serving children through TEFRA or adults with IDD, coordinate with BHDDH or pediatric case managers.

Step 4: Submit documentation including care protocols, nurse credentials, and facility (if applicable).

Step 5: Begin receiving authorizations based on medical necessity and care plan approvals.

5. REQUIRED DOCUMENTATION

Articles of Incorporation and business registration
RIDOH license for nursing/home care agency
EIN and NPI confirmations
Medicaid provider enrollment confirmation
Insurance certificates (professional liability, general, workers’ comp)
Skilled Nursing Services Policy & Procedure Manual including:
- Clinical documentation templates and shift notes
- Medication administration and error reporting procedures
- Infection control and PPE usage guidelines
- Incident reporting, abuse prevention, and emergency response plans
- Staff credentialing, training logs, and nursing supervision protocols
- HIPAA compliance and participant rights policies

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements: Active RI license, CPR certification, experience in home care or chronic condition management.

Role: Licensed Practical Nurse (LPN)

Requirements: RI license, works under RN supervision, CPR certified.

Role: Clinical Supervisor / Director of Nursing

Requirements: Oversees care plans, staff compliance, and clinical documentation. Typically an RN with management experience.

All staff must complete:

HIPAA and confidentiality training
Abuse prevention and mandatory reporting
Infection control and emergency preparedness
Medication safety and nursing delegation protocols
Continuing education (per RIDOH requirements)

7. MEDICAID WAIVER PROGRAMS

Skilled Nursing Services are available through:

Medicaid State Plan (EPSDT for children, PCA/HCBS for adults)
Katie Beckett/TEFRA Program – For medically fragile children
1115 Global Waiver (HCBS) – For individuals receiving home-based long-term care
BHDDH DD Waivers – For adults with developmental disabilities needing medical oversight
Hospice and End-of-Life Waivers (if applicable)

8. TIMELINE TO LAUNCH

Phase: Business Formation & Policy Manual Development

Timeline: 1–2 months

Phase: RIDOH Licensing & Medicaid Enrollment

Timeline: 2–3 months

Phase: RN/LPN Hiring, Credentialing, and Training

Timeline: 30–60 days

Phase: Readiness Review & Service Authorization

Timeline: Begins once care plans are approved and participants assigned

9. CONTACT INFORMATION

Rhode Island Executive Office of Health and Human Services (EOHHS)

Website: https://eohhs.ri.gov

Rhode Island Department of Health (RIDOH)Home Nursing Care Licensing:

Website: https://health.ri.gov

Rhode Island Medicaid Provider Portal

Website: https://www.riproviderportal.org

Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH)

Website: https://bhddh.ri.gov

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

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

WCG supports skilled nursing providers in Rhode Island with launching and sustaining compliant, high-quality clinical services for Medicaid beneficiaries.

Scope of Work: