SKILLED NURSING SERVICES PROVIDER IN TENNESSEE

Fatumata Kaba
3 days ago
3 min read

DELIVERING CLINICALLY NECESSARY CARE IN THE HOME OR COMMUNITY TO SUPPORT HEALTH, STABILITY, AND INDEPENDENCE

Skilled Nursing Services in Tennessee are medically necessary, licensed nursing services provided in a participant’s home or community setting. These services are authorized under TennCare’s State Plan Home Health Benefit, the Employment and Community First (ECF) CHOICES program, and certain 1915(c) Waivers for individuals with chronic conditions, disabilities, or complex medical needs. Services must be performed by a licensed nurse (RN or LPN) and are generally ordered by a physician or incorporated into a person-centered support plan.

1. GOVERNING AGENCIES

Agency: TennCare (Tennessee Medicaid)

Role: Administers Medicaid reimbursement for Skilled Nursing through the State Plan, ECF CHOICES, and other HCBS waiver programs.

Agency: Tennessee Department of Health (DOH)

Role: Licenses home health agencies and regulates nursing scope of practice.

Agency: Tennessee Department of Intellectual and Developmental Disabilities (DIDD)

Role: Oversees providers serving people with I/DD under waivers such as ECF CHOICES and legacy 1915(c) waivers.

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

Role: Ensures compliance with federal Medicaid guidelines for Skilled Nursing Services.

2. SKILLED NURSING SERVICES OVERVIEW

These services must be medically necessary and provided by licensed professionals under a plan of care or Individualized Service Plan (ISP). Services are typically intermittent, though continuous nursing may be authorized in exceptional cases.

Covered services include:

Medication Administration (oral, injectable, IV)
Wound and Ostomy Care
Tube Feeding and Tracheostomy Suctioning
Vital Signs Monitoring and Chronic Disease Management
Catheter Care and Skin Integrity Monitoring
Health Assessments and Nursing Documentation
Coordination with Physician or Care Team

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Form a legal business entity with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Apply through TennCare for Medicaid provider status
If providing under a home health model, obtain DOH Home Health Agency License
For waiver programs, register with DIDD as a Skilled Nursing provider
Maintain professional liability and general insurance
Develop a Skilled Nursing Services Policy & Procedure Manual

4. TENNESSEE PROVIDER ENROLLMENT PROCESS

Step 1: Form business and acquire EIN/NPI

Step 2: Apply to TennCare for State Plan Medicaid enrollment or to DIDD for waiver-based skilled nursing

Step 3: If applicable, obtain DOH license as a Home Health Agency

Step 4: Submit staffing rosters, credentials, and service descriptions

Step 5: Begin services after authorization and care plan approval

5. REQUIRED DOCUMENTATION

Articles of Incorporation, EIN, NPI
DOH Home Health License (if applicable)
RN/LPN licensure and current CPR/BLS certification
Skilled Nursing Services Policy Manual including:
- Physician order process and care coordination
- Medication administration protocols
- Infection control and emergency procedures
- Documentation and billing logs
- Participant rights and HIPAA protections
- Delegation (LPN) and supervision (RN) protocols

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements: Tennessee RN license, experience in home/community care, CPR/BLS certification

Role: Licensed Practical Nurse (LPN)

Requirements: Tennessee LPN license; must operate under RN supervision

Optional Role: Clinical Supervisor or Director of Nursing

Requirements: RN with administrative oversight of care planning and quality assurance

All clinical staff must complete:

HIPAA, infection control, and documentation training
Emergency and medication error protocols
Participant-specific orientation and plan of care review
Annual license verification and CEU tracking

7. MEDICAID WAIVER PROGRAMS & COVERAGE OPTIONS

Skilled Nursing is available under:

TennCare State Plan Home Health Services – For acute or chronic needs with physician orders
ECF CHOICES – Skilled nursing tasks may be part of a participant’s ISP
1915(c) Waivers – For children and adults with disabilities or complex care needs
EPSDT (under 21) – May authorize extended skilled care for medically fragile youth
Katie Beckett Program – For medically complex children not otherwise Medicaid-eligible

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensure (if applicable)

Timeline: 1–2 months

Phase: Medicaid/DIDD Enrollment

Timeline: 2–3 months

Phase: Nurse Credentialing & Compliance Documentation

Timeline: 1–2 months

Phase: Service Delivery Start

Timeline: Upon referral and care plan authorization

9. CONTACT INFORMATION

TennCare (Tennessee Medicaid Program)

Website: https://www.tn.gov/tenncare

Tennessee Department of Health (DOH)

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

Tennessee Department of Intellectual and Developmental Disabilities (DIDD)

Website: https://www.tn.gov/didd

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

SKILLED NURSING SERVICES PROVIDER IN TENNESSEE

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

WCG partners with nurses, home health entrepreneurs, and community providers to launch Medicaid-approved skilled nursing operations tailored for waiver and home health models.

Scope of Work: