SKILLED NURSING SERVICES PROVIDER IN TEXAS

Fatumata Kaba
2 days ago
3 min read

DELIVERING CLINICALLY SUPERVISED CARE IN HOME AND COMMUNITY SETTINGS TO PROMOTE HEALTH, SAFETY, AND STABILITY FOR MEDICAID WAIVER PARTICIPANTS

Skilled Nursing Services in Texas are medically necessary, clinically supervised interventions delivered by licensed nursing professionals. These services are authorized through both the Texas Medicaid State Plan and 1915(c) Home and Community-Based Services (HCBS) Waiver Programs, such as HCS, CLASS, TxHmL, DBMD, and MDCP, and are coordinated under the oversight of the Texas Health and Human Services Commission (HHSC).

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1. GOVERNING AGENCIES

Agency: Texas Health and Human Services Commission (HHSC)

Role: Oversees nursing service authorization, provider enrollment, and Medicaid reimbursement under waiver and state plan programs.

Agency: Texas Board of Nursing (BON)

Role: Regulates nursing licensure, scope of practice, and clinical standards in Texas.

Agency: Texas Department of State Health Services (DSHS)

Role: Issues licenses for Home and Community Support Services Agencies (HCSSAs), which include skilled nursing services.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Sets national requirements for Medicaid nursing services and HCBS program compliance.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing Services consist of medically necessary, goal-driven care performed by an RN or LPN/LVN under a physician’s order or care plan. These services are used to treat, manage, or monitor health conditions, prevent complications, and promote independence.

Examples of skilled interventions include:

Medication administration (including injections and IV therapy)
Wound care and dressing changes
Tracheostomy and ventilator care
Catheter and ostomy care
G-tube feeding and monitoring
Vital signs monitoring and clinical assessments
Health education and caregiver training
Coordination with primary care and specialists

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Apply for licensure as a Home and Community Support Services Agency (HCSSA) through the Texas DSHS
Enroll as a Medicaid provider via TMHP (Texas Medicaid & Healthcare Partnership)
Apply for HHSC contract approval under specific waivers (e.g., HCS, CLASS)
Ensure compliance with nurse delegation and supervision rules
Develop a Skilled Nursing Services Policy & Procedure Manual

4. TEXAS PROVIDER ENROLLMENT PROCESS

Step 1: Form your business entity, secure EIN/NPI

Step 2: Apply for a HCSSA license through DSHS, designating "Licensed and Certified Home Health Services"

Step 3: Enroll with TMHP as a Medicaid provider

Step 4: Apply for HHSC waiver contracts (HCS, CLASS, etc.)

Step 5: Complete readiness review and begin accepting physician referrals and ISP-based authorizations

5. REQUIRED DOCUMENTATION

Business registration, EIN, and NPI confirmation
HCSSA licensure from DSHS
Proof of Medicaid enrollment via TMHP
Professional liability and general insurance
Skilled Nursing Services Policy Manual including:
- Clinical protocols for skilled procedures (e.g., wound care, G-tube management)
- RN supervisory standards and nurse delegation processes
- Care planning and service documentation templates
- Emergency preparedness and infection control policies
- Incident reporting, client rights, and medication management
- Billing logs and physician order forms