SKILLED NURSING SERVICES PROVIDER IN VERMONT

Fatumata Kaba
2 days ago
4 min read

DELIVERING MEDICALLY NECESSARY NURSING CARE IN THE HOME AND COMMUNITY TO SUPPORT COMPLEX HEALTH NEEDS AND PROMOTE INDEPENDENCE

Skilled Nursing Services in Vermont offer professional, clinical support to individuals with chronic conditions, disabilities, or post-acute needs. These services are delivered by licensed nurses and are essential for individuals requiring ongoing medical oversight outside of institutional settings. Skilled Nursing is covered under Vermont Medicaid’s State Plan and Home and Community-Based Services (HCBS) Waivers. Services must be authorized through an Individual Support Plan (ISP) or physician-ordered Plan of Care and are overseen by the Department of Vermont Health Access (DVHA) and the Department of Disabilities, Aging and Independent Living (DAIL).

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1. GOVERNING AGENCIES

Agency: Department of Vermont Health Access (DVHA)

Role: Administers Medicaid billing, prior authorizations, and reimbursement for skilled nursing services.

Agency: Vermont Department of Disabilities, Aging and Independent Living (DAIL)

Role: Authorizes waiver-based nursing services, ensures compliance with HCBS ISP goals.

Agency: Vermont Secretary of State – Office of Professional Regulation (OPR)

Role: Licenses Registered Nurses (RNs) and Licensed Practical Nurses (LPNs).

Agency: Designated Agencies (DAs) / Specialized Services Agencies (SSAs)

Role: Coordinate waiver service delivery and provide authorization for ISP-based nursing supports.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing Services involve medical care delivered by an RN or LPN to address complex health needs, prevent complications, and support safe living in the home or community.

Covered services may include:

Medication administration and injections
Wound care and dressing changes
Ventilator or tracheostomy care
Catheter and ostomy care
Chronic condition monitoring (e.g., diabetes, epilepsy, seizures)
Pain and symptom management
Teaching and training caregivers or family members
Emergency response readiness (for high-risk cases)

Services must be deemed medically necessary, follow a physician’s order, and be documented per Medicaid standards.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Vermont Secretary of State
Obtain EIN and Type 2 NPI
Secure professional licenses for all nursing staff (RN, LPN)
Contract with a Designated Agency or apply for independent approval through DVHA
Develop a Skilled Nursing Policy & Procedure Manual
Obtain liability and malpractice insurance
Complete Medicaid enrollment through DVHA (if billing directly)

4. VERMONT PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI

Step 2: Apply for provider affiliation through a Designated Agency or DAIL

Step 3: Submit licensure and credentials of nursing staff

Step 4: Complete Medicaid provider enrollment with DVHA

Step 5: Submit Policy & Procedure Manual for review

Step 6: Begin service delivery upon Plan of Care or ISP authorization

5. REQUIRED DOCUMENTATION

EIN, NPI, and Articles of Incorporation
Professional licensure verification for RNs and LPNs
Medicaid enrollment confirmation (if applicable)
DA/SSA affiliation (if applicable)
Skilled Nursing Policy & Procedure Manual, including:
- Clinical care protocols and standing orders
- Medication administration and documentation standards
- Infection control, wound care, and universal precautions
- Shift note templates and nursing assessments
- Emergency procedures and on-call availability plans
- HIPAA, patient rights, and grievance policies
- Staff supervision, CEU tracking, and competency review

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements:

Vermont license from OPR
CPR certification
Skilled in assessments, care planning, and documentation
Responsible for training LPNs and aides

Role: Licensed Practical Nurse (LPN)

Requirements:

Vermont license
Provides hands-on skilled nursing care under RN direction
Must document per Plan of Care and ISP guidelines

Optional Role: Clinical Supervisor / Nurse Administrator

Responsibilities: Oversees program quality, ensures compliance, and supervises clinical staff

All staff must complete:

HIPAA and emergency response training
Infection control and documentation protocols
Annual skills check and clinical competency review
Ongoing CEUs and license renewals

7. MEDICAID WAIVER PROGRAMS

Skilled Nursing is an authorized service under:

Choices for Care (CFC) Waiver – Adults with physical disabilities or age-related needs
Developmental Disabilities Services Waiver (DDSW) – Individuals with ID/DD and medical needs
Brain Injury Program – High-needs cases requiring specialized care
Children with High-Tech Needs – Pediatric participants needing tracheostomy or vent care
Children’s Personal Care Services (CPCS) – For children requiring skilled intervention in the home

All services must be linked to the Individual Support Plan (ISP) or physician Plan of Care and reviewed regularly.

8. TIMELINE TO LAUNCH

Phase: Entity Formation & Licensing Verification

Timeline: 2–3 weeks

Phase: Policy Manual & DA/SSA Contracting

Timeline: 2–4 weeks

Phase: Medicaid Enrollment with DVHA

Timeline: 1–2 months

Phase: Staff Training & Compliance Review

Timeline: 2–3 weeks

Phase: Service Launch

Timeline: Upon authorization and physician order approval

9. CONTACT INFORMATION

Vermont Department of Disabilities, Aging and Independent Living (DAIL)

Website: https://dail.vermont.gov

Department of Vermont Health Access (DVHA)

Website: https://dvha.vermont.gov

Vermont Secretary of State – Office of Professional Regulation (OPR)

Website: https://sos.vermont.gov/opr

Designated Agencies Directory

Website: https://mentalhealth.vermont.gov/services/designated-agencies

SKILLED NURSING SERVICES PROVIDER IN VERMONT

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

WCG helps licensed professionals and clinical teams build Medicaid-compliant Skilled Nursing Services programs that align with state regulations and meet the needs of medically complex individuals across Vermont.

Scope of Work: