SKILLED NURSING SERVICES PROVIDER IN VIRGINIA

Fatumata Kaba
3 days ago
3 min read

DELIVERING CLINICAL CARE AT HOME TO SUPPORT MEDICAL STABILITY, INDEPENDENCE, AND QUALITY OF LIFE

Skilled Nursing Services in Virginia offer medically necessary nursing care to individuals with chronic conditions, disabilities, or post-acute needs in a home or community setting. These services are essential in preventing unnecessary hospitalizations and supporting individuals who require regular clinical oversight while remaining at home.

Skilled Nursing is covered under Virginia Medicaid’s CCC Plus Waiver, Community Living (CL) Waiver, Family and Individual Supports (FIS) Waiver, and the EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) program for children. Services are regulated by the Virginia Department of Medical Assistance Services (DMAS) in partnership with the Virginia Department of Health (VDH).

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1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)

Role: Administers Medicaid coverage and enrollment for nursing services.

Agency: Virginia Department of Health (VDH)

Role: Licenses Home Health and Private Duty Nursing providers.

Agency: Managed Care Organizations (MCOs)

Role: Coordinate authorization and reimbursement under the CCC Plus program.

Agency: Community Services Boards (CSBs)

Role: Coordinate services under the CL and FIS Waivers.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing involves the delivery of clinical, hands-on care provided by licensed nurses under physician oversight.

Covered services may include:

Medication administration (oral, IM, IV)
Wound care and dressing changes
Tracheostomy or ventilator care
Catheter or ostomy maintenance
Tube feedings and suctioning
Chronic disease monitoring (e.g., diabetes, epilepsy)
Care coordination and caregiver education
RN assessments and health documentation

All services must be medically necessary and tied to a physician-ordered Plan of Care.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Virginia State Corporation Commission (SCC)
Obtain EIN and Type 2 NPI
Apply for a Home Care Organization (HCO) license from VDH
Employ a Director of Nursing (RN) to oversee care plans and supervision
Secure general liability, workers’ comp, and clinical malpractice insurance
Enroll as a Medicaid provider through DMAS via the MES portal
Contract with CSBs or MCOs, depending on the waiver

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your business, obtain EIN and NPI

Step 2: Apply for an HCO license from the Virginia Department of Health

Step 3: Hire RN Supervisor and develop skilled nursing protocols

Step 4: Enroll as a Medicaid provider via the MES portal

Step 5: Contract with MCOs (CCC Plus) or CSBs (CL/FIS Waivers)

Step 6: Begin services upon Plan of Care approval and service authorization

5. REQUIRED DOCUMENTATION

EIN, NPI, Articles of Incorporation
VDH HCO license and inspection certificate
Medicaid enrollment and provider agreement
MCO or CSB authorizations
Skilled Nursing Policy & Procedure Manual, including:
- Clinical care protocols and Plan of Care management
- RN/LPN job descriptions and supervision schedules
- Medication administration procedures
- Infection control and wound care standards
- Emergency response and reporting protocol
- Documentation templates and billing tools
- HIPAA, grievance, and patient rights compliance

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements:

Active Virginia RN license
Responsible for assessments, Plan of Care development, and staff supervision

Role: Licensed Practical Nurse (LPN)

Requirements:

Virginia LPN license
Works under RN direction; provides direct clinical care

Role: Skilled Nursing Coordinator (optional)

Responsibilities: Oversees scheduling, documentation, and quality control

All staff must complete:

CPR and First Aid certification
HIPAA and documentation training
Infection control and universal precautions
Annual skills validation and clinical competency checks

7. MEDICAID WAIVER PROGRAMS

Skilled Nursing Services are included in:

CCC Plus Waiver – For medically fragile adults requiring ongoing clinical care
Community Living (CL) Waiver – For individuals with I/DD and complex health needs
Family and Individual Supports (FIS) Waiver – Case-by-case for in-home clinical needs
EPSDT – Pediatric nursing services under age 21 for eligible children

Services must be prescribed by a physician, included in a Plan of Care, and authorized by the payer (MCO or CSB).

8. TIMELINE TO LAUNCH

Phase: Business Formation & HCO Licensing

Timeline: 2–3 months (includes VDH inspection and approval)

Phase: Medicaid Enrollment & MCO/CSB Contracts

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, & Policy Development

Timeline: 4–6 weeks

Phase: Launch of Services

Timeline: Begins upon Plan of Care approval and service authorization

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)

Website: https://www.dmas.virginia.gov

Virginia Department of Health – Home Care Licensing

Website: https://www.vdh.virginia.gov/olc/home-care/

MES Provider Portal (Medicaid Enrollment)

Website: https://vamedicaid.dmas.virginia.gov/provider

Community Services Boards Directory

Website: https://dbhds.virginia.gov/community-services-boards/

SKILLED NURSING SERVICES PROVIDER IN VIRGINIA

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

WCG assists healthcare agencies in launching fully compliant Skilled Nursing programs with clinical documentation, staffing compliance, and Medicaid readiness.

Scope of Work: