SKILLED NURSING SERVICES PROVIDER IN WASHINGTON

Fatumata Kaba
2 hours ago
4 min read

DELIVERING LICENSED NURSING CARE TO SUPPORT MEDICAL STABILITY, INDEPENDENCE, AND QUALITY OF LIFE IN HOME AND COMMUNITY SETTINGS

Skilled Nursing Services in Washington provide licensed clinical care to individuals with complex medical needs who require ongoing monitoring, treatment, or rehabilitation. These services are critical for individuals with chronic conditions, disabilities, or after hospitalization—allowing them to receive medical care safely at home or in community-based settings, rather than in institutions.

Skilled nursing is covered under Apple Health (Washington Medicaid) as both a State Plan benefit and through Home and Community-Based Services (HCBS) waivers, including the Community First Choice (CFC) program and DDA waivers (e.g., Core, Basic Plus).

Oversight is shared by the Washington State Health Care Authority (HCA), Department of Social and Health Services (DSHS), and the Department of Health (DOH).

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1. GOVERNING AGENCIES

Agency: Washington State Department of Health (DOH)

Role: Licenses Home Health Agencies and individual nurses; ensures clinical practice standards and nursing regulations.

Agency: Health Care Authority (HCA)

Role: Manages Apple Health and Medicaid reimbursement for nursing services.

Agency: Developmental Disabilities Administration (DDA)

Role: Authorizes nursing services for waiver participants based on medical necessity.

Agency: Department of Social and Health Services (DSHS)

Role: Manages caregiver supports, provider credentialing, and training for in-home services.

2. SKILLED NURSING SERVICES OVERVIEW

These services involve licensed nurses (RNs or LPNs) providing medically necessary interventions in home or community-based settings under a physician's order.

Examples of covered skilled nursing care include:

Medication administration (including injections, IVs)
Wound care and pressure ulcer management
Catheter and ostomy care
Respiratory therapy (trach or ventilator support)
Chronic disease management and health monitoring
Pre/post-operative care
Education for patients and caregivers
Clinical documentation and plan of care adherence

All nursing care must be prescribed by a physician and documented under a Plan of Care (POC).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites (Agency):

Register the business with the Washington Secretary of State
Obtain an EIN and Type 2 NPI
Apply for a Home Health Agency license through DOH (if billing under agency model)
Complete ProviderOne enrollment as a Medicaid provider
Secure malpractice, liability, and workers’ compensation insurance
Develop a Skilled Nursing Policy & Procedure Manual per CMS and DOH standards

Prerequisites (Individual Nurses):

Active Washington RN or LPN license
Medicaid provider number
CPR certification and background check clearance
Signed agreements to provide care under physician's orders

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI

Step 2: Apply for DOH Home Health or Nurse Delegation agency license (if applicable)

Step 3: Enroll with ProviderOne under correct taxonomy (individual or agency)

Step 4: Submit credentials, insurance, and supervisory agreements

Step 5: Coordinate with DDA or case managers for referrals

Step 6: Begin services upon physician order and POC authorization

5. REQUIRED DOCUMENTATION

Business registration, EIN, NPI
DOH Home Health license (if agency model)
ProviderOne enrollment confirmation
Skilled Nursing Policy & Procedure Manual, including:
- Scope of practice for RN and LPN
- Physician order processing and POC development
- Medication administration and documentation protocols
- Infection control, PPE, and wound care procedures
- Shift documentation, charting, and communication templates
- HIPAA, incident reporting, and emergency response plans
- Staff credentialing and continuing education logs

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)Requirements:

Current WA State RN license
Oversees assessments, plan of care, and medication administration
May supervise LPNs or Home Health Aides

Role: Licensed Practical Nurse (LPN)Requirements:

WA State LPN license
Provides direct nursing care under RN supervision

Role: Nursing Supervisor / Administrator (if agency model)Responsibilities:

Ensures quality assurance, staff oversight, and compliance

All staff must complete:

HIPAA, abuse prevention, and documentation training
Universal precautions and infection control
CPR certification and annual skills competency

7. MEDICAID PROGRAMS THAT COVER SKILLED NURSING

Skilled Nursing is covered under:

Apple Health State Plan Medicaid – Short-term post-acute care under physician orders
Community First Choice (CFC) – Ongoing skilled tasks for medically fragile individuals
Basic Plus Waiver – Periodic skilled care in family settings
Core Waiver – Long-term nursing supports for individuals in residential or intensive settings
Private Duty Nursing (PDN) – For individuals needing >4 hours/day of nursing care (subject to eligibility)

All services must be listed in the participant’s Plan of Care (POC) or PCSP, with medical necessity documentation.

8. TIMELINE TO LAUNCH

Phase: Business Setup & Licensing (agency model)

Timeline: 1–2 months

Phase: DOH Application & ProviderOne Enrollment

Timeline: 2–3 months

Phase: Policy Manual & Credentialing

Timeline: 2–4 weeks

Phase: Referrals & Service Start

Timeline: Begins upon POC authorization and staffing

9. CONTACT INFORMATION

Washington State Department of Health (DOH)

Website: https://www.doh.wa.gov

Washington Health Care Authority (HCA)

Website: https://www.hca.wa.gov

Developmental Disabilities Administration (DDA)

Website: https://www.dshs.wa.gov/dda

ProviderOne Enrollment Portal

Website: https://www.waproviderone.org

Nursing Care Quality Assurance Commission

Website: https://nursing.wa.gov

SKILLED NURSING SERVICES PROVIDER IN WASHINGTON

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

WCG helps RNs, LPNs, and home health agencies launch compliant skilled nursing services with tailored policy manuals, billing systems, and clinical workflows.

Scope of Work: