1. GOVERNING AGENCIES

Agency: Alabama Department of Mental Health (ADMH)
Role: Approves and monitors Skilled Nursing providers under HCBS Waivers

Agency: Alabama Medicaid Agency
Role: Administers Medicaid enrollment, billing, and compliance for waiver services

​Agency: Alabama Board of Nursing
Role: Licenses Registered Nurses (RNs) and Licensed Practical Nurses (LPNs), and enforces nursing practice standards

​Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight for Medicaid-funded skilled services

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2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services are prescribed medical services provided by licensed nursing professionals. These services are designed to help individuals with IDD manage chronic medical conditions, recover from illness or surgery, or maintain health stability in the community.

Approved Skilled Nursing providers may deliver:

• Medication administration and monitoring
• Tube feedings and nutrition care
• Wound care and dressing changes
• Catheter care and other medical procedures
• Health assessments and monitoring of chronic conditions
• Education and training of caregivers on medical needs
• Coordination with physicians and interdisciplinary teams

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your agency with the Alabama Secretary of State
• Obtain an EIN from the IRS and a Type 2 NPI
• Maintain a physical business location in Alabama
• Employ RNs and/or LPNs with current licenses from the Alabama Board of Nursing
• Develop policies aligned with nursing practice standards and ADMH regulations
• Ensure staff training and documentation meet HCBS requirements

4. ADMH PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Request Skilled Nursing Provider Application Packet from ADMH
• Submit business plan, scope of nursing services, and staffing plan
• Include policy and procedure manual and care coordination strategy

Background & Credentialing:

• Conduct fingerprint-based criminal background checks for all staff
• Verify nursing licenses and certifications
• Screen for abuse/neglect registry and drug use

Program Review and Site Readiness (if applicable):

• Review documentation systems and clinical protocols
• Ensure medical records management and HIPAA compliance
• Provide staff training plans, supervision structure, and QA procedures

Approval & Medicaid Enrollment:

• Once ADMH-approved, enroll with Alabama Medicaid as a Skilled Nursing Waiver provider
• Add appropriate HCBS service codes for Skilled Nursing

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or LLC Certificate
• IRS EIN Letter
• NPI Confirmation
• Lease or deed for physical office site
• Alabama Board of Nursing licenses for all RNs/LPNs
• Certificate of General and Professional Liability Insurance

ADMH-Compliant Policy & Procedure Manual, including:

• Medication administration and delegation
• Wound care protocols
• Infection control procedures
• Emergency medical procedures
• HIPAA compliance and confidentiality
• Supervision, documentation, and quality monitoring
• Coordination with physicians and IDT (Interdisciplinary Team)
• Client intake, physician orders, and skilled nursing documentation forms
• Staff orientation and clinical training records

6. STAFFING REQUIREMENTS

Role: Director of Nursing (DON)
Requirements: Licensed RN in Alabama with clinical management experience

Role: Registered Nurse (RN)
Requirements: Active Alabama license; responsible for assessments, care planning, training, and supervision

Role: Licensed Practical Nurse (LPN)
Requirements: Active Alabama license; provides delegated care under RN supervision

All staff must complete:

• ADMH orientation and HCBS nursing training
• Annual competency reviews and continuing education
• HIPAA, infection control, emergency care, and documentation training

7. MEDICAID WAIVER SERVICES

The following Alabama Medicaid Waivers include Skilled Nursing:

• ID Waiver (Intellectual Disabilities Waiver)
• LAH Waiver (Living at Home Waiver)
• State of Alabama Community Waiver Program

Approved Skilled Nursing Providers may deliver:

• Intermittent or continuous nursing care
• Specialized nursing procedures ordered by a physician
• Care coordination and health monitoring services
• Delegated nursing tasks as allowed by state regulations

8. TIMELINE TO LAUNCH

Phase: Business Formation
Timeline: 0–1 week

Phase: ADMH Application Review
Timeline: 60–120 days

Phase: Clinical Readiness and Quality Review
Timeline: 30–60 days

Phase: Medicaid Enrollment
Timeline: 60–90 days

9. CONTACT INFORMATION

Alabama Department of Mental Health (ADMH) – Division of Developmental Disabilities
Email: ddprovider@mh.alabama.gov
Phone: (334) 242-3702
Website: https://mh.alabama.gov

Alabama Medicaid Agency – Waiver Services
Website: https://medicaid.alabama.gov

Alabama Board of Nursing
Website: https://www.abn.alabama.gov

10. SCOPE OF WORK

• Business formation (LLC, EIN, NPI)
• ADMH application and compliance assistance
• Development of nursing-based Policy & Procedure Manual
• Staffing plan and clinical documentation templates
• License verification support and training guidance
• Medicaid enrollment and waiver service code setup
• Mock audit and readiness checks for clinical operations
• Ongoing compliance support and quality assurance coaching