1. GOVERNING AGENCIES

Agency: Arizona Health Care Cost Containment System (AHCCCS)
Role: Oversees Medicaid enrollment, service authorization, and reimbursement for Skilled Nursing Services

Agency: Arizona Department of Economic Security (DES) – Division of Developmental Disabilities (DDD) (for DDD members)
Role: Coordinates skilled nursing supports for individuals with developmental disabilities

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring that skilled nursing services comply with Medicaid HCBS guidelines

2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services provide clinical interventions based on physician orders, designed to address specific health conditions and promote individual health, wellness, and stability.

Approved providers may deliver:

• Medication administration and complex medication management
• Wound care and treatment of pressure ulcers
• Tracheostomy care and ventilator support
• Catheter care and management
• Gastrostomy (G-tube) care and enteral nutrition
• Diabetes management, including insulin administration
• Chronic disease monitoring and clinical assessments
• Training caregivers on health support procedures
• Coordination with physicians, therapists, and case managers

Services must be provided by licensed nurses (Registered Nurses [RNs] or Licensed Practical Nurses [LPNs]) and comply with an individualized person-centered service plan.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Arizona Corporation Commission
• Obtain EIN from the IRS and NPI (Type 2)
• Employ licensed RNs and/or LPNs with active Arizona Board of Nursing licenses
• Secure malpractice insurance and liability coverage
• Develop clinical protocols and policies aligned with Arizona nursing standards
• Ensure compliance with HIPAA and Medicaid documentation standards

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4. AHCCCS/DDD PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Request Skilled Nursing Provider application materials from AHCCCS or DDD
• (Recommended) Attend Medicaid or HCBS provider orientation sessions

Application and Documentation Submission:

• Submit business documents, staffing rosters, clinical service descriptions, and liability insurance proof
• Provide sample nursing care plans, incident reporting protocols, and emergency procedures
• Submit background checks and licensing verification for all clinical staff

Program Readiness Review:

• AHCCCS and/or DDD review staffing qualifications, policies, and operational readiness
• May require demonstration of clinical documentation systems and quality assurance processes

Approval & Medicaid Enrollment:

• Upon approval, complete Medicaid enrollment with AHCCCS
• Contract with Medicaid Managed Care Organizations (MCOs) and/or DDD for service delivery
• Configure billing systems and Medicaid claims processes

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5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License
• IRS EIN confirmation
• NPI confirmation
• RN and/or LPN licensure verification
• Liability insurance and malpractice coverage proof

Policy & Procedure Manual including:

• Participant intake and clinical assessment protocols
• Skilled service documentation procedures
• Medication administration policies
• Emergency medical response and reporting procedures
• Resident/client rights, HIPAA privacy compliance, and informed consent policies
• Staff background checks, credentials, and continuing education records
• Incident tracking, infection control policies, and quality assurance systems
• Medicaid billing, service authorization, and claim tracking systems

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6. STAFFING REQUIREMENTS

Role: Nursing Supervisor (RN)
Requirements: Active Arizona RN license, supervisory experience in clinical care settings, Medicaid familiarity

Role: Skilled Nurse (RN or LPN)
Requirements: Current Arizona nursing license, CPR certification, background check clearance

All staff must complete:

• Medicaid HCBS and DDD service documentation training
• Emergency preparedness and infection control training
• Annual continuing education and skills competency assessments
• Training in person-centered planning and client rights protection

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7. MEDICAID WAIVER SERVICES

The following Arizona Medicaid Waivers authorize Skilled Nursing Services:

• Arizona Long Term Care System (ALTCS) – Elderly and Physically Disabled (EPD) Program
• ALTCS – Developmental Disabilities (DD) Program

HCBS Waivers under AHCCCS and DDD programs

Approved providers may deliver:

• In-home or facility-based skilled nursing interventions
• Clinical assessments and ongoing health monitoring
• Training for family members and caregivers
• Participation in interdisciplinary care team meetings and service plan updates

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8. TIMELINE TO LAUNCH

Phase: Business Formation and Initial Setup
Timeline: 2–3 weeks

Phase: AHCCCS/DDD Application and Readiness Review
Timeline: 60–90 days

Phase: Staff Hiring, Training, and Clinical Protocol Finalization
Timeline: 30–45 days

Phase: MCO Contracting and Medicaid Claims Configuration
Timeline: 45–60 days

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9. CONTACT INFORMATION

Arizona Health Care Cost Containment System (AHCCCS)
Website: https://www.azahcccs.gov/

Arizona Department of Economic Security – Division of Developmental Disabilities (DDD)
Website: https://des.az.gov/services/disabilities/developmental-disabilities

Arizona Medicaid Provider Enrollment Portal
Website: https://www.azahcccs.gov/PlansProviders/NewProviders/

10. SCOPE OF WORK

• Business registration and EIN/NPI setup
• AHCCCS/DDD provider application and documentation support
• Development of Skilled Nursing Policy & Procedure Manual
• Staff credentialing, tracking, and clinical documentation templates
• Medicaid enrollment, MCO contracting, and billing configuration
• Website, domain, and email setup
• Client intake and care plan documentation packets
• Emergency response and incident reporting templates
• Quality assurance and compliance management tools
• Referral networking and clinical service expansion strategies

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

We support healthcare entrepreneurs, clinicians, and home health agencies in launching Medicaid-compliant Skilled Nursing Services under Arizona’s HCBS Waiver programs and ALTCS.