1. GOVERNING AGENCIES

Agency: California Department of Health Care Services (DHCS)
Role: Administers Medi-Cal and HCBS waiver funding for skilled nursing services

Agency: California Department of Public Health (CDPH)
Role: Licenses Home Health Agencies (HHAs) and oversees compliance with Title 22 regulations

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight and ensures HCBS and skilled nursing standards are met

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2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services involve direct care delivered by a Registered Nurse (RN) or Licensed Vocational Nurse (LVN) in the home under a physician’s written order. These services are for individuals with complex medical needs who require regular clinical support to prevent institutionalization.

Approved providers may deliver:

• Medication administration and IV therapy
• Wound care, catheter care, and tracheostomy management
• Feeding tube maintenance and monitoring
• Chronic disease management (e.g., diabetes, cardiac, pulmonary)
• Skilled assessments and nursing notes
• Coordination with primary care physicians and interdisciplinary teams
• Emergency planning and health education for caregivers

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the California Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Apply for a Home Health Agency (HHA) license through CDPH
• Complete Medi-Cal enrollment for reimbursement of in-home skilled nursing
• Comply with federal Conditions of Participation if also Medicare-certified
• Carry liability insurance and workers’ compensation
• Implement HIPAA-compliant clinical documentation systems

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4. PROVIDER ENROLLMENT PROCESS

Step 1: Register your agency and obtain NPI
Step 2: Apply for Home Health Agency licensure through CDPH’s Centralized Applications Unit (CAU)

Submit business plan, staffing model, policies, and undergo a site survey

Step 3: Enroll as a Medi-Cal provider through the Provider Application and Validation for Enrollment (PAVE) portal
Step 4: Apply to provide services under HCBS Waivers (such as NF/AH Waiver) if eligible
Step 5: Begin accepting referrals from physicians, case managers, or waiver agencies

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5. REQUIRED DOCUMENTATION

• Articles of Incorporation or business registration
• IRS EIN Letter
• NPI confirmation
• CDPH HHA license and Medicare certification (if applicable)
• Medi-Cal provider number and waiver program approval

Policy & procedure manual including:

• Nursing care plans and physician order tracking
• Medication administration records and treatment logs
• Infection control and emergency preparedness
• Incident reporting and quality assurance protocols
• HIPAA compliance and patient privacy standards
• Staff credentialing, training, and clinical supervision
• Documentation for Medi-Cal and CMS audits

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6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements:

• California RN license
• Experience in home health or acute care preferred
• CPR certification, background check, and TB clearance

Role: Licensed Vocational Nurse (LVN)
Requirements:

• California LVN license
• Works under RN supervision
• Medication administration and clinical care experience

Role: Clinical Supervisor / Director of Patient Care Services (DPCS)
Requirements:

• Active California RN license
• Two or more years of clinical experience, including at least one year in home health supervision

Training Requirements for All Staff:

• HIPAA and patient confidentiality
• Documentation and billing compliance
• Infection control and emergency response
• Cultural competence and patient communication
• Annual skills verification and CEU tracking

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7. MEDICAID WAIVER SERVICES

Skilled Nursing is reimbursed through:

• California Medi-Cal (State Plan benefit)

Home and Community-Based Services Waivers, such as:

• NF/AH Waiver
• Home and Community-Based Alternatives (HCBA) Waiver

Approved providers may deliver:

• Short- or long-term nursing care based on medical necessity
• Care planning in coordination with waiver case managers
• Documentation for Level of Care reviews and ongoing eligibility
• In-home skilled services to avoid hospitalization or nursing facility placement

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8. TIMELINE TO LAUNCH

Phase: Business Formation
Timeline: 1–2 weeks

Phase: CDPH Licensing Process
Timeline: 3–6 months

Phase: Medi-Cal Enrollment
Timeline: 60–90 days

Phase: Waiver Program Application (optional)
Timeline: 30–60 days

Phase: Staffing and Referral Activation
Timeline: Ongoing

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9. CONTACT INFORMATION

California Department of Public Health (CDPH) – Licensing and Certification
Phone: (916) 558-1784
Website: https://www.cdph.ca.gov

California Department of Health Care Services (DHCS)
Phone: (800) 541-5555
Website: https://www.dhcs.ca.gov

Medi-Cal Provider Enrollment (PAVE)
Website: https://pave.dhcs.ca.gov

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10. SCOPE OF WORK

• Business registration (LLC, EIN, NPI)
• CDPH Home Health Agency licensing support
• Medi-Cal and waiver provider enrollment guidance
• Policy & procedure manual for nursing care, compliance, and documentation
• Templates for care plans, physician orders, treatment logs, and incident reports
• Website, domain, and email setup
• Staff credentialing trackers and CEU monitoring tools
• Client intake packet, consent forms, and HIPAA documents
• Audit preparation systems and waiver readiness tools
• Referral networking with hospitals, physicians, and managed care plans

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WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — CALIFORNIA SKILLED NURSING SERVICES PROVIDER

We help licensed healthcare professionals and home health agencies launch compliant Skilled Nursing Services programs under Medi-Cal and HCBS waiver programs in California.