DELIVERING PROFESSIONAL MEDICAL CARE TO SUPPORT HEALTH, INDEPENDENCE, AND COMMUNITY LIVING FOR INDIVIDUALS WITH COMPLEX NEEDS

1. GOVERNING AGENCIES

Agency: Connecticut Department of Social Services (DSS)
Role: Oversees Medicaid enrollment, authorizations, and compliance for Skilled Nursing Services

Agency: Connecticut Department of Public Health (DPH)
Role: Licenses and regulates nursing agencies and home health care providers

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight, ensuring compliance with Medicaid HCBS rules and quality standards

2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services include medical and nursing interventions ordered by a physician and tailored to meet the specific clinical needs of individuals in their home or community setting.

Approved providers may deliver:

• Medication administration and complex medication management
• Wound care, pressure ulcer treatment, and post-surgical care
• Tracheostomy care and ventilator management
• Catheter care and bowel program management
• Diabetic care including insulin administration and blood glucose monitoring
• Enteral feeding and G-tube management
• Clinical assessments and monitoring of chronic conditions
• Education and training for participants and caregivers
• Care coordination with physicians, therapists, and interdisciplinary teams

All services must be provided by Registered Nurses (RNs) or Licensed Practical Nurses (LPNs) and follow the participant’s individualized service plan.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Connecticut Secretary of the State
• Obtain EIN from the IRS and NPI (Type 2)
• Obtain a Home Health Care Agency or Nursing Registry license from the Connecticut Department of Public Health (if providing skilled services in participant homes)
• Employ Connecticut-licensed RNs and/or LPNs
• Maintain professional liability and general business insurance
• Develop clinical service policies aligned with Connecticut nursing standards and Medicaid HCBS rules

4. DSS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Request Skilled Nursing Services provider application materials from Connecticut DSS
• (Recommended) Attend DSS provider orientation webinars or sessions

Application and Documentation Submission:

• Submit agency licensure, organizational documents, staff rosters with licensure verification, and clinical service descriptions
• Provide sample care plans, medication administration records, and emergency response protocols
• Include background check documentation and staff training records

Program Readiness Review:

• DSS reviews licensing, staffing, and documentation processes
• May require on-site or virtual audit of compliance systems
• Verifies emergency preparedness plans, HIPAA compliance, and participant rights protections

Approval & Medicaid Enrollment:

• Upon DSS approval, enroll as a Medicaid provider through Connecticut’s Medicaid Management Information System (MMIS)
• Finalize service codes selection and configure claims processing systems

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5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License
• IRS EIN confirmation
• NPI confirmation
• Home Health Agency or Nursing Registry license (if applicable)
• Professional liability and general insurance coverage

DSS-Compliant Policy & Procedure Manual including:

• Participant intake and nursing assessment procedures
• Clinical service delivery and care planning policies
• Medication management and administration procedures
• Emergency response and incident management protocols
• Client rights, privacy policies, and HIPAA compliance documentation
• Staff background checks, licensing verification, and annual training logs
• Quality assurance and service improvement plans
• Medicaid billing, authorization tracking, and documentation retention policies

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6. STAFFING REQUIREMENTS

Role: Nursing Services Administrator
Requirements: Active Connecticut RN license; experience in home health management; background check clearance

Role: Registered Nurse (RN)
Requirements: Current Connecticut RN license; CPR certification; background check clearance

Role: Licensed Practical Nurse (LPN)
Requirements: Current Connecticut LPN license; CPR certification; background check clearance

All staff must complete:

• DSS and Medicaid service documentation training
• Emergency procedures, infection control, and abuse prevention training
• Annual competency evaluations and clinical continuing education
• HIPAA and confidentiality training

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7. MEDICAID WAIVER SERVICES

The following Connecticut Medicaid Waivers authorize Skilled Nursing Services:

• Connecticut Home Care Program for Elders (CHCPE)
• Acquired Brain Injury (ABI) Waivers I and II
• Connecticut Mental Health Waiver
• Katie Beckett Waiver (for medically complex children)
• Personal Care Assistance Waiver (with skilled nursing components if authorized)

Approved providers may deliver:

• In-home skilled nursing services as part of person-centered service plans
• Clinical assessments, medication administration, and chronic disease management
• Coordination with case managers and healthcare providers
• Training and support for family members and informal caregivers

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8. TIMELINE TO LAUNCH

Phase: Business Formation and Licensing Setup
Timeline: 3–4 weeks

Phase: Connecticut DPH Licensing and Compliance Review (if required)
Timeline: 90–120 days

Phase: DSS Medicaid Application and Program Readiness Review
Timeline: 60–90 days

Phase: Staff Hiring, Training, and Clinical Systems Implementation
Timeline: 30–45 days

Phase: Medicaid Enrollment and Claims System Setup
Timeline: 45–60 days

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9. CONTACT INFORMATION

Connecticut Department of Social Services (DSS)
Website: https://portal.ct.gov/DSS

Connecticut Department of Public Health (DPH) – Facility Licensing and Investigation Section
Website: https://portal.ct.gov/DPH

Connecticut Medicaid Provider Enrollment Portal (Gainwell Technologies MMIS)
Website: https://www.ctdssmap.com/CTPortal/

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10. SCOPE OF WORK

• Business registration and EIN/NPI setup
• DPH licensing support for Home Health Agencies or Nursing Registries
• DSS provider application and Medicaid documentation assistance
• Development of Skilled Nursing Policy & Procedure Manual
• Staff credentialing templates and clinical documentation forms
• Medicaid billing setup and authorization management tools
• Website, domain, and email setup
• Participant intake and individualized care plan packet creation
• Emergency response and quality assurance system templates
• Referral networking and healthcare provider outreach strategies

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

We help home health agencies and healthcare entrepreneurs launch Medicaid-compliant Skilled Nursing Services under Connecticut’s HCBS Waiver programs.