DELIVERING LICENSED MEDICAL CARE IN THE HOME TO SUPPORT HEALTH, SAFETY, AND INDEPENDENT LIVING FOR INDIVIDUALS WITH COMPLEX NEEDS

1. GOVERNING AGENCIES

Agency: Delaware Division of Developmental Disabilities Services (DDDS)
Role: Authorizes waiver-funded skilled nursing services for individuals with developmental disabilities

Agency: Delaware Division of Medicaid and Medical Assistance (DMMA)
Role: Administers Medicaid State Plan and waiver reimbursements for skilled care

Agency: Delaware Division of Health Care Quality
Role: Licenses Home Health Agencies and oversees nursing practice standards

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures federal compliance for Medicaid-funded home health services

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2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services consist of clinical care provided by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) based on a written physician’s order. These services help manage complex medical conditions in the home, preventing hospitalizations or nursing facility placement.

Approved providers may deliver:

• Medication administration and injections
• Wound care and catheter maintenance
• Tracheostomy or ventilator monitoring
• Tube feeding and nutritional support
• Health assessments and documentation
• Monitoring of chronic conditions (e.g., diabetes, seizure disorders)
• Coordination with caregivers and primary care physicians

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Delaware Division of Corporations
• Obtain EIN from the IRS and NPI (Type 2)
• Obtain licensure as a Home Health Agency (HHA) through the Division of Health Care Quality
• Enroll as a Medicaid provider through DMAP for skilled nursing reimbursement
• Carry malpractice, liability, and workers’ compensation insurance
• Hire and supervise licensed nurses (RN/LPN) with valid Delaware licensure
• Maintain HIPAA-compliant documentation systems and quality assurance procedures

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4. PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and obtain NPI
Step 2: Apply for HHA licensure from the Division of Health Care Quality

Submit operations plan, staffing chart, nursing protocols, and emergency policies

Complete on-site survey and compliance checks

Step 3: Enroll in Delaware Medicaid (DMAP) for billing authorization
Step 4: Apply to DDDS for approval to serve individuals under the Lifespan Waiver
Step 5: Begin accepting referrals from physicians, DDDS teams, and case managers

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5. REQUIRED DOCUMENTATION

• Articles of Incorporation or business registration
• IRS EIN Letter
• NPI confirmation
• HHA license from Delaware Division of Health Care Quality
• Medicaid provider approval and waiver authorization

Policy & procedure manual including:

• Physician orders and care plan procedures
• Medication administration and nursing documentation logs
• Infection control and safety guidelines
• Incident reporting and emergency protocols
• Staff credentialing and supervision plan
• HIPAA compliance and patient rights policy
• Quality assurance and service audit tracking forms

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6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements:

• Delaware RN license
• Experience in home health or skilled nursing
• CPR certification, TB test, and background check

Role: Licensed Practical Nurse (LPN)
Requirements:

• Delaware LPN license
• Works under RN supervision
• Clinical experience and Medicaid documentation familiarity

Role: Director of Nursing / Clinical Supervisor
Requirements:

• Active RN license
• Responsible for care oversight, staff supervision, and compliance

Training Requirements for All Staff:

• HIPAA and documentation training
• Emergency preparedness and infection control
• Abuse prevention and mandated reporting
• Annual skills verification and CEU tracking

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7. MEDICAID WAIVER SERVICES

Skilled Nursing is reimbursed under:

• Delaware Lifespan Waiver (administered by DDDS)
• Delaware Medicaid State Plan

Approved providers may deliver:

• Short-term or long-term skilled nursing services as medically necessary
• Home-based care that aligns with the participant’s service plan
• Documentation for service delivery and coordination with care teams
• Clinical oversight and quality assurance under state and federal guidelines

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8. TIMELINE TO LAUNCH

Phase: Business Formation
Timeline: 1–2 weeks

Phase: Home Health Agency Licensure
Timeline: 60–90 days

Phase: Medicaid Enrollment (DMAP)
Timeline: 30–60 days

Phase: DDDS Waiver Authorization
Timeline: 30–60 days

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9. CONTACT INFORMATION

Delaware Division of Health Care Quality – HHA Licensing
Phone: (302) 421-7400
Website: https://www.dhss.delaware.gov/dhss/dhcq

Delaware Division of Developmental Disabilities Services (DDDS)
Phone: (302) 744-9600
Website: https://dhss.delaware.gov/dhss/ddds

Delaware Division of Medicaid and Medical Assistance (DMMA)
Phone: (302) 255-9500
Website: https://dhss.delaware.gov/dhss/dmma

Delaware Medicaid Provider Enrollment (DMAP)
Website: https://www.demap.dhss.delaware.gov

10. SCOPE OF WORK

• Business registration (LLC, EIN, NPI)
• Home Health Agency licensing support and Medicaid enrollment
• Policy & procedure manual for clinical care, HIPAA, and documentation
• Templates for care plans, physician orders, medication logs, and incident forms
• Website, domain, and email setup
• Staff credentialing trackers and CEU compliance tools
• Client intake packet, consent forms, and emergency contact records
• Incident reporting systems and audit readiness tools
• Referral networking with hospitals, DDDS, and physicians