Skilled Nursing Services in Georgia provide medically necessary nursing care to individuals with chronic conditions, disabilities, or complex health needs. These services are authorized under Georgia’s Medicaid Home and Community-Based Services (HCBS) waiver programs and Medicaid State Plan programs, enabling participants to receive high-quality clinical care while remaining in their homes and communities.

1. GOVERNING AGENCIES

Agency: Georgia Department of Community Health (DCH)
Role: Oversees Medicaid provider enrollment, service authorization, and reimbursement for Skilled Nursing Services

Agency: Georgia Board of Nursing
Role: Regulates licensure and practice standards for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Skilled Nursing Services meet Medicaid and Medicare home health and HCBS standards

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2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services involve clinical assessments, medical treatments, and health monitoring performed under the direction of a licensed healthcare provider.

Approved providers may deliver:

Medication administration, complex medication management, and IV therapy

• Wound care, dressing changes, and pressure sore management
• Tracheostomy care, ventilator support, and respiratory therapies
• Gastrostomy (G-tube) feeding and related interventions
• Diabetic management and insulin injections
• Catheter care and urinary system management
• Chronic disease monitoring and health education
• Emergency intervention planning and caregiver education

All services must be physician-ordered, documented in the participant’s plan of care, and delivered by appropriately licensed nursing professionals.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Georgia Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Obtain a Home Health Agency License (if operating a full agency) through DCH’s Healthcare Facility Regulation Division (HFRD) or operate under a nurse delegation model (for certain waiver services)
• Ensure nurses hold active Georgia RN or LPN licensure
• Maintain professional liability insurance and general liability insurance
• Develop clinical care policies aligned with Georgia Medicaid and Medicare standards

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4. DCH PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Skilled Nursing Services provider application through the Georgia Medicaid Management Information System (GAMMIS)
• If operating a Home Health Agency, obtain licensing through DCH HFRD first

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance documentation, staff credentialing, and clinical service policies
• Provide sample care plans, emergency protocols, and medication management documentation templates

Program Readiness Review:

• DCH reviews readiness for clinical service delivery, Medicaid documentation standards, and participant safety compliance
• Facility inspections may be required for agency-based models

Approval & Medicaid Enrollment:

• After licensing (if applicable) and documentation approval, finalize Medicaid enrollment in GAMMIS
• Set up billing codes specific to Skilled Nursing Services under State Plan and HCBS programs

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Georgia Secretary of State)
• IRS EIN confirmation
• NPI confirmation
• Home Health Agency License (if required)
• Proof of professional and general liability insurance
• Georgia Nursing Licenses for all clinical staff

DCH-Compliant Policy & Procedure Manual including:

• Participant intake, nursing assessment, and individualized care plan development
• Medication administration, respiratory support, and wound care protocols
• Incident reporting, infection control, and emergency preparedness procedures
• Client rights, HIPAA compliance, and grievance resolution policies
• Staff credentialing, competency verification, and continuing education records
• Medicaid billing, authorization tracking, and clinical documentation systems

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6. STAFFING REQUIREMENTS

Role: Director of Nursing / Clinical Supervisor
Requirements: Active Georgia RN license; at least two years of nursing experience, preferably in home health or complex care settings; background screening clearance

Role: Registered Nurses (RNs)
Requirements: Active Georgia nursing license; CPR certification; background screening clearance

Role: Licensed Practical Nurses (LPNs)
Requirements: Active Georgia nursing license; CPR certification; background screening clearance

All staff must complete:

• HIPAA confidentiality, participant rights, and abuse prevention training
• Emergency response, infection control, and incident reporting training
• Clinical competency assessments and annual skill evaluations
• Continuing education to maintain nursing licensure and Medicaid compliance

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7. MEDICAID WAIVER SERVICES

The following Georgia Medicaid Waivers and Programs authorize Skilled Nursing Services:

• Comprehensive Supports Waiver Program (COMP)
• New Options Waiver Program (NOW)
• Independent Care Waiver Program (ICWP)
• Georgia Pediatric Program (GAPP)
• Medicaid State Plan (Home Health Services)

Approved providers may deliver:

• Intermittent or continuous nursing care
• In-home medical assessments and interventions
• Caregiver education and health-related training
• Transition nursing support during hospital discharges

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8. TIMELINE TO LAUNCH

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

Phase: Home Health Agency Licensing (if applicable) and Readiness Review
Timeline: 90–120 days

Phase: Staff Hiring, Credentialing, and Clinical System Development
Timeline: 30–45 days

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

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9. CONTACT INFORMATION

Georgia Department of Community Health (DCH)
Website: https://dch.georgia.gov/

Georgia Medicaid Management Information System (GAMMIS)
Website: https://www.mmis.georgia.gov/

Georgia Board of Nursing
Website: https://sos.ga.gov/

Georgia Healthcare Facility Regulation Division (HFRD)
Website: https://dch.georgia.gov/divisionsoffices/hfrd

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10. SCOPE OF WORK

• Business registration and EIN/NPI setup
• Home Health Agency licensing support and Medicaid enrollment assistance
• Development of Skilled Nursing Services Policy & Procedure Manual
• Staff credentialing templates and clinical documentation systems
• Medicaid billing setup and claims configuration
• Website, domain, and email setup
• Participant intake, clinical assessment, and individualized plan templates
• Emergency preparedness, infection control, and quality assurance systems