1. Program Definition and Services 

Skilled nursing services in Michigan provide 24-hour medical care and support for individuals who require rehabilitation, therapy, or ongoing medical supervision. These services are typically offered in skilled nursing facilities (SNFs) and include skilled nursing care, physical, occupational, and speech therapy, wound care, and medication management. Skilled nursing is often used for short-term recovery after hospitalization but can also be long-term for those needing ongoing care 

2. Regulations 

Key regulations governing skilled nursing services include: 

• Michigan Public Health Code: Establishes licensing requirements for nursing facilities. 

• Federal Requirements for Medicare and Medicaid: Facilities must comply with federal standards for reimbursement, including the Conditions of Participation (CoPs) for SNFs. 

• PASARR Process: Preadmission Screening and Annual Resident Review (PASARR) is required for Medicaid beneficiaries entering nursing facilities 

3. Licensing or Certification 

To operate as a skilled nursing provider, facilities must be licensed by the Michigan Department of Licensing and Regulatory Affairs (LARA). Certification is also required for participation in Medicare and Medicaid programs. 

4. Responsible State Agency 

The Michigan Department of Licensing and Regulatory Affairs (LARA) handles facility licensing, while the Michigan Department of Health and Human Services (MDHHS) oversees Medicaid services. 

5. Application Process 

Facilities must submit a state licensure application (BCHS-HFD-100) to LARA. For Medicare and Medicaid certification, facilities must meet federal CoPs and apply through the Centers for Medicare & Medicaid Services (CMS)  

6. Required Documentation 

• Business Registration Documents: Proof of business registration in Michigan. 

• Insurance and Liability Coverage: Proof of adequate insurance coverage. 

• Staff Qualifications: Documentation of staff qualifications, including training records. 

• Licensure Application: Completed BCHS-HFD-100 form. 

• CMS Certification Forms: Completed forms for Medicare and Medicaid certification. 

• PASARR Screening Forms: Completed PASARR Level I screening forms for Medicaid beneficiaries 

7. Timeline for Approval 

The approval timeline varies depending on the completeness of the application and specific requirements. Generally, it can take several weeks to a few months. 

8. Pre-Application Process 

There is no specific pre-license application process, but potential providers should familiarize themselves with state and federal regulations before applying. 

9. Pre-Application Training 

Staff must undergo ongoing training and education as required by state and federal regulations. This includes training in resident rights and care standards 

10. Additional Notes 

• Staff-to-Resident Ratios: Facilities must maintain regulated staff-to-resident ratios. 

• Quality of Care Standards: Facilities must meet quality standards for care, including regular monitoring and therapy services