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1. GOVERNING AGENCIES

Agency: Michigan Department of Health and Human Services (MDHHS)
Role: Oversees Medicaid-funded skilled nursing services and HCBS waiver compliance

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight and funding through 1915(c) waivers and Medicaid state plans

Agency: Michigan Board of Nursing
Role: Licenses Registered Nurses (RNs) and Licensed Practical Nurses (LPNs), ensuring adherence to professional standards

Agency: Michigan Department of Licensing and Regulatory Affairs (LARA)
Role: Issues licenses to home health agencies providing skilled nursing care

Agency: Local Area Agencies on Aging (AAA)
Role: Coordinate skilled nursing under the MI Choice Waiver for seniors and adults with disabilities

2. SKILLED NURSING SERVICE OVERVIEW

Skilled nursing services involve clinical care provided by licensed nurses (RNs and LPNs) to manage and treat medical conditions at home. These services are typically prescribed by a physician and documented in the client’s Plan of Care (POC).

Services may include:

• Medication administration and intravenous therapy
• Wound care and dressing changes
• Catheter care, ostomy maintenance, and enteral feeding
• Pain management and palliative care
• Chronic disease monitoring (e.g., diabetes, hypertension)
• Health assessments and vital sign monitoring
• Care coordination with physicians and specialists
• Client and caregiver education on medical management

Skilled nursing services are time-limited, based on medical necessity, and must be delivered according to a physician’s order.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Michigan Department of Licensing and Regulatory Affairs (LARA)
• Obtain IRS EIN and Type 2 NPI
• Secure general liability and professional malpractice insurance
• Obtain a Home Health Agency License from LARA
• Ensure all nurses are licensed by the Michigan Board of Nursing
• Develop HIPAA-compliant policies and clinical protocols
• Conduct background checks and verify nursing credentials

Clinical Licensing:
 

• All RNs and LPNs must have active Michigan nursing licenses and be in good standing with the Board of Nursing.

4. PROVIDER ENROLLMENT PROCESS

Step 1: Apply for a Home Health Agency License
Submit your application via LARA's Licensing Portal

Step 2: Enroll with Michigan Medicaid
Apply through the CHAMPS system:
CHAMPS Login

Step 3: Credentialing for MI Choice Waiver and HCBS Programs
Register as a waiver provider through local Area Agencies on Aging (AAAs) and MDHHS

Step 4: Prepare for State and Federal Inspections
Ensure compliance with safety, staffing, and clinical documentation standards

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or DBA registration
• IRS EIN and NPI confirmations
• Proof of LARA home health agency license
• Proof of liability and malpractice insurance

Skilled Nursing Services Policy & Procedure Manual, including:

• Care planning and physician order templates
• Clinical progress notes and patient assessment forms
• Medication administration records (MARs)
• Infection control protocols and emergency plans
• HIPAA compliance and data security measures
• Training logs and staff credential verification
• Billing documentation and compliance records

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements: Active Michigan RN license, CPR certification, clinical experience, CORI background check

Role: Licensed Practical Nurse (LPN)
Requirements: Valid LPN license in Michigan, supervised by RN, experience in home care preferred

Role: Director of Nursing (DON)
Requirements: RN license with supervisory experience, oversees clinical policies and quality assurance

Required Trainings:

• Infection control and universal precautions
• Medication administration and management
• Wound care and chronic disease management
• Pain management and palliative care
• HIPAA and patient confidentiality
• Abuse, neglect, and mandatory reporting

7. MEDICAID & HCBS WAIVER PROGRAMS COVERING SKILLED NURSING

Skilled nursing is covered under:

• MI Choice Waiver Program (for elderly and adults with disabilities)
• Medicaid State Plan Home Health Services
• Habilitation Supports Waiver (HSW) (for individuals with developmental disabilities)
• Community Mental Health (CMH) Programs (for behavioral health support)
• Medicare (if client qualifies)

Providers may bill for:

• Hourly nursing care
• Complex medical interventions (e.g., infusions, wound care)
• RN supervision and care planning
• Post-hospitalization transitional care
• Chronic disease monitoring and management

8. TIMELINE TO LAUNCH

Phase: Business Registration and Insurance Setup
Timeline: 2–3 weeks

Phase: LARA Licensing and Medicaid Enrollment
Timeline: 2–4 months

Phase: Staff Hiring and Credential Verification
Timeline: 1–2 months

Phase: Clinical Policy Manual and Compliance Setup
Timeline: 1 month

Phase: Client Intake and Service Initiation
Timeline: Ongoing based on physician referrals and care plan authorizations

9. CONTACT INFORMATION

Michigan Medicaid Provider Enrollment (CHAMPS)
https://milogintp.michigan.gov/

​Michigan Department of Health and Human Services (MDHHS)
https://www.michigan.gov/mdhhs

​Michigan Department of Licensing and Regulatory Affairs (LARA)
https://www.michigan.gov/lara

​Michigan Board of Nursing
https://www.michigan.gov/lara

​Area Agency on Aging (AAA) Locator
https://www.michigan.gov/osa

10. SCOPE OF WORK

• Business setup and LARA licensing guidance
• Medicaid and MI Choice waiver enrollment support
• Skilled Nursing Policy & Procedure Manual development
• Clinical staffing models and compliance monitoring
• Nurse training and credentialing templates
• Referral network development with hospitals and case managers
• Billing and documentation systems for Medicaid and Medicare