Skilled Nursing Services in Louisiana provide Medicaid waiver participants with medically necessary nursing care delivered by licensed professionals in home or community-based environments. These services are critical for individuals who require regular medical oversight, complex care management, or support with chronic conditions, enabling them to remain in their homes rather than institutional settings.

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1. GOVERNING AGENCIES

Agency: Louisiana Department of Health (LDH) — Office of Aging and Adult Services (OAAS) & Office for Citizens with Developmental Disabilities (OCDD)
Role: Defines program requirements and monitors the delivery of skilled nursing services within HCBS waivers

Agency: Medicaid Management Information System (MMIS) / Molina Medicaid Solutions
Role: Handles Medicaid provider enrollment, claims processing, and reimbursement

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight for skilled services under 1915(c) HCBS waiver programs

Agency: Managed Care Organizations (MCOs) (under Bayou Health)
Role: Authorizes skilled nursing services based on the participant’s Plan of Care (POC), coordinates care, and issues payments

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2. SERVICE OVERVIEW

Skilled Nursing Services involve professional clinical care delivered by Registered Nurses (RNs) or Licensed Practical Nurses (LPNs) under the supervision of a physician or waiver case manager.

Covered services may include:

• Medication administration and IV therapy
• Wound care and catheter maintenance
• Tube feedings and tracheostomy care
• Vital sign monitoring and skilled assessments
• Disease management for chronic conditions (e.g., diabetes, COPD, CHF)
• Health teaching and caregiver education
• Complex care coordination and reporting
• Emergency response planning and delegated nursing tasks

All services must be medically necessary, documented in the participant’s Plan of Care, and pre-authorized by the participant’s MCO or waiver case manager.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Louisiana Secretary of State
• Obtain IRS EIN and Type 2 NPI
• Secure Home Health Agency Licensure (if operating as a full agency) or enroll as an individual licensed nurse
• Enroll through the Louisiana Medicaid Provider Enrollment Portal
• Maintain professional liability and workers’ compensation insurance
• Hire and credential licensed RNs and LPNs in accordance with Louisiana State Board of Nursing (LSBN)
• Develop a Skilled Nursing Services Policy & Procedure Manual
• Implement HIPAA-compliant electronic health records and billing systems

4. LOUISIANA PROVIDER ENROLLMENT PROCESS

Step 1: Medicaid Provider Enrollment

• Apply through https://www.lamedicaid.com under the appropriate waiver service category

Step 2: Home Health Licensure (if applicable)

• Apply through the LDH Health Standards Section if operating as an agency

Step 3: Submit Supporting Documents

• Provide business documents, nursing licenses, insurance, and sample care plans

Step 4: MCO Credentialing & Case Manager Coordination

• Credential with MCOs for referrals and billing
• Coordinate with case managers to initiate care per participant-specific Plan of Care

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5. REQUIRED DOCUMENTATION

• Louisiana Articles of Incorporation or Business License
• IRS EIN and NPI confirmation
• Home Health Agency License (if applicable)
• Certificates of insurance (liability and workers’ comp)

Skilled Nursing Services Policy & Procedure Manual, including:

• Nursing assessment forms and care plan templates
• Medication administration records (MARs)
• Clinical documentation logs and shift notes
• HIPAA compliance policies and participant consent forms
• Emergency protocols and infection control procedures
• Nurse credentialing and license verification logs
• Billing logs, time sheets, and audit-ready service summaries

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6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements: Active Louisiana license through LSBN, CPR certified, clinical experience preferred

Role: Licensed Practical Nurse (LPN)
Requirements: Licensed in Louisiana, works under RN supervision, experience in long-term or complex care

Role: Nurse Supervisor or Clinical Director (for agencies)
Requirements: RN license, responsible for oversight, compliance, and supervision

All staff must complete:

• HIPAA and confidentiality training
• Abuse, neglect, and exploitation prevention protocols
• Documentation standards and Plan of Care training
• Infection control and emergency preparedness
• Annual continuing education and license renewal tracking

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7. MEDICAID PROGRAMS & HCBS WAIVERS

Skilled Nursing Services are reimbursable under:

• Residential Options Waiver (ROW)
• New Opportunities Waiver (NOW)
• Supports Waiver
• Children’s Choice Waiver
• Community Choices Waiver (CCW)
• Long-Term Personal Care Services (LT-PCS) (with authorization)
• Technology Assisted (TA) Program (via EPSDT)

Service delivery settings include:

• Participant’s home or community-based residence
• Adult day programs or school (if medically justified and authorized)

8. TIMELINE TO LAUNCH

Phase: Business Registration and Nurse Recruitment
Timeline: 1–2 months

Phase: Licensure (Home Health) and Medicaid Enrollment
Timeline: 60–90 days

Phase: Staff Credentialing and Manual Development
Timeline: 1 month

Phase: Service Launch Following MCO Approvals
Timeline: Rolling, based on referrals and participant eligibility

9. CONTACT INFORMATION

Louisiana Medicaid Provider Enrollment Portal
Website: https://www.lamedicaid.com

Louisiana State Board of Nursing (LSBN)
Website: https://www.lsbn.state.la.us

Louisiana Department of Health (LDH)
Website: https://ldh.la.gov

Health Standards Section (Home Health Licensure)
Website: https://ldh.la.gov/page/282

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10. SCOPE OF WORK

• Provider enrollment and home health licensure support
• Skilled Nursing Policy & Procedure Manual development
• Staff credentialing templates and compliance trackers
• Clinical documentation and audit-prep tools
• HIPAA-compliant charting and MAR systems
• Referral and care coordination pathways with waiver teams and physicians