1. GOVERNING AGENCIES

Agency: Missouri Department of Health and Senior Services (DHSS)

Role: Administers Medicaid and HCBS Waiver programs, including skilled nursing services

Agency: Missouri Department of Social Services (DSS)

Role: Oversees Medicaid provider enrollment and service authorization

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight and ensures waiver compliance

2. SKILLED NURSING SERVICE OVERVIEW

Skilled Nursing Services focus on delivering clinical care at the client's home, tailored according to the Individual Service Plan (ISP) or Person-Centered Plan (PCP). Services may include:

• Wound care and dressing changes
• Medication administration and management
• IV therapy and injections
• Chronic disease management (e.g., diabetes, COPD)
• Health monitoring and vital sign tracking
• Patient and caregiver education
• Coordination with primary care providers

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Missouri Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Enroll as a Medicaid provider with the Missouri Department of Social Services
• Obtain a Home Health Agency License from the Missouri Department of Health and Senior Services
• Maintain liability insurance and clinical staff documentation

4. MEDICAID PROVIDER ENROLLMENT PROCESS

Step 1: Pre-Application Contact

• Contact the Missouri Department of Social Services for skilled nursing provider requirements

Step 2: Application Submission

• Submit business registration, home health agency license, liability insurance, and service descriptions

Step 3: License Verification

• Obtain and verify the Home Health Agency License

Step 4: Approval and Medicaid Number Assignment

• Once approved, receive a Medicaid provider number and authorization to deliver services

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business Name Registration
• IRS EIN Letter
• NPI confirmation
• Home Health Agency License
• Liability insurance certificate

Policy & procedure manual including:

• Clinical care protocols and patient safety guidelines
• Medication management and administration procedures
• Infection control and hygiene practices
• Documentation of care and patient progress logs
• Staff training and competency assessment records

6. STAFFING REQUIREMENTS

Role: Skilled Nursing Program Manager

Requirements: Licensed Registered Nurse (RN) with experience in home healthcare management

Role: Registered Nurse (RN) / Licensed Practical Nurse (LPN)

Requirements:

• Nursing degree and active license
• CPR/First Aid certification
• Background check and TB clearance

Training Requirements:

• Infection control and patient safety practices
• Medication administration and documentation
• Chronic disease management techniques
• Emergency response and client safety

7. TIMELINE TO LAUNCH

Skilled Nursing Services in Missouri are available through:

• Aged and Disabled Waiver (ADW)
• Independent Living Waiver
• Medically Fragile Adult Waiver

Approved providers may deliver:

• In-home nursing care and medical monitoring
• Chronic disease management and patient education
• Coordination with healthcare teams and primary care providers

8. TIMELINE TO LAUNCH

Phase: Business Formation

Timeline: 1–2 weeks

Phase: Medicaid Provider Enrollment

Timeline: 60–90 days

Phase: Staff Hiring and Training

Timeline: 30–45 days

Phase: Clinical Setup and Safety Compliance

Timeline: 2–4 weeks

9. CONTACT INFORMATION

Missouri Department of Health and Senior Services (DHSS)

Website: https://health.mo.gov

Missouri Department of Social Services (DSS)

Website: https://mydss.mo.gov

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10. SCOPE OF WORK

• Business registration and licensing assistance
• Medicaid provider enrollment
• Policy & procedure manual for skilled nursing operations
• Templates for care plans, medication logs, and patient progress notes
• Website, domain, and email setup
• Staff credentialing and training documentation
• Client intake packet and health assessment forms
• Risk management and infection control protocols
• Referral networking with healthcare providers and community organizations