Nursing Agency Application
We want to partner with you to help medically complex children thrive in their home!
Our staff helps coordinate and monitor in-home shift nursing services for Illinois children and young adults through the Home Care Program.
It’s easy to become one of our approved nursing agencies. We need the following information:
- Training & experience information (Initial Nursing Agency Information Sheet)
- Home Nursing Agency license
For licensure assistance, please visit the Illinois Department of Public Health website.
- Tax information (DSCC form or W-9)
For certified vendor assistance, visit the Illinois State Comptroller’s website.
- Home Nursing Agency provider with the subspecialty of Nursing Services in the Illinois Medicaid Program Advanced Cloud Technology (IMPACT)
For enrollment assistance, visit the IMPACT website.
We look forward to answering your questions and assisting you with the application process.