How to start a skilled nursing facility in Oklahoma

Oklahoma requires a Nursing facility (or specialized facility) license from Oklahoma State Department of Health, Protective Health Services — Health Facility Systems to operate a skilled nursing facility. Fee: $10 per licensed bed per year. Initial license is issued for 180 days: fee = beds × $10 × 0.5. CON: $3,000 for new applications; acquisitions 0.5% of capital cost up to $5,000.

License required

Yes

License

Nursing facility (or specialized facility) license

Issuing agency

Oklahoma State Department of Health, Protective Health Services — Health Facility Systems

Fee

$10 per licensed bed per year. Initial license is issued for 180 days: fee = beds × $10 × 0.5. CON: $3,000 for new applications; acquisitions 0.5% of capital cost up to $5,000.

Renewal

Every 3 years · Licenses renew every three years: beds × $10 × 3.

Certificate of need

Required

Medicare certification

Separate from the state license. The state survey agency runs an unannounced standard health survey, a Life Safety Code survey and an emergency-preparedness survey against 42 CFR Part 483 Subpart B. For a Medicare SNF the state certifies and the CMS Location decides Medicare participation; for a Medicaid-only NF the state's certification is final and the state Medicaid agency decides participation.

Regulation

OAC 310:675 (Nursing and Specialized Facilities); 63 O.S. §1-851 et seq. (Long-Term Care Certificate of Need Act); OAC 310:4

1. Obtain a Long-Term Care Certificate of Need from OSDH (new construction, beds or acquisitions)
2. File the license application with the per-bed filing fee
3. Receive a 180-day initial license and pass the licensure survey
4. Renew every three years
5. For Medicare/Medicaid, complete federal certification and enroll with SoonerCare

Program

SoonerCare (Oklahoma Health Care Authority, OHCA), including SoonerSelect managed care

Enrollment portal

OHCA Provider Portal (ohcaprovider.com) — online provider contracting

Application fee

OAC 317:30-3-19.4 sets the fee at the CMS amount, adjusted for inflation, for provider types listed in OHCA's appendix. Individual physicians and non-physician practitioners are exempt, as are providers who already paid the fee to Medicare or another state's Medicaid/CHIP program. The fee is not refunded if screening leads to denial. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.

Fingerprinting

Under OAC 317:30-3-19.4, high-risk screening adds a fingerprint-based criminal background check of the provider and of anyone owning 5% or more. OHCA's enrollment sheet lists DME and home health as high-risk provider types and says providers enrolled with Medicare may be exempt. Limited- or moderate-risk providers move to high risk after a fraud-based payment suspension, an overpayment, or an exclusion.

Site visit

Moderate-risk screening includes pre- and post-enrollment site visits by OHCA Provider Enrollment staff. OHCA lists these moderate-risk types: ambulance services, behavioral health agencies and groups, individual behavioral health providers, hospice, independent diagnostic testing facilities, laboratories, and physical therapy groups and physical therapists. High-risk types also get site visits.

Revalidation

OHCA screens and enrolls providers and revalidates them periodically, as federal rules require. Existing providers handle this through 'renewal contracts' in the OHCA provider portal. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.

Full Oklahoma Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need (Long-term Care CON Act; Psychiatric and Chemical Dependency Facility CON Act)

Agency

Oklahoma State Department of Health, Health Facility Systems

Services covered

• long-term care facilities as defined in 63 O.S. §1-851.1 (licensed nursing facility beds)
• ICF/IID beds
• psychiatric or chemical dependency facilities, services or units in hospitals or related institutions
• acquisitions of covered health care facilities

Oklahoma certificate of need details →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Skilled nursing facilities — active organization NPIs (NPPES)

530 (as of Sep 13, 2026)

Medicare/Medicaid-certified nursing homes (CMS Care Compare)

283 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

992,735 (as of Jun 1, 2026)

All Oklahoma Skilled nursing Medicaid rates, ranked →