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Medicaid HCBS Certification

The FSSA Office of Medicaid Policy and Planning (OMPP) is now certifying providers for home and community-based services (HCBS) through the Indiana PathWays for Aging, Health & Wellness (H&W), and Traumatic Brain Injury (TBI) waivers.  These waivers allow individuals to receive services in an individual’s home or other community setting rather than an institutional setting.

Providers who wish to participate in one of the waiver programs will need to complete three steps:

  1. Become certified by OMPP to provide HCBS waiver services
  2. Enroll with the Indiana Health Coverage Programs (IHCP)
  3. Finish your waiver program enrollment

Each of these three steps is further described below.

1. OMPP Certification

Prior to beginning an application, providers are encouraged to review Required Document Definitions in order to prepare required documents.

OMPP Certification Portal

OMPP requires providers to submit applications through the OMPP Certification Portal.  The OMPP Certification Portal can be used for the following requests:

  • Initial provider certifications
  • Requests to add or remove services
  • Requests to serve additional counties
  • Change of ownership requests
  • Requests to decertify

Additional educational resources will be made available to current and potential waiver providers, including the following:

Video Resources

Document Resources

Provider Guidelines

Providers are encouraged to follow these guidelines to ensure a responsive certification process:

  • Providers should only create one account in the OMPP Certification Portal.  All future certification updates and recertifications will occur within the single account created.
  • Providers will be given 30 calendar days to fully submit an application upon starting.  After 30 calendar days, an incomplete application will expire, the provider will need to start a new application.
  • Providers are not allowed to create multiple applications while a current application is under review with OMPP.
  • Providers are responsible for understanding service definitions and requirements.  Providers who submit an application with services they are not qualified to provide will need to start a new application and exclude services they are unable to provide for.
  • Providers must have all documents prepared prior to submitting an application. Providers who submit incomplete documents will not be accepted or reviewed.
  • Providers will have ten calendar days to return any documents that require updates by the OMPP certification team.  After ten days, any applications that contain documents that have not been corrected will expire, and the provider will need to start a new application.
    • Providers will be given two attempts to correct a document.  After two attempts, if a document is not corrected and acceptable, the provider will need to start a new application
  • A provider’s certification effective date will be the date the application is fully processed and completed.
    • Providers subject to heightened scrutiny will have an effective date as of the date the provider has passed heightened scrutiny.

2. Enroll with the IHCP

Once you have been certified as an HCBS provider through OMPP, you need to enroll with the IHCP (also known as Indiana Medicaid).  To complete this enrollment, you need to access the online application through the IHCP Provider Healthcare Portal.  You can also access paper applications through the Waiver Provider webpage.

To learn more about enrolling as an IHCP waiver provider, you can visit the Waiver Provider Enrollment IHCP webpage.  If you need assistance with your application, you also can contact the IHCP at 800-457-4584.

3. Finishing Your Waiver Program Enrollment

Once you are enrolled with the IHCP, you’ll need to finish your waiver program enrollment:

If you are certified under the Indiana PathWays for Aging program – you need to enroll and contract with each of the managed care entities (MCEs) who administer the program. The MCEs are Anthem, Humana, and UnitedHealthcare.  You can find more information about participating with each of the health plans by clicking the links below:

If you are certified under the Health & Wellness or TBI waivers – your agency will be added to the applicable waiver’s pick list with the Division of Disability and Rehabilitative Services (DDRS).  Your agency will be directed to contact FSSA at BDSProviderServices@fssa.in.gov.  This will allow you to complete any additional work DDRS requires.

Heightened Scrutiny

While all HCBS providers are subject to the final Settings Rule regulation, some providers subject to heightened scrutiny.  Heightened scrutiny applies to the following HCBS settings:

  • Settings that are located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment;
  • Settings that are in a building located on the grounds of, or immediately adjacent to, a public institution; and
  • Any other settings that have the effect of isolating individuals receiving Medicaid home and community-based services (HCBS) from the broader community of individuals not receiving Medicaid HCBS (including secure memory units).

Settings that are subject to heightened scrutiny will receive a site visit and will be asked to complete an additional packet of information.  The full results of the assessment will be posted for public comment and submitted to CMS for review.  Upon feedback from CMS, FSSA will be able to make a final determination for heightened scrutiny compliance.

Current Sites Open for Public Comment