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:
- Become certified by OMPP to provide HCBS waiver services
- Enroll with the Indiana Health Coverage Programs (IHCP)
- 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 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
- Demonstration for updating a returned application
- Demonstration for continuing an application
- Service definition videos - coming soon!
- Add link for navigating salesforce - coming soon!
Document Resources
- Service definition:
- Adult Day Service
- Adult Family Care
- Assisted Living
- Attendant Care
- Behavior Management
- Caregiver Coaching and Behavior Management
- Care Management
- Community Transition
- Home and Community Assistance
- Home Delivered Meals
- Home Modification
- Home Modification Assessment
- Integrated Health Care Coordination
- Nonmedical Transportation
- Nutritional Supplements
- Participant Directed Home Care Service
- Personal Emergency Response System
- Pest Control
- Residential Based Habilitation
- Respite Services
- Specialized Medical Equipment and Supplies
- Structured Day Program
- Structured Family Caregiving
- Supported Employment
- Vehicle Modification
- Instructions for OMPP HCBS Certification Portal
- FAQ's
- Document checklist - coming soon!
Provider Guidelines
Providers are encouraged to follow these guidelines to ensure a responsive certification process:
- Providers will create one account in the OMPP Certification Portal. All future certification updates and recertifications will occur within the single account created for a single entity. Providers with multiple entities will be required to create a separate account with a unique email associated with the entity.
- Please refer to BT202577 for further details regarding this requirement.
- Providers will be given 30 calendar days to fully submit an application upon starting. Once 30 calendar days have passed, the application will be considered incomplete and expire. The provider will need to start a new application.
- Providers are allowed only one active application to be reviewed by the OMPP Certification team. The active status remains until a Provider ID has been assigned or services successfully enrolled after an IHCP update. Additional applications submitted by an agency during this active status will be expired until all steps have been successfully completed for an active application.
- Providers are responsible for understanding service definitions and requirements. Please review all resources made available for Step 1 to avoid a delay for OMPP Certification. Providers who submit an application with services they are not qualified to provide will have the selected services denied. This may also result in an application being set to expired and require a new application to be submitted.
- Please make sure that all correct services and counties are selected before submitting an application. If an error does occur during this process, please reach out to the OMPP Certification Team using the Inquiry feature within the OMPP Certification Portal for assistance. This issue may lead to an expiration and require a new application to be submitted.
- Providers must have all documents prepared prior to submitting an application. Providers who submit incomplete will not be accepted or reviewed. The application will be set to expire and require that a new application is submitted.
- As mentioned above, the following is a list of documents that will fall under an incomplete application.
- Receipts for letters or licenses that should be current and acquired
- Quotes or templates for the Liability Insurance Policy
- Expired Documents or Licensures
- Expired Background Checks
- Blank Organizational Charts
- Blank Documents
- Policies that contain a different agency’s name from the associated application
- Please make sure to upload the correct policy required by the OMPP Certification Portal. Full Operational Manuals that are uploaded multiple times in an application will not be accepted or reviewed. The application will be set to expire and a new application will be required to be submitted.
- To ensure a timely and proactive process for Step 1, the following is in place for the initial review:
- Providers will receive feedback, if any, during the initial review for corrections needed for a document. Applications that receive feedback containing 10 or more corrections will be notified of the policies needing corrections with the current application set to be expired. Resources will be provided in the feedback to assist with corrections. A new application will be required to be submitted if this occurs.
- An initial review with 9 or less corrections will be given two attempts to correct a document. After two attempts, if a document is not corrected to meet requirements, the application will need to be expired, and provider will need to start a new application.
- Providers will have five business days, at the end of business day (5PM), to return any documents that require updates by the OMPP certification team. After five business days, any applications that contain documents that have not been corrected will expire, and 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
All HCBS providers are subject to the final Settings Rule regulation. However, some providers are subject to heightened scrutiny. Heightened scrutiny applies to the following Home and Community-Based Services (HCBS) settings:
- Settings that are located inside 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.
- Any additional settings that could have the effect of isolating individuals receiving 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 conducted by an MCE and will be asked to complete an additional packet of information during the heightened scrutiny process. This information will need to be filled out and returned to OMPP as part of the Heightened Scrutiny Process.
Upon receiving the packet and results of the site visit, both will be posted for public comment and then submitted to CMS for review. Upon feedback from CMS, FSSA will make a final determination regarding heightened scrutiny compliance.
Current Sites Open for Public Comment
- American Village
- Bickford of Greenwood
- Hoosier MC, LLC-Cedar Creek of Bloomington Memory Care
- Residential Care V- Rose gate Commons
- VOP Solana, LLC- Traditions at Solana
- Witham Memorial Hospital- Arlington Place Health Campus
- VOP Gentry Park, LLC
- VOP Reagen Park, LLC
Any interested party may request to review the completed heightened scrutiny evidence packet by sending a request via email to the OMPP Certification Team inbox- OMPPWaiverCertification@fssa.in.gov. The contents of the full heightened scrutiny packet for a site visit will be provided within 3 business days from the date the request is submitted.
