NURSING SERVICES PROVIDER IN INDIANA

DELIVERING SKILLED, MEDICALLY NECESSARY CARE TO SUPPORT HEALTH, SAFETY, AND COMMUNITY INDEPENDENCE

Nursing Services in Indiana provide skilled care to individuals with complex medical conditions, disabilities, or recovery needs. These services help maintain participants’ health and safety in home and community-based settings, avoiding unnecessary hospitalization or institutionalization. Nursing Services are reimbursable under Indiana Medicaid State Plan and Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: Indiana Family and Social Services Administration (FSSA) — Office of Medicaid Policy and Planning (OMPP)

Role: Administers Medicaid funding for Nursing Services and manages provider enrollment, claims, and reimbursement

Agency: Indiana State Department of Health (ISDH)

Role: Licenses Home Health Agencies (HHAs), enforces nursing regulations, and oversees facility and provider compliance

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring Medicaid-funded Nursing Services meet HCBS requirements, participant-centered standards, and Conditions of Participation (CoPs)

2. NURSING SERVICE OVERVIEW

Nursing Services deliver skilled interventions under a physician’s order to support participants with medical conditions requiring ongoing clinical oversight.

Approved providers may deliver:

• Intermittent or continuous skilled nursing care (by RN or LPN)

• Medication administration, injections, and IV therapy

• Wound care and tracheostomy management

• Ventilator and enteral feeding tube support

• Catheter care and bowel program management

• Chronic disease management (e.g., diabetes, epilepsy, hypertension)

• Health monitoring, education, and coordination of medical services

• Emergency medical response and post-acute care follow-up

All services must be documented in the participant’s Plan of Care (POC) and approved through Medicaid authorization protocols.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business entity with the Indiana Secretary of State

• Obtain EIN from the IRS and NPI (Type 2)

• Obtain Home Health Agency License through the Indiana State Department of Health (ISDH)

• Apply for CMS certification if serving Medicare beneficiaries

• Enroll as a Medicaid provider through Indiana Medicaid Provider Enrollment Portal

• Maintain general liability, professional liability, and malpractice insurance

• Develop clinical policies for skilled care delivery, participant protection, emergency response, and infection control

• Ensure nursing staff meet licensure, background screening, and annual training requirements

4. INDIANA PROVIDER ENROLLMENT PROCESS

Initial Application and Licensure:

• Submit application for ISDH Home Health Agency licensure

• Prepare operational policies, staff training documentation, and facility compliance plans

• Undergo ISDH survey for license issuance

Medicaid & Medicare Enrollment:

• Enroll via Indiana Medicaid Portal and, if applicable, CMS PECOS

• Provide required documents: EIN/NPI, licenses, proof of insurance, policies, staffing plan

Billing Readiness:

• Set up billing infrastructure to handle hourly/unit billing for RN/LPN services and required documentation

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License

• IRS EIN confirmation

• NPI confirmation

• ISDH Home Health Agency License

• CMS Provider Number (if billing Medicare)

• Proof of general, professional, and malpractice insurance

• Nursing Services Policy & Procedure Manual including:

  • Participant assessment, intake, and Plan of Care procedures

  • Skilled care documentation protocols

  • Emergency preparedness and infection control measures

  • HIPAA compliance, participant rights, and grievance policies

  • Staff credentialing, licensure, and competency tracking

  • Medicaid billing and audit-ready clinical records

6. STAFFING REQUIREMENTS

Role: Director of Nursing (DON)

Requirements: Active Indiana RN license; supervisory and home health experience; background clearance

Role: Registered Nurses (RNs)

Requirements: Active Indiana RN license; CPR certification; clinical competency verification

Role: Licensed Practical Nurses (LPNs)

Requirements: Active Indiana LPN license; works under RN supervision; background screening clearance

Role (optional): Certified Home Health Aides (HHAs)

Requirements: State-approved training program completion; background clearance

All clinical staff must complete:

• HIPAA, abuse prevention, and confidentiality training

• Infection control, emergency procedures, and participant safety protocols

• Annual clinical evaluations and ongoing continuing education

7. MEDICAID WAIVER PROGRAMS AND STATE PLAN COVERAGE

Nursing Services are reimbursable through:

• Indiana Medicaid State Plan Home Health Services

• Aged and Disabled (A&D) Waiver

• Traumatic Brain Injury (TBI) Waiver

• Community Integration and Habilitation (CIH) Waiver

• Family Supports Waiver (FSW) — limited skilled nursing services

Approved providers may deliver:

• Hourly skilled RN/LPN care

• Complex condition monitoring and chronic care management

• Medical intervention training for caregivers

• Coordination with physicians and interdisciplinary care teams

8. TIMELINE TO LAUNCH

Phase: Business Formation, Licensing, and Policy Development

Timeline: 2–4 months

Phase: Staff Hiring, Credentialing, and Compliance Program Setup

Timeline: 2–3 months

Phase: ISDH Survey, Medicaid Enrollment, and CMS Certification (if applicable)

Timeline: 60–90 days

Phase: Billing System Configuration and Nursing Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Indiana State Department of Health (ISDH) — Home Health Licensing

Website: https://www.in.gov/health/

Indiana Medicaid Provider Portal

Website: https://www.in.gov/medicaid/providers/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — INDIANA NURSING SERVICES PROVIDER

WCG supports nursing agencies, home health providers, and skilled care businesses in launching Medicaid- and Medicare-compliant Nursing Services in Indiana.

Scope of Work:

• Business registration, ISDH licensing, and CMS/Medicaid enrollment guidance

• Development of Nursing Services Policy & Procedure Manual

• Staff credentialing templates, care planning forms, and clinical documentation systems

• Medicaid billing system setup and audit-ready claims management

• Website, domain, and branding development

• Infection control, incident reporting, and clinical QA program setup

• Strategic partnership building with hospitals, discharge planners, and waiver case managers

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