Indiana - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) requires prospective Case Management providers to obtain OMPP Certification before enrolling to serve participants on the PathWays for Aging, Health & Wellness (H&W), and Traumatic Brain Injury (TBI) waivers. Case management in Indiana is strictly governed by Conflict-Free Case Management (CFCM) rules, meaning an agency cannot provide both case management and direct waiver services to the same individual.

After securing OMPP Certification, agencies must enroll as a Waiver Provider (Type 32) through the Indiana Health Coverage Programs (IHCP) Provider Healthcare Portal managed by Gainwell Technologies. For the PathWays for Aging program, enrollment is further gated by a requirement to contract directly with one or more of the state's designated Managed Care Entities (MCEs).

1. Service Definition and Scope

In Indiana, Case Management Services provide comprehensive coordination of services and supports for individuals receiving long-term care under Medicaid Home and Community-Based Services (HCBS) waivers. The service ensures participants navigate resources, maintain service quality, and promote independence.

Approved providers deliver comprehensive assessments, develop the Person-Centered Service Plan (PCSP), coordinate waiver and non-waiver services, and conduct ongoing monitoring to ensure service effectiveness and participant safety.

• Assessment: Comprehensive evaluation of participant needs, risks, and strengths.
• Service Planning: Development and updating of the Individualized Support Plan (ISP) or PCSP.
• Coordination: Arranging both waiver and community-based services.
• Monitoring: Ongoing participant support and monitoring visits to ensure service quality.
• Advocacy: Support in making informed decisions and protecting participant rights.
• Transition Support: Assisting with moves from institutional care to community settings.

2. Regulatory and Oversight Agencies

Multiple divisions within the Indiana FSSA oversee the certification, enrollment, and monitoring of Case Management providers. The specific division depends on the target population and the waiver program.

Medicaid enrollment and claims processing are handled by the IHCP, with Gainwell Technologies acting as the fiscal agent.

• Indiana Family and Social Services Administration (FSSA): Oversees all Medicaid and HCBS programs (https://www.in.gov/fssa/).
• Office of Medicaid Policy and Planning (OMPP): Certifies HCBS providers and administers Medicaid reimbursement (https://www.in.gov/fssa/ompp/).
• Division of Disability and Rehabilitative Services (DDRS): Manages the CIH and FSW waivers (https://www.in.gov/fssa/ddrs/).
• Division of Aging: Oversees aging programs and transitions to PathWays (https://www.in.gov/fssa/da/).
• Indiana Health Coverage Programs (IHCP): The Medicaid enrollment and billing system (https://www.in.gov/medicaid/providers/).
• Gainwell Technologies: The IHCP Provider Enrollment Unit and fiscal agent (https://portal.indianamedicaid.com/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Indiana enforces strict structural preconditions for Case Management providers. The most absolute requirement is compliance with Conflict-Free Case Management (CFCM) mandates, which prohibit an agency from delivering both case management and direct care services to the same waiver participant.

Additionally, providers targeting the PathWays for Aging waiver cannot operate independently; they must secure contracts with specific Managed Care Entities (MCEs) after IHCP enrollment.

• Conflict-Free Mandate: Providers must submit a Conflict-Free Case Management attestation and cannot provide direct HCBS services to their case management clients.
• MCE Contracting: PathWays for Aging providers must apply directly with Anthem, Humana, or UnitedHealthcare.
• OMPP Certification: Required prior to IHCP enrollment for PathWays, H&W, and TBI waivers.
• Business Registration: Must be registered with the Indiana Secretary of State.
• NPI Requirement: Must obtain a Type 2 National Provider Identifier (NPI).
• Enrollment Moratoria: Providers must verify if any temporary HCBS Waiver Provider Enrollment Moratoriums are active, as Indiana occasionally enacts 6-month pauses.

4. Licensure and Certification Requirements

Indiana does not issue a traditional facility license for Case Management agencies. Instead, providers must obtain OMPP Certification through the OMPP Certification Portal.

The certification process involves a Program Readiness Review where FSSA evaluates provider qualifications, conflict-of-interest safeguards, and operational policies.

• Certification Portal: Applications must be submitted via the OMPP Certification Portal (https://omppproviders.fssa.in.gov/).
• Readiness Review: FSSA reviews documentation systems, staff training, and participant protections.
• Insurance: Must maintain general and professional liability insurance.
• Policy Manual: Must submit a comprehensive Case Management Policy & Procedure Manual.
• Settings Rule Compliance: Must comply with the CMS HCBS Final Settings Rule.
• Heightened Scrutiny: Settings located inside institutional facilities face additional FSSA review.

5. Medicaid Provider Enrollment

After obtaining OMPP Certification, agencies must enroll as billing providers with the Indiana Health Coverage Programs (IHCP). This is done through the IHCP Provider Healthcare Portal.

Case Management agencies enroll as a Waiver Provider (Provider Type 32). Applications rejected for missing information will receive a letter detailing the required corrections.

• Provider Type: Enroll as Waiver Provider (Type 32).
• Enrollment Portal: Submit via the IHCP Provider Healthcare Portal.
• W-9 Form: Must include a revised W-9 form as an attachment.
• EFT Agreement: Must complete the IHCP Provider Electronic Funds Transfer Addendum.
• Physical Address: The service location address must be a physical location; PO Boxes are not valid.
• Processing Time: Providers must allow 15 business days plus mailing time before inquiring about application status.

6. Staffing, Training and Background Checks

Indiana requires Case Management staff to meet specific educational and experiential thresholds. Agencies must maintain credentialing and training records for all personnel.

All staff must undergo background screening clearances and complete mandatory state training modules before providing billable services.

• Program Director: Requires a Bachelor's or Master's degree in a human services field and experience in waiver services.
• Case Managers: Requires a Bachelor's degree in human services or a related field.
• Background Checks: All staff must clear state and federal background screenings.
• Person-Centered Training: Mandatory completion of person-centered service planning training.
• Conflict-Free Training: Staff must complete conflict-free case management training.
• Annual CEUs: Required annual continuing education and competency reassessments.

7. Documentation, Policies and Records

Providers must maintain an audit-ready Case Management Policy & Procedure Manual. FSSA requires specific policies to be uploaded during the OMPP Certification process.

Uploading full operational manuals multiple times is prohibited; providers must upload only the specific policy requested by the portal to avoid application expiration.

• Assessment Procedures: Documented intake and comprehensive assessment protocols.
• Risk Mitigation: Policies for service authorization and emergency response.
• Grievance Procedures: Documented participant rights and grievance resolution processes.
• HIPAA Compliance: Strict confidentiality and data protection protocols.
• Staff Records: Maintenance of staff credentialing, training, and supervision files.
• Audit Readiness: Medicaid billing and service documentation protocols must be maintained for state review.

8. Billing, Rates and Claims

Case Management services are billed to the IHCP or the respective MCE depending on the waiver program. Reimbursement rates are established by FSSA and published in the IHCP fee schedules.

Providers must accept IHCP payment as payment in full and ensure all claims comply with 42 CFR 447.10 regarding electronic funds transfers.

• Fee Schedule: Rates are published on the IHCP Provider Reference Materials page.
• Billing System: Claims are submitted via the IHCP Provider Healthcare Portal or MCE clearinghouses.
• Payment in Full: Providers must accept IHCP reimbursement as payment in full, excluding authorized cost sharing.
• EFT Requirement: Payments are made exclusively via Electronic Funds Transfer.
• MCE Billing: PathWays claims must be routed to Anthem, Humana, or UnitedHealthcare.
• False Claims: Fraudulent billing is subject to prosecution under State and federal law.

9. Approval Sequence and Timeline

The approval process is sequential and cannot be expedited. Providers must first establish their business entity, then obtain OMPP Certification, followed by IHCP enrollment.

For PathWays providers, the final step is MCE contracting, which adds additional time to the launch sequence.

• Business Setup: 1-2 months for business formation and conflict-free compliance setup.
• Policy Development: 2-3 months for staff hiring, credentialing, and policy creation.
• OMPP Certification: Initial review provides feedback for necessary document corrections.
• IHCP Enrollment: 60-90 days for Medicaid enrollment and readiness review.
• MCE Contracting: Additional 30-90 days to execute contracts with PathWays health plans.
• Service Launch: 30-45 days for Medicaid billing setup and final launch.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to administrative errors in the OMPP Certification Portal or IHCP enrollment packet. FSSA actively rejects applications with generic or incomplete documentation.

During readiness reviews, failure to adequately demonstrate conflict-free safeguards is a primary reason for denial.

• Blank Documents: Uploading blank documents or organizational charts to the OMPP portal.
• Wrong Agency Name: Submitting policies that contain a different agency's name.
• Expired Documents: Submitting expired background checks or licensures.
• PO Box Usage: Listing a PO Box as the physical service location address.
• Missing W-9: Failure to include a revised W-9 form for name or address updates.
• Full Manual Uploads: Uploading a full operational manual instead of the specific requested policy.

11. Key Contacts and Resources

Providers must utilize official state portals and contact designated support units for assistance with certification and enrollment.

For waiver-specific questions, providers should contact the respective FSSA division or the designated MCEs.

• OMPP Certification Portal: https://omppproviders.fssa.in.gov/
• IHCP Provider Portal: https://portal.indianamedicaid.com/
• IHCP Customer Assistance: 800-457-4584
• DDRS Provider Services: [email protected]
• Anthem PathWays: https://providers.anthem.com/indiana-provider/patient-care/pathways-aging
• Humana PathWays: https://www.humana.com/provider/medical-resources/indiana-medicaid

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