Indiana - Home Modification 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) certifies Home Modification providers through the PathWays for Aging, Health & Wellness (H&W), and Traumatic Brain Injury (TBI) waivers. Providers must first secure OMPP HCBS certification through the OMPP Certification Portal before submitting an Indiana Health Coverage Programs (IHCP) enrollment application.

Indiana does not issue a distinct state-level "Home Modification License"; instead, applicants must hold applicable local or municipal general contractor licenses and permits, then pass the OMPP HCBS certification review. Following IHCP enrollment, providers must complete waiver-specific network enrollment, which requires contracting directly with Managed Care Entities (MCEs) for the PathWays program or being added to the Division of Disability and Rehabilitative Services (DDRS) pick list for the H&W and TBI waivers.

1. Service Definition and Scope

In Indiana Medicaid HCBS waivers, Home Modification services encompass assessed, permitted, and inspected structural changes to a waiver participant's private residence that are necessary to ensure the individual's health, welfare, and safety, or to enable greater independence in the home.

These adaptations must be specified in the individual's person-centered service plan and are strictly limited to modifications that provide direct medical or remedial benefit to the participant, excluding general home maintenance or aesthetic upgrades.

• Covered Adaptations: Installation of ramps, grab bars, widening of doorways, and modification of bathroom facilities.
• Excluded Services: General home repairs, roofing, carpeting, or modifications that add square footage to the home.
• Property Ownership: Modifications to rental properties require prior written approval from the landlord or property owner.
• Code Compliance: All structural changes must meet applicable local and state building codes and pass municipal inspections where required.

2. Regulatory and Oversight Agencies

The Indiana Family and Social Services Administration (FSSA) oversees all Medicaid waiver programs through its specialized divisions. The Office of Medicaid Policy and Planning (OMPP) handles the initial HCBS certification for providers.

Once certified, providers interact with the Indiana Health Coverage Programs (IHCP) for Medicaid enrollment and billing, and either the Division of Disability and Rehabilitative Services (DDRS) or designated Managed Care Entities (MCEs) for ongoing waiver administration.

• FSSA Office of Medicaid Policy and Planning (OMPP): Certifies HCBS providers (https://www.in.gov/fssa/ompp/).
• OMPP Certification Portal: System for submitting initial certification and change requests (https://omppproviders.fssa.in.gov/).
• Indiana Health Coverage Programs (IHCP): Manages Medicaid provider enrollment and claims (https://portal.indianamedicaid.com/).
• FSSA Division of Disability and Rehabilitative Services (DDRS): Administers the H&W and TBI waivers (https://www.in.gov/fssa/ddrs/).
• Anthem: PathWays for Aging MCE (https://providers.anthem.com/indiana-provider/patient-care/pathways-aging).
• Humana: PathWays for Aging MCE (https://www.humana.com/provider/medical-resources/indiana-medicaid).
• UnitedHealthcare: PathWays for Aging MCE (https://www.uhcprovider.com/en/health-plans-by-state/indiana-health-plans/in-comm-plan-home/how-to-join-indiana.html).

3. Gatekeeping Prerequisites: Who Can Even Apply

Indiana requires prospective Home Modification providers to pass through a strict three-step gating process: OMPP Certification, IHCP Enrollment, and Waiver Program Enrollment. An applicant cannot enroll in IHCP without first obtaining OMPP HCBS certification.

For the PathWays for Aging waiver, providers face a managed care contracting gate; they must successfully credential and contract with at least one of the state's designated MCEs (Anthem, Humana, or UnitedHealthcare) to receive authorizations. For H&W and TBI waivers, providers must be approved for the DDRS pick list.

• Application Limit: Providers are allowed only one active application in the OMPP Certification Portal at a time; additional applications are expired until the active one is resolved.
• Submission Window: Providers have exactly 30 calendar days to fully submit an application in the OMPP portal once started, or it expires.
• PathWays MCE Contracting: Required affiliation with Anthem, Humana, or UnitedHealthcare to serve PathWays for Aging members.
• DDRS Pick List: Required placement on the DDRS provider pick list to serve H&W and TBI waiver members.

4. Licensure and Certification Requirements

Because Indiana does not issue a specific state-level license for Medicaid Home Modification providers, applicants must operate as legally established businesses holding all necessary local general contractor licenses, permits, and registrations required by the municipalities in which they work.

The primary state-level credential is the OMPP HCBS Certification, which verifies that the contractor meets Medicaid's administrative, insurance, and policy standards to perform waiver-funded structural modifications.

• Local Licensure: Must hold applicable municipal or county general contractor licenses where the modifications are performed.
• OMPP HCBS Certification: Mandatory state-level approval required before IHCP enrollment.
• Business Registration: Must be registered and in good standing with the Indiana Secretary of State.
• Settings Rule Compliance: Must comply with the CMS HCBS Final Settings Rule, ensuring modifications do not institutionalize the home environment.

5. Medicaid Provider Enrollment

After obtaining OMPP certification, providers must enroll in the Indiana Health Coverage Programs (IHCP) as an atypical or waiver-specialty provider. This is done via the IHCP Provider Healthcare Portal or by mailing the required paper applications.

Providers must submit the Medicaid Home and Community-Based Services Waiver Provider Agreement (State Form 53870, Schedule A) and complete the IHCP Provider Enrollment Application, adhering to the requirements in the IHCP Provider Enrollment Type and Specialty Matrix.

• IHCP Provider Healthcare Portal: The primary system for submitting the Medicaid enrollment application.
• State Form 53870: Schedule A - Medicaid Home and Community-Based Services Waiver Provider Agreement.
• NPI Requirement: Home Modification providers typically enroll as atypical providers, meaning a National Provider Identifier (NPI) is not strictly required unless they also provide standard medical services.
• Application Fee: Must determine risk level and pay the applicable federal Medicaid application fee unless waived or already paid to Medicare/another state.

6. Staffing, Training and Background Checks

Home Modification providers must ensure that all personnel, including subcontractors, who enter a waiver participant's home meet Indiana's background check and qualification standards.

While structural contractors do not require clinical medical training, they must be trained on Medicaid waiver incident reporting, participant rights, and HIPAA compliance.

• Background Checks: Required state and national criminal history checks for all employees and subcontractors interacting with participants.
• Subcontractor Liability: The enrolled provider retains full legal responsibility for ensuring all subcontractors meet Medicaid standards and local building codes.
• Incident Reporting Training: Staff must be trained on identifying and reporting abuse, neglect, and exploitation to FSSA.
• Trade Qualifications: Personnel performing electrical, plumbing, or structural work must hold the appropriate trade licenses required by local jurisdictions.

7. Documentation, Policies and Records

FSSA requires Home Modification providers to maintain a comprehensive policy manual and detailed project-specific documentation to ensure audit compliance. Uploading blank documents or policies with a different agency's name during the OMPP certification process will result in immediate application expiration.

Providers must maintain records of all bids, local permits, inspection sign-offs, and participant approvals for every modification project.

• Liability Insurance: Must upload current, active liability insurance policies (quotes or templates are rejected by OMPP).
• Organizational Chart: Must provide a completed organizational chart detailing agency structure and ownership.
• Project Documentation: Must retain written bids, before-and-after photos, and final municipal inspection reports for all modifications.
• Record Retention: Medicaid records must be securely maintained and available for state or federal audit for the period specified in the IHCP Provider Manual.

8. Billing, Rates and Claims

Home Modification services are reimbursed based on authorized project bids rather than a standard hourly fee schedule. All modifications require prior authorization from the waiver case manager or MCE before any work begins.

Claims are submitted through the IHCP Provider Healthcare Portal or directly to the contracted MCE for PathWays members, utilizing the specific HCPCS procedure codes outlined in the participant's approved service plan.

• Prior Authorization: No work may commence, and no claims will be paid, without a prior authorization matching the approved project bid.
• Claim Submission: Claims for H&W and TBI waivers are submitted via the IHCP Provider Healthcare Portal.
• MCE Billing: Claims for PathWays for Aging members must be submitted directly to Anthem, Humana, or UnitedHealthcare.
• Exhausting Other Sources: Providers must exhaust all other sources of reimbursement (e.g., Medicare, if applicable) before billing Medicaid.

9. Approval Sequence and Timeline

The end-to-end approval process requires sequential clearance through OMPP, IHCP, and the respective waiver administrators. Delays at any step halt the entire process.

Providers must actively monitor the OMPP Certification Portal and IHCP communications, as failure to respond to requests for information within specified windows will result in application termination.

• OMPP Application Window: 30 calendar days to complete and submit the application in the OMPP Certification Portal.
• IHCP Processing Time: Allow at least 15 business days for the IHCP Provider Enrollment Unit to process the enrollment application.
• MCE Credentialing: PathWays MCE credentialing timelines vary by plan but typically add 30 to 90 days after IHCP enrollment.
• Change Notifications: Providers must notify FSSA/DDRS and the fiscal agent at least 60 days before making changes to ownership, address, or tax ID.

10. Common Denials and Survey Findings

OMPP strictly enforces documentation standards during the initial certification review. Applications are frequently denied or expired due to administrative carelessness rather than lack of contractor qualifications.

During post-enrollment audits, providers are most commonly cited for failing to secure required local permits or failing to document final participant and inspector sign-offs on completed modifications.

• Expired Documents: Submitting expired background checks or licensures results in an incomplete application.
• Invalid Insurance: Uploading quotes or templates instead of actual, bound liability insurance policies.
• Policy Name Mismatches: Uploading policy manuals that contain a different agency's name (often from copied templates).
• Unqualified Service Selection: Selecting waiver services in the portal that the provider is not qualified to deliver results in service denial.

11. Key Contacts and Resources

Providers should utilize the official FSSA portals and IHCP reference modules for the most current enrollment matrices, bulletins, and billing guidelines.

For technical assistance during the certification phase, providers must use the Inquiry feature within the OMPP Certification Portal or contact the IHCP directly.

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

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