Indiana - Medical Supply Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Indiana Family and Social Services Administration (FSSA) funds Specialized Medical Equipment and Supplies through the Community Integration and Habilitation (CIH), Family Supports (FSW), Health & Wellness (H&W), Traumatic Brain Injury (TBI), and PathWays for Aging waivers. Applicants must secure Home and Community-Based Services (HCBS) Certification from the Office of Medicaid Policy and Planning (OMPP) or the Bureau of Disabilities Services (BDS) before submitting an Indiana Health Coverage Programs (IHCP) Type 25 enrollment application.

Approval requires passing a multi-agency sequence that includes Medicare DMEPOS accreditation, state waiver certification, and managed care contracting. Providers serving the PathWays for Aging population must execute network contracts with Anthem, Humana, or UnitedHealthcare after IHCP enrollment to receive reimbursement.

1. Service Definition and Scope

In Indiana, Specialized Medical Equipment and Supplies include devices, controls, or appliances specified in the participant's plan of care that enable individuals to increase their abilities to perform activities of daily living or perceive, control, or communicate with the environment in which they live.

This service covers items necessary for life support, ancillary supplies, and equipment necessary to the proper functioning of such items, and durable and non-durable medical equipment not available under the Medicaid State Plan.

• Covered Items: Durable medical equipment, disposable medical supplies, and adaptive devices specified in the service plan.
• Excluded Items: Items that are not of direct medical or remedial benefit to the participant.
• Waiver Authority: CIH, FSW, H&W, TBI, and PathWays for Aging waivers.
• Provider Type: IHCP Type 25 (Durable Medical Equipment/Medical Supply Dealer).

2. Regulatory and Oversight Agencies

The Indiana Family and Social Services Administration (FSSA) divides oversight of HCBS waivers between two primary divisions. The Office of Medicaid Policy and Planning (OMPP) oversees the PathWays, H&W, and TBI waivers, while the Division of Disability and Rehabilitative Services (DDRS) manages the CIH and FSW waivers through its Bureau of Disabilities Services (BDS).

Medicaid enrollment and claims processing are managed through the Indiana Health Coverage Programs (IHCP) portal.

• Indiana Family and Social Services Administration (FSSA): https://www.in.gov/fssa/
• Office of Medicaid Policy and Planning (OMPP): https://www.in.gov/fssa/ompp/
• Bureau of Disabilities Services (BDS): https://www.in.gov/fssa/ddars/bds/
• Indiana Health Coverage Programs (IHCP) Provider Portal: https://provider.indianamedicaid.com

3. Gatekeeping Prerequisites: Who Can Even Apply

Indiana requires prior state certification before a provider can enroll in Medicaid to bill for waiver services. An IHCP enrollment application for waiver services will be rejected if the provider has not first obtained HCBS Certification from OMPP or pending provisional approval from BDS.

Additionally, providers targeting the PathWays for Aging waiver must secure network contracts with designated Managed Care Entities (MCEs) after IHCP enrollment to serve those participants.

• HCBS Certification: OMPP or BDS approval is a strict prerequisite required before an IHCP Type 25 application is accepted.
• Medicare Enrollment: DMEPOS providers must typically hold active Medicare enrollment and CMS-approved accreditation prior to Medicaid enrollment.
• BDS Leadership Training: Agency leadership must attend the BDS Leadership Training Series within one year of pending provisional approval for DD waivers.
• Managed Care Contracting: PathWays providers must contract with Anthem, Humana, or UnitedHealthcare to receive reimbursement for that population.

4. Licensure and Certification Requirements

Indiana does not issue a standalone state "license" specifically for HCBS medical supply providers. Instead, the operating authority is granted through the HCBS Certification process managed by OMPP (for H&W, TBI, and PathWays) or the New Provider Approval Process managed by BDS (for CIH and FSW).

Applicants must demonstrate financial solvency, provide professional references, and submit comprehensive operational policies tailored to the specific waiver populations they intend to serve.

• OMPP Certification Portal: Used to submit certification applications for H&W, TBI, and PathWays waivers.
• BDS New Provider Application: Used to submit certification applications for CIH and FSW waivers.
• Financial Solvency: BDS requires proof of cash reserves or capital during the application phase.
• Business Entity: Must be registered and in good standing with the Indiana Secretary of State.
• Professional References: BDS requires two professional references (one in the IDD community) and one personal reference.

5. Medicaid Provider Enrollment

Once HCBS Certification is obtained, providers must enroll in the Indiana Health Coverage Programs (IHCP) via the Provider Healthcare Portal. Medical supply providers enroll under Provider Type 25.

Providers must select the appropriate specialties and submit all required documentation, including proof of Medicare enrollment if applicable, to avoid Return to Provider (RTP) delays.

• Provider Type: 25 (Durable Medical Equipment/Medical Supply Dealer).
• Specialties: 250 (DME/Medical Supply Dealer) or 251 (HME/Home Medical Equipment).
• Application Fee: Required for institutional providers unless waived by Medicare or Medicaid enrollment in another state.
• Processing Time: IHCP requires at least 15 business days for initial processing before status checks.
• Enrollment Deadline: Successful IHCP enrollment must occur within 12 months of BDS approval, or the approval is denied.

6. Staffing, Training and Background Checks

Agency personnel must meet state and federal background check requirements to ensure participant safety. Leadership staff for agencies serving the DD waivers must complete specific state-mandated training.

Failure to complete the required leadership training within the specified timeframe results in the voluntary withdrawal of the provider's application.

• Criminal History: Documentation of criminal history checks required per 460 IAC 6-10-5.
• OIG Exclusion: Monthly checks against the LEIE required for all staff and contractors.
• Leadership Training: CEO/Director, COO/CFO, and Waiver Administrator must attend the BDS Leadership Training Series.
• Training Location: Offered in-person each quarter at the Indiana Government Center.
• Educational Background: Documentation supporting qualification as a provider of HCBS supports in Indiana.

7. Documentation, Policies and Records

Providers must maintain and upload specific operational policies during the certification process. OMPP and BDS strictly review these documents for accuracy and agency-specific customization.

Uploading generic templates or policies containing another agency's name will result in application expiration or denial.

• Organizational Chart: Must be fully completed; blank templates are rejected.
• Liability Insurance: Quotes or templates for the Liability Insurance Policy must be provided.
• Settings Rule Compliance: Documentation showing compliance with the HCBS Final Settings Rule.
• Policy Customization: Policies must contain the applying agency's actual name.
• Record Retention: Providers must maintain records for at least 7 years per IHCP rules.

8. Billing, Rates and Claims

Reimbursement for Specialized Medical Equipment and Supplies is based on the IHCP Fee Schedule or contracted MCE rates. Claims for fee-for-service waivers are submitted through the CoreMMIS system.

Most waiver DME and supplies require prior authorization based on the participant's approved plan of care before items are dispensed and billed.

• Prior Authorization: Required for most waiver DME and supplies via the waiver case manager.
• Fee Schedule: Maximum allowable rates are published on the IHCP Professional Fee Schedule.
• Billing System: CoreMMIS is used for fee-for-service claims (CIH, FSW, H&W, TBI).
• MCE Claims: PathWays claims are submitted directly to Anthem, Humana, or UnitedHealthcare clearinghouses.

9. Approval Sequence and Timeline

Becoming a fully approved provider is a sequential process that spans several months. Providers must secure federal identifiers, state waiver certification, Medicaid enrollment, and managed care contracts in a strict order.

Missing deadlines, such as the 30-day RFI response window or the 12-month IHCP enrollment window, forces the applicant to restart the process.

• Step 1: Obtain NPI and Medicare DMEPOS accreditation (if applicable).
• Step 2: Submit OMPP or BDS HCBS Certification application.
• Step 3: Attend BDS Leadership Training within one year of pending provisional approval (for DD waivers).
• Step 4: Submit IHCP Type 25 enrollment via the Provider Healthcare Portal.
• Step 5: Execute network contracts with PathWays MCEs (Anthem, Humana, UHC).

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete documentation or failure to follow state-specific formatting rules. BDS explicitly states that incomplete applications will not be reviewed.

During the OMPP certification process, uploading full operational manuals multiple times instead of the specific required policy will cause the application to expire.

• Incomplete Applications: BDS will notify the applicant and refuse review until complete.
• RFI Deadlines: Failure to respond to a Request for Information within 30 calendar days results in written denial.
• Training Failure: Missing the 1-year window for BDS training withdraws the application.
• Policy Mismatches: Uploading policies with a different agency's name in the OMPP portal.
• Resubmission Penalty: Denied BDS applicants must wait a minimum of two years before submitting a new application.

11. Key Contacts and Resources

Providers should utilize the official state portals and managed care entity provider pages to manage their enrollment and certification processes.

Direct contact with BDS Provider Services or the IHCP helpdesk is recommended for application status inquiries.

• IHCP Provider Enrollment Portal: https://provider.indianamedicaid.com
• BDS Provider Services Email: [email protected]
• OMPP HCBS Certification Page: https://www.in.gov/fssa/ompp/hcbs-certification-process/
• Anthem Indiana Medicaid: https://providers.anthem.com/indiana-provider/patient-care/pathways-aging
• Humana Indiana Medicaid: https://www.humana.com/provider/medical-resources/indiana-medicaid
• UnitedHealthcare Indiana Medicaid: https://www.uhcprovider.com/en/health-plans-by-state/indiana-health-plans/in-comm-plan-home/how-to-join-indiana.html

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