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Indiana - Personal Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) requires prospective Personal Assistance Services providers to obtain formal HCBS Certification through the OMPP Certification Portal before they can apply for Medicaid enrollment. This service, funded primarily through the Indiana PathWays for Aging, Health & Wellness (H&W), and Traumatic Brain Injury (TBI) waivers, delivers hands-on assistance with activities of daily living directly in the participant's home.

Approval operates on a strict three-step sequential gate: providers must first secure OMPP HCBS Certification, subsequently enroll as an Indiana Health Coverage Programs (IHCP) provider, and finally complete waiver-specific network enrollment. For the PathWays for Aging program, this final step mandates securing active contracts with the state's designated Managed Care Entities (Anthem, Humana, and UnitedHealthcare), without which a provider cannot receive authorizations or reimbursement for those waiver participants.

1. Service Definition and Scope

In Indiana, Personal Assistance Services (often billed under Personal Care Services or Attendant Care depending on the specific waiver) provide direct, hands-on assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). These services are designed to prevent institutionalization by supporting participants in their own homes or community settings.

The scope includes bathing, grooming, dressing, toileting, transferring, and mobility assistance, alongside secondary IADL supports like light housekeeping and meal preparation when directly related to the participant's care plan. Services must be explicitly authorized in the participant's Individualized Support Plan (ISP) or care plan.

2. Regulatory and Oversight Agencies

The Indiana Family and Social Services Administration (FSSA) is the umbrella agency managing Medicaid and HCBS waivers. Within FSSA, the Office of Medicaid Policy and Planning (OMPP) handles HCBS certification and overall Medicaid policy.

The Division of Disability and Rehabilitative Services (DDRS) oversees the H&W and TBI waivers, while the managed care entities oversee the PathWays for Aging program under OMPP's direction.

3. Gatekeeping Prerequisites: Who Can Even Apply

Indiana does not utilize a Certificate of Need process for Personal Assistance Services, but it enforces a strict sequential enrollment process. An applicant cannot submit an IHCP Medicaid enrollment application without first possessing an approved HCBS Certification from OMPP.

Furthermore, for providers intending to serve the aging population under the PathWays for Aging program, obtaining IHCP enrollment is not the final gate. Providers must successfully credential and contract with at least one of the three designated Managed Care Entities (MCEs) to receive participant referrals and authorizations.

4. Licensure and Certification Requirements

Indiana does not issue a distinct conventional 'license' for non-medical Personal Assistance Services agencies; instead, the state uses the OMPP HCBS Certification process as the functional equivalent of licensure for waiver providers. Providers must submit their operational policies, insurance quotes, and organizational charts through the OMPP Certification Portal.

During the initial review, OMPP evaluates the agency's compliance with HCBS standards, participant rights, and emergency preparedness. Full operational manuals uploaded multiple times will be rejected; providers must upload specific policies to the corresponding portal requirements.

5. Medicaid Provider Enrollment

Once OMPP HCBS Certification is granted, the agency must enroll as a billing provider with the Indiana Health Coverage Programs (IHCP). This is completed via the IHCP Provider Healthcare Portal.

Providers must submit a full enrollment application to enroll for the first time or to add a new service location. The IHCP Provider Enrollment Unit requires at least 15 business days for processing before status inquiries can be made.

6. Staffing, Training and Background Checks

Agencies must ensure all Direct Support Professionals (DSPs) and Personal Care Aides meet Indiana's baseline qualifications before providing hands-on care. This includes passing comprehensive criminal background checks and completing required training modules.

Supervisory staff must oversee the delivery of care, ensuring that aides follow the authorized Individualized Support Plan and adhere to infection control and safety protocols.

7. Documentation, Policies and Records

Providers must maintain comprehensive records demonstrating compliance with OMPP standards and the HCBS Final Settings Rule. Documentation must prove that services were delivered exactly as authorized in the ISP.

Agencies are required to report critical incidents to FSSA within specified timeframes and maintain a grievance policy that is communicated to all participants upon intake.

8. Billing, Rates and Claims

Personal Assistance Services are typically billed in 15-minute increments using specific HCPCS codes assigned by IHCP and the respective waivers. Claims for H&W and TBI waivers are submitted directly to IHCP, while PathWays for Aging claims are submitted to the participant's MCE.

Providers must exhaust all other sources of reimbursement (Third Party Liability) before billing Medicaid. Electronic Visit Verification (EVV) is federally mandated for all personal care services in Indiana.

9. Approval Sequence and Timeline

The end-to-end process for becoming a fully active Personal Assistance Services provider in Indiana spans several months due to the sequential nature of the approvals. Providers cannot begin the next step until the previous one is fully approved.

OMPP Certification is the first and often longest phase, followed by IHCP enrollment, and concluding with MCE credentialing or DDRS pick list activation.

10. Common Denials and Survey Findings

OMPP frequently returns certification applications for corrections during the initial review phase if documents do not strictly align with the Required Document Definitions. Uploading generic, unedited franchise manuals is a primary cause for application expiration.

Post-enrollment, providers face claim denials or audit findings primarily due to EVV non-compliance or failing to document the specific ADLs performed during a shift.

11. Key Contacts and Resources

Prospective providers must utilize the official FSSA and IHCP portals for all application steps. The OMPP Certification Portal is the starting point for all new HCBS waiver providers.

For assistance with IHCP enrollment, providers can contact the IHCP customer service line. For waiver-specific operational questions, providers engage with DDRS or the respective MCEs.

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