Indiana - Residential Care Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Indiana Department of Health (IDOH) licenses 24-hour residential settings as Residential Care Facilities (RCFs) under 410 IAC 16.2-5, which serves as the foundational license for delivering Assisted Living services under the state's PathWays for Aging and Health & Wellness (H&W) Medicaid waivers. Providers targeting the intellectual and developmental disability populations instead deliver Residential Habilitation and Support (RHS) or Supervised Group Living (SGL) under the Community Integration and Habilitation (CIH) Waiver, overseen by the Division of Disability and Rehabilitative Services (DDRS).

Approval to bill Medicaid for these services requires passing distinct structural gates depending on the target population. RCFs seeking to serve the aging population must secure network contracts with the specific Managed Care Entities (MCEs) administering the PathWays program (Anthem, Humana, UnitedHealthcare) after obtaining OMPP certification, while RHS providers under DDRS are strictly required by Indiana Code § 12-11-1.1-1 to achieve national accreditation from bodies like CARF or CQL before the state will approve their provider application.

1. Service Definition and Scope

Indiana defines this service across two primary regulatory pathways based on the waiver population. For aging and physically disabled individuals, it is defined as Assisted Living delivered within an IDOH-licensed Residential Care Facility (RCF), providing three meals a day, personal care, and medication administration.

For individuals with intellectual and developmental disabilities, 24-hour care is defined as Residential Habilitation and Support (RHS) or Supervised Group Living (SGL) under the CIH Waiver, focusing on skill acquisition, community integration, and daily living support in settings of up to eight individuals.

• RCF Licensure Rule: 410 IAC 16.2-5 governs the physical and operational standards for Residential Care Facilities.
• PathWays Assisted Living: Covers personal care, homemaker, and chore services delivered within a licensed RCF setting.
• CIH Waiver RHS: Provides intermittent or 24-hour support for individuals with developmental disabilities in supported living environments.
• SGL Capacity: Supervised Group Living programs serve at least four and not more than eight individuals per setting.
• Excluded Costs: Room and board are not Medicaid-reimbursable under HCBS waivers and must be covered by the resident or state assistance.

2. Regulatory and Oversight Agencies

Multiple agencies under the Indiana Family and Social Services Administration (FSSA) and the Indiana Department of Health (IDOH) share oversight. IDOH handles the physical facility licensure, while FSSA divisions manage waiver certification and Medicaid enrollment.

Managed Care Entities (MCEs) provide direct oversight and credentialing for the PathWays for Aging program, whereas the Bureau of Developmental Disabilities Services (BDDS) oversees the CIH waiver.

• Indiana Department of Health (IDOH): https://www.in.gov/health/long-term-carenursing-homes/residential-care-facility-licensing-program
• Office of Medicaid Policy and Planning (OMPP): https://www.in.gov/fssa/ompp/hcbs-certification-process
• Division of Disability and Rehabilitative Services (DDRS): https://www.in.gov/fssa/ddrs/
• Indiana Health Coverage Programs (IHCP) Portal: https://portal.indianamedicaid.com/hcp/provider
• PathWays MCE - Anthem: https://www.anthem.com/in/medicaid/
• PathWays MCE - Humana: https://www.humana.com/medicaid/indiana
• PathWays MCE - UnitedHealthcare: https://www.uhccommunityplan.com/in

3. Gatekeeping Prerequisites: Who Can Even Apply

Indiana imposes strict structural preconditions before a provider can bill Medicaid for residential services. There is no Certificate of Need (CON) required for RCFs, but waiver enrollment is heavily gated by managed care contracting and accreditation mandates.

Providers must secure these prerequisites before OMPP or DDRS will finalize their Medicaid HCBS enrollment.

• MCE Network Contracting: PathWays for Aging providers must successfully contract with Anthem, Humana, or UnitedHealthcare; OMPP certification alone does not guarantee network inclusion or the ability to bill.
• National Accreditation Mandate: Per IC 12-11-1.1-1, DDRS RHS and SGL providers must be accredited by CARF, CQL, JCAHO, or the Council on Accreditation before the state will approve them.
• Housing with Services Registration: Unlicensed facilities using the term "assisted living" must file a disclosure form with the FSSA Division of Aging before operating.
• Administrator Licensure: RCFs must employ an administrator licensed by the Indiana State Board of Health Facility Administrators prior to licensure.

4. Licensure and Certification Requirements

Facilities providing medication administration and nursing care must obtain an RCF license from IDOH. The process involves a pre-licensure survey and compliance with health and life safety codes.

Following IDOH licensure, providers seeking to serve waiver participants must obtain HCBS Certification from OMPP via the OMPP Certification Portal.

• RCF Application: Submitted to IDOH with architectural plans, operational policies, and proof of administrator licensure.
• Pre-Licensure Survey: IDOH conducts an initial on-site survey to verify life safety and operational readiness before issuing the RCF license.
• OMPP Certification Portal: Applications must be fully submitted within 30 calendar days of starting, or they automatically expire.
• Heightened Scrutiny: Facilities with institutional characteristics must pass a heightened scrutiny review to ensure compliance with the federal HCBS settings rule.
• Renewal Cycle: IDOH conducts licensure renewal surveys every 9 to 15 months.

5. Medicaid Provider Enrollment

After obtaining OMPP HCBS Certification, providers must enroll in the Indiana Health Coverage Programs (IHCP) as a billing provider.

Enrollment is processed through the IHCP Provider Healthcare Portal, requiring the provider to link their OMPP certification and National Provider Identifier (NPI).

• IHCP Provider Healthcare Portal: The central system for submitting the Medicaid enrollment application and linking OMPP certification.
• Provider Type/Specialty: Must align exactly with the specific waiver services approved during the OMPP certification step.
• Application Fee: Subject to the federal Medicaid/Medicare institutional application fee unless already paid to Medicare or another state.
• Active Application Limit: OMPP allows only one active certification application at a time per agency to prevent duplicate processing.
• Effective Date: The OMPP certification effective date is the date the application is fully processed, or the date heightened scrutiny is passed.

6. Staffing, Training and Background Checks

Indiana mandates strict background checks and training standards for all direct care staff in residential settings. RCFs and RHS agencies must maintain documentation of these qualifications in personnel files.

Nursing and medication administration tasks require specific state credentials, such as a Qualified Medication Aide (QMA) or licensed nurse.

• Criminal History Checks: Required under 460 IAC 6-10-5 for RHS and state law for RCFs; facilities cannot employ individuals with abuse or neglect convictions.
• Nurse Aide Registry: Providers must verify staff against the state registry and report any findings of misappropriation or abuse.
• Administrator Background Check: RCF administrator applicants must submit a national criminal history background check at their own cost.
• Medication Administration: Must be performed by an RN, LPN (meeting IC 25-23), or a state-certified Qualified Medication Aide (412 IAC 2).
• Direct Care Training: RHS staff must meet training requirements outlined in 460 IAC 6-14-4 before providing unsupervised care.

7. Documentation, Policies and Records

Providers must maintain comprehensive operational policies and resident records. OMPP certification requires uploading specific policy documents, and blank or generic templates will cause the application to expire.

Resident agreements and disclosure forms are heavily regulated to ensure transparency regarding costs, services, and eviction procedures.

• Resident Agreements: Must detail base rate services, additional costs, complaint resolution, and discharge policies.
• Annual Disclosure Document: RCFs must file annually with the Division of Aging and provide a copy to each resident upon admission.
• OMPP Required Documents: Must include current licenses, valid background checks, and agency-specific organizational charts.
• Billing Documentation: RHS providers cannot bill for hours the consumer was not present or for more hours than staff actually worked.
• Policy Uploads: Uploading full operational manuals instead of the specific requested policy in the OMPP portal will result in application rejection.

8. Billing, Rates and Claims

Claims for waiver residential services are submitted through the IHCP portal or directly to the MCEs for PathWays participants.

Rates are established by FSSA and vary based on the waiver, the tier of need, and whether the service is billed hourly or daily.

• PathWays Claims: Billed directly to Anthem, Humana, or UnitedHealthcare according to their specific provider manuals and fee schedules.
• CIH Waiver Billing: RHS can be billed in hourly or daily formats depending on the participant's authorized service plan.
• Service Overlaps: RHS and Electronic Monitoring services are not billable during the same time period.
• Transportation Limits: RHS cannot be used in conjunction with Transportation Services when 35 or more hours of RHS are utilized per week.
• Residential Care Assistance Program (RCAP): A state-funded program providing financial assistance for room and board to eligible low-income RCF residents.

9. Approval Sequence and Timeline

The end-to-end process for becoming a fully enrolled residential provider spans several months, requiring sequential approvals from IDOH, OMPP, IHCP, and MCEs.

Delays often occur if OMPP applications are incomplete or if the facility requires a heightened scrutiny review for HCBS settings compliance.

• Step 1: IDOH RCF Licensure: Submit application, pass architectural review, and complete the pre-licensure survey.
• Step 2: OMPP Certification: Submit via the portal; must be completed within 30 days of initiation.
• Step 3: IHCP Enrollment: Submit the Medicaid enrollment application via the IHCP Provider Healthcare Portal.
• Step 4: MCE Contracting: For PathWays, apply for network inclusion and credentialing with the three designated health plans.
• Accreditation Timeline: For DDRS RHS, national accreditation must be secured prior to state approval, which can add 6-12 months to the initial startup phase.

10. Common Denials and Survey Findings

Applications are frequently denied or expired at the OMPP certification stage due to administrative errors or incomplete documentation.

During IDOH surveys, life safety code violations and medication administration errors are the most common citations that can delay or jeopardize licensure.

• Expired OMPP Applications: Failing to submit the full application within the 30-day window results in automatic expiration.
• Generic Policies: Uploading policies that contain a different agency's name or uploading a massive manual instead of the specific policy causes OMPP rejection.
• Unqualified Services: Selecting services in the OMPP portal that the agency lacks the prerequisite license or accreditation to provide leads to denial.
• Life Safety Code: IDOH frequently cites RCFs for inadequate fire safety documentation or physical plant deficiencies during pre-licensure surveys.
• Background Check Gaps: Employing staff before the return of a clear criminal history check or nurse aide registry verification results in survey citations.

11. Key Contacts and Resources

Providers should utilize the official FSSA and IDOH portals for the most current manuals, bulletins, and application forms.

The OMPP Certification team can be reached via the inquiry feature within the certification portal for application-specific assistance.

• Indiana Department of Health (IDOH) RCF Licensing: https://www.in.gov/health/long-term-carenursing-homes/residential-care-facility-licensing-program
• OMPP HCBS Certification Portal: https://omppproviders.fssa.in.gov/
• IHCP Provider Healthcare Portal: https://portal.indianamedicaid.com/hcp/provider
• FSSA Division of Disability and Rehabilitative Services (DDRS): https://www.in.gov/fssa/ddrs/
• IHCP Provider Customer Service: 800-457-4584
• PathWays MCE - Anthem: https://www.anthem.com/in/medicaid/

See all Indiana services · Indiana Medicaid consulting · book a consultation.