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Indiana - Skilled Respite Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Indiana Family and Social Services Administration (FSSA) funds skilled respite care through the PathWays for Aging, Health and Wellness, Traumatic Brain Injury, and Family Supports waivers, requiring providers to hold an active Home Health Agency (HHA) license from the Indiana Department of Health (IDOH) before applying. Indiana does not issue a distinct "Skilled Respite" license; instead, the state designates waiver specialties such as B18 and F32 (Respite) which mandate HHA licensure when the care needs exceed what an unlicensed attendant or personal services agency can legally provide.

Effective August 1, 2026, the Indiana Health Coverage Programs (IHCP) implemented a six-month statewide moratorium on certifying and enrolling new home- and community-based services 1915(c) waiver providers, explicitly including Respite and Respite Care Services. Applications that did not complete all IHCP screening requirements prior to this date are denied and expired, though providers may submit a narrative exception request to the Office of Medicaid Policy and Planning (OMPP) if they can prove their enrollment addresses a critical access shortage in a specific geographic area.

1. Service Definition and Scope

In Indiana, skilled respite provides temporary relief to primary caregivers of waiver participants whose medical conditions require nursing-level interventions. Because the state's standard attendant care and basic respite services are limited to non-medical assistance, skilled respite must be delivered by licensed nursing personnel (RNs or LPNs) operating under a licensed Home Health Agency.

The service is authorized under multiple 1915(c) waivers, including PathWays for Aging and the Health and Wellness waiver. It is designed to prevent institutionalization by ensuring that participants with complex medical needs, such as ventilator dependency or severe seizure disorders, can safely remain at home while their primary caregiver is unavailable.

2. Regulatory and Oversight Agencies

Multiple state divisions coordinate the oversight of skilled respite services. The Indiana Department of Health (IDOH) handles the foundational facility licensure, while divisions under the Family and Social Services Administration (FSSA) manage waiver certification and Medicaid enrollment.

Managed Care Entities (MCEs) also play a role for participants enrolled in managed care programs like PathWays for Aging, requiring providers to credential directly with the MCEs after obtaining state IHCP enrollment.

3. Gatekeeping Prerequisites: Who Can Even Apply

The state of Indiana enforces strict structural prerequisites for skilled respite providers. The most immediate precondition is the statewide HCBS provider enrollment moratorium effective August 1, 2026, which halts all new waiver certifications and enrollments for respite services unless a specific access-shortage exception is granted by OMPP.

Additionally, an applicant cannot apply for waiver certification for skilled respite (specialties B18 or F32) without already possessing a fully approved Home Health Agency license from IDOH. Personal Services Agency (PSA) licensure is insufficient for skilled respite.

4. Licensure and Certification Requirements

To provide skilled respite, an agency must first navigate the IDOH Home Health Agency licensure process. This involves submitting an initial application, paying the state fee, and passing an initial state survey to demonstrate compliance with Indiana Administrative Code (410 IAC 17).

Once licensed by IDOH, the provider must obtain a certification letter from the appropriate waiver administering division (such as DDRS for the Health and Wellness waiver) authorizing them to provide waiver services.

5. Medicaid Provider Enrollment

After obtaining the HHA license and waiver certification, providers must enroll in the Indiana Health Coverage Programs (IHCP) via the Provider Healthcare Portal. The enrollment requires the IHCP Waiver provider enrollment packet.

Providers must select the specific waiver specialties that align with their licensure. For skilled respite, this typically involves specialties B18 or F32, which the IHCP Provider Enrollment Type & Specialty Matrix explicitly flags as requiring Home Health Agency licensure.

6. Staffing, Training and Background Checks

Because this service involves skilled nursing tasks, all direct care must be provided by Registered Nurses (RNs) or Licensed Practical Nurses (LPNs) holding active, unencumbered Indiana nursing licenses. Unlicensed personnel cannot deliver skilled respite.

Agencies must conduct comprehensive background checks on all staff, including national fingerprint-based criminal history checks, and verify credentials through the Indiana Professional Licensing Agency (IPLA).

7. Documentation, Policies and Records

Providers must maintain rigorous clinical documentation to justify the skilled nature of the respite care. This includes a detailed plan of care signed by a physician, outlining the specific nursing interventions required during the respite period.

Clinical notes must be recorded for every shift, detailing the participant's status, medications administered, and any skilled interventions performed, aligning with both IDOH HHA regulations and IHCP waiver documentation standards.

8. Billing, Rates and Claims

Skilled respite is billed to the IHCP or the participant's Managed Care Entity (MCE) using specific HCPCS procedure codes and modifiers that denote the skilled nursing level of care. Claims are submitted through the IHCP Provider Healthcare Portal or the respective MCE clearinghouse.

Rates for waiver services are established by FSSA and published in the IHCP fee schedules. Providers must ensure they do not bill for skilled respite concurrently with other overlapping services like State Plan Home Health.

9. Approval Sequence and Timeline

The approval sequence is strictly linear and currently impacted by the enrollment moratorium. Normally, a provider must first secure the IDOH Home Health Agency license, which can take 6 to 12 months depending on survey scheduling.

Following licensure, the provider requests waiver certification from the FSSA division (e.g., DDRS), and finally submits the IHCP enrollment application. The IHCP states to allow at least 15 business days for processing once the application is submitted, though the moratorium halts new processing without an approved exception.

10. Common Denials and Survey Findings

Applications for skilled respite are frequently denied at the IHCP level if the provider attempts to enroll using only a Personal Services Agency (PSA) license rather than the required Home Health Agency license for specialties B18/F32.

During the current moratorium period, any application that did not have all screening requirements completed by August 1, 2026, is automatically denied or expired unless a formal access-shortage exception is granted by OMPP.

11. Key Contacts and Resources

Providers should rely on the official FSSA and IDOH portals for the most current manuals, fee schedules, and moratorium updates. The IHCP Provider Reference Modules are the definitive guides for billing and enrollment policies.

For exception requests related to the HCBS moratorium, providers must communicate directly with the OMPP Provider Relations team.

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