Indiana - Speech & Language Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Indiana Professional Licensing Agency (PLA) Speech-Language Pathology and Audiology Board issues the mandatory state license required before any practitioner can bill the Indiana Health Coverage Programs (IHCP) for communication, cognition, and swallowing therapies. The Indiana Family and Social Services Administration (FSSA) manages the Medicaid reimbursement side, integrating these services across fee-for-service, managed care, and Home and Community-Based Services (HCBS) waivers like the Family Supports Waiver (FSW) and PathWays for Aging.

Applicants cannot initiate IHCP Medicaid enrollment until they have completed a Clinical Fellowship Year (CFY), passed the Indiana jurisprudence examination with a score of at least 75%, and secured an active, unrestricted SLP license from the PLA. For those intending to bill under HCBS waivers, an additional structural gate requires obtaining a waiver provider certification letter from the Division of Disability and Rehabilitative Services (DDRS) or the Division of Aging before the IHCP portal will accept the enrollment application.

1. Service Definition and Scope

In the Indiana Health Coverage Programs (IHCP), Speech-Language Pathology encompasses the clinical evaluation and therapeutic intervention for speech, language, voice, swallowing (dysphagia), and cognitive-communication disorders. Services must be medically necessary and ordered by a physician to restore or maintain a member's functional communication or swallowing abilities.

The service is delivered across traditional fee-for-service Medicaid, managed care programs like the Healthy Indiana Plan (HIP) and Hoosier Healthwise, and HCBS waivers. Under waivers, it is often authorized as Specialized Therapies to support individuals with intellectual and developmental disabilities or aging populations in community settings.

• Target Populations: Medicaid members with congenital or acquired speech, language, cognitive, or swallowing deficits.
• Covered Modalities: Direct one-on-one therapy, comprehensive evaluations, and augmentative and alternative communication (AAC) assessments.
• Waiver Integration: Authorized under DDRS waivers (FSW, CIH) as Specialized Therapies or Division of Aging/PathWays as Speech Therapy.
• Exclusions: Academic tutoring, purely vocational training, and experimental treatments are not reimbursable as clinical SLP services.
• Telehealth: Permitted for certain speech and language interventions when clinically appropriate and aligned with current IHCP telehealth bulletins.

2. Regulatory and Oversight Agencies

Multiple state agencies govern SLP practice and Medicaid reimbursement in Indiana. The PLA handles professional licensure and disciplinary actions, ensuring practitioners meet educational and clinical standards.

The FSSA manages Medicaid policy, waiver administration, and provider enrollment. Within FSSA, specific divisions oversee the HCBS waivers that fund community-based SLP services.

• Licensing Authority: Indiana Professional Licensing Agency (PLA) Speech-Language Pathology and Audiology Board (https://www.in.gov/pla/professions/speech-language-pathology-and-audiology-home/)
• Medicaid Authority: Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) (https://www.in.gov/fssa/ompp/)
• Waiver Administration (IDD): FSSA Division of Disability and Rehabilitative Services (DDRS) (https://www.in.gov/fssa/ddrs/)
• Waiver Administration (Aging): FSSA Division of Aging (https://www.in.gov/fssa/da/)
• Medicaid Portal: IHCP Provider Healthcare Portal (CoreMMIS) (https://portal.indianamedicaid.com)

3. Gatekeeping Prerequisites: Who Can Even Apply

Indiana does not impose a Certificate of Need (CON) or closed-network moratorium on independent Speech-Language Pathologists. The state operates an open enrollment model for qualified clinicians.

The absolute structural prerequisite is holding an active Indiana PLA license; IHCP will reject any enrollment application lacking this credential. For HCBS waiver billing, providers must also obtain waiver certification from the respective FSSA division before IHCP enrollment.

• Certificate of Need: None required for independent SLP practices or clinics in Indiana.
• Licensure Prerequisite: Must hold an active Indiana PLA Speech-Language Pathologist license prior to initiating IHCP enrollment.
• Waiver Certification Gate: HCBS waiver providers must receive an approval letter from DDRS/BDDS or the Division of Aging before submitting the IHCP waiver provider application.
• Managed Care Contracting: Required to serve members in Hoosier Healthwise, HIP, or Hoosier Care Connect; requires separate credentialing with Managed Care Entities (MCEs) after IHCP enrollment.
• Out-of-State Providers: Must obtain an Indiana PLA license by reciprocity to enroll as an IHCP rendering provider, even for telehealth.

4. Licensure and Certification Requirements

The Indiana PLA requires a master's degree, a supervised clinical fellowship, and successful examination for full licensure. Applicants must pass both a national clinical exam and a state-specific legal exam.

During the clinical fellowship, practitioners must hold a temporary CFY license. Full licensure requires submitting transcripts, exam scores, and background check results directly to the PLA.

• Education: Master's degree or higher in speech-language pathology from an accredited institution.
• Clinical Fellowship Year (CFY): Completion of a supervised clinical fellowship; a temporary CFY license ($50 fee) is required during this period.
• National Examination: Passing score on the Praxis Examination in Speech-Language Pathology.
• Jurisprudence Examination: Mandatory written exam covering IC 25-35 and Title 880, requiring a minimum passing score of 75%.
• Application Fee: $150 nonrefundable fee submitted to the Indiana PLA via the MyLicense One portal.
• Background Check: Mandatory criminal background check with fingerprinting for all initial applicants.
• Positive Response Documentation: Applicants answering yes to disciplinary questions must submit court documents and a detailed statement.

5. Medicaid Provider Enrollment

Enrollment is processed through the IHCP Provider Healthcare Portal (CoreMMIS). SLPs enroll using specific provider types and specialties to ensure claims route correctly.

Group practices must enroll the business entity and link individual licensed SLPs as rendering providers. Failure to establish this linkage prevents the group from billing for the individual's services.

• System: IHCP Provider Healthcare Portal (CoreMMIS).
• Provider Classification: Provider Type 15 (Therapist), Specialty 152 (Speech Pathologist).
• NPI Requirement: Must obtain and register a National Provider Identifier (NPI) matching the enrollment taxonomy.
• Application Fee: Individual practitioners are typically exempt from the institutional application fee, but groups may be subject to risk-based screening fees depending on structure.
• Rendering Linkage: Individual SLPs must be linked to the billing group's Service Location via Schedule A.3/A.4 or the portal.
• Revalidation: Required every three to five years as directed by IHCP bulletins and portal notifications.

6. Staffing, Training and Background Checks

Beyond professional licensure, SLPs and their support personnel must meet ongoing state training and supervision standards. Continuing education is strictly monitored by the PLA.

SLP Support Personnel (assistants) must be licensed and strictly supervised by a fully licensed SLP. The state requires new licensure if an assistant changes employers.

• Continuing Education: Licensed SLPs must complete 36 hours of continuing education every two-year renewal cycle.
• Self-Study Limit: No more than six (6) hours of the required CEUs may be acquired through self-study.
• Support Personnel Licensure: SLP assistants must hold an active SLP Support Personnel license linked to their specific supervising SLP.
• Supervisor Changes: If an assistant changes employers, they must submit an application for a new SLP Support Personnel license and receive a new license number.
• Waiver Training: SLPs billing under HCBS waivers must complete state-mandated incident reporting, rights, and dignity training.
• OIG Exclusion Checks: Agencies must screen all staff monthly against state and federal exclusion databases.

7. Documentation, Policies and Records

IHCP requires strict clinical documentation to substantiate the medical necessity of all SLP evaluations and treatments. Missing signatures or incomplete session notes are primary targets for recoupment.

Records must be maintained securely and be immediately available for state, federal, or MCE audits. Waiver providers have additional documentation requirements regarding incident reporting.

• Plan of Care: Must have a physician-signed order and a detailed Plan of Care updated at least every 6 months or per specific waiver rules.
• Session Notes: Daily documentation must include date, start/stop times, specific interventions used, patient response, and the rendering provider's signature.
• Prior Authorization Records: Must maintain copies of all approved PAs and supporting clinical assessments in the member's file.
• Record Retention: Indiana Medicaid requires providers to retain all clinical and billing records for at least seven years.
• Incident Reporting: Waiver providers must maintain policies for reporting adverse events to the state via the incident reporting system within 24 hours.
• Discharge Summaries: Required when therapy goals are met or services are discontinued, detailing progress and final status.

8. Billing, Rates and Claims

SLP services are billed using standard CPT codes on professional claims. Reimbursement rates are established by the FSSA and published in the IHCP Professional Fee Schedule.

Many services require Prior Authorization (PA) after an initial evaluation. Providers must verify eligibility and PA requirements with the specific MCE or waiver administrator before initiating treatment.

• Claim Format: CMS-1500 or the electronic 837P equivalent submitted via the IHCP Portal or a clearinghouse.
• Common Codes: 92523 for speech/language evaluation; 92507 for individual speech/language/hearing treatment.
• Prior Authorization (PA): Often required after an initial evaluation or a set number of unmanaged visits, depending on the member's specific MCE or waiver.
• Fee Schedule: Current reimbursement rates are located in the IHCP Outpatient/Professional Fee Schedule updated annually in CoreMMIS.
• Third-Party Liability (TPL): Providers must bill commercial insurance or Medicare before submitting claims to IHCP as the payer of last resort.
• Place of Service: Claims must include the correct POS code (e.g., 11 for Office, 12 for Home) matching the authorized setting.

9. Approval Sequence and Timeline

The pathway to becoming a billable SLP provider in Indiana is strictly sequential. Professional licensure must be secured before any Medicaid enrollment steps can begin.

Once licensed, providers must complete IHCP enrollment, followed by MCE credentialing if serving managed care populations. Attempting to bill before all linkages are active results in denied claims.

• Step 1: Complete CFY and pass Praxis and Jurisprudence exams (approx. 9-12 months).
• Step 2: Submit PLA licensure application and background check (approx. 4-6 weeks for processing).
• Step 3: Obtain DDRS or Division of Aging waiver certification if providing HCBS waiver services (approx. 30-60 days).
• Step 4: Submit IHCP Provider Enrollment application via the portal (approx. 15-30 days).
• Step 5: Complete credentialing and contracting with Managed Care Entities (MCEs) (approx. 60-90 days).
• Step 6: Verify rendering provider linkages in CoreMMIS before submitting the first claim.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to administrative errors, missing linkages, or incomplete documentation. The IHCP portal requires exact matches between NPI data and state records.

Post-payment audits often target insufficient documentation of medical necessity. Surveyors look closely at physician orders and the specificity of daily session notes.

• Enrollment Rejection: Failing to upload a copy of the active PLA license or matching the NPI taxonomy to the IHCP specialty.
• Linkage Errors: Group claims denying because the rendering SLP was not properly linked to the group's service location in CoreMMIS.
• PA Denials: Commencing treatment before receiving formal Prior Authorization approval from the MCE or state.
• Audit Findings: Recoupment of funds due to missing start/stop times on session notes or lack of a current, signed physician order.
• Jurisprudence Failure: Licensure delays caused by failing to achieve the mandatory 75% score on the state law exam.
• Support Personnel Violations: Billing for services rendered by an SLP assistant who is not properly licensed or linked to the supervising SLP.

11. Key Contacts and Resources

Providers should bookmark these official state resources for applications, fee schedules, and policy updates. The IHCP Bulletins are the primary method the state uses to announce coding changes and policy updates.

Maintaining active accounts in both the PLA MyLicense One portal and the IHCP Provider Healthcare Portal is essential for compliance and billing.

• Indiana PLA SLP Board: https://www.in.gov/pla/professions/speech-language-pathology-and-audiology-home/
• IHCP Provider Healthcare Portal: https://portal.indianamedicaid.com
• FSSA Medicaid Policy Manual: https://www.in.gov/fssa/ompp/
• DDRS Provider Services: https://www.in.gov/fssa/ddrs/
• IHCP Bulletins & Banner Pages: https://www.in.gov/medicaid/providers/provider-references/bulletins-banner-pages-and-reference-modules/ihcp-bulletins/
• Division of Aging / PathWays: https://www.in.gov/fssa/da/

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