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

Last reviewed: 2026-09-09

The Indiana Family and Social Services Administration (FSSA) funds Community Transition Services through the Community Integration and Habilitation (CIH) Waiver, the Health & Wellness (H&W) Waiver, and the PathWays for Aging program to cover one-time setup expenses when a Medicaid member moves from an institution to a private residence. Providers do not obtain a traditional facility license for this service; instead, they must secure Home and Community-Based Services (HCBS) certification directly through the Office of Medicaid Policy and Planning (OMPP) Certification Portal before applying for Medicaid enrollment.

Operating this service requires navigating a bifurcated system depending on the target population. Providers serving the aging population must secure network contracts with specific Managed Care Entities (MCEs) after certification, while those serving individuals with developmental disabilities must complete the Bureau of Disabilities Services (BDS) New Provider Approval Process and be added to the state's waiver pick list.

1. Service Definition and Scope

In Indiana, Transitional Assistance Services are officially designated as Community Transition Services. This service provides non-recurring setup expenses for individuals transitioning from an institutional setting (such as a nursing facility or ICF/IID) to a private community-based residence where the person is directly responsible for their own living expenses.

The scope of the service is strictly limited to essential physical transition needs and does not cover ongoing rent or room and board. It is utilized to ensure the new community environment is safe, furnished, and habitable on day one of the transition.

• Covered Expense: Security deposits and first month's rent required to obtain a lease.
• Covered Expense: Essential household furnishings, including furniture, window coverings, and basic kitchen supplies.
• Covered Expense: Set-up fees or deposits for utility or service access, including telephone, electricity, heating, and water.
• Covered Expense: Services necessary for the individual's health and safety, such as pest eradication and one-time cleaning prior to occupancy.
• Covered Expense: Moving expenses required to transport the individual's belongings to the new residence.
• Exclusion: Monthly rental or mortgage expenses, food, regular utility charges, and household appliances or items that are intended for purely diversional or recreational purposes.

2. Regulatory and Oversight Agencies

Oversight of Community Transition Services in Indiana is divided between the overarching Medicaid authority and the specific operating divisions that manage the waiver populations. The Office of Medicaid Policy and Planning (OMPP) handles the initial HCBS certification for all waiver providers.

Once certified, providers are overseen by either the Bureau of Disabilities Services (BDS) for developmental disability waivers or the managed care plans for the PathWays for Aging program.

• Certifying Authority: Office of Medicaid Policy and Planning (OMPP) (https://www.in.gov/fssa/ompp/)
• Operating Agency (DD Waivers): Bureau of Disabilities Services (BDS) under the Division of Disability and Rehabilitative Services (DDRS) (https://www.in.gov/fssa/ddars/)
• Operating Program (Aging): Indiana PathWays for Aging (https://www.in.gov/pathways/)
• Enrollment Contractor: Indiana Health Coverage Programs (IHCP) (https://www.in.gov/medicaid/providers/)
• Managed Care Entity: Anthem (https://providers.anthem.com/indiana-provider/patient-care/pathways-aging)
• Managed Care Entity: Humana (https://www.humana.com/provider/medical-resources/indiana-medicaid)
• Managed Care Entity: UnitedHealthcare (https://www.uhcprovider.com/en/health-plans-by-state/indiana-health-plans/in-comm-plan-home/how-to-join-indiana.html)

3. Gatekeeping Prerequisites: Who Can Even Apply

Indiana does not require a Certificate of Need for Community Transition Services, but it imposes strict structural prerequisites depending on the waiver program. For the CIH Waiver, applicants must pass the BDS New Provider Approval Process, which grants a pending provisional approval status before full enrollment is permitted.

For the PathWays for Aging program, providers face a managed care contracting gate. Certification by OMPP does not guarantee the ability to bill; providers must successfully execute network contracts with Anthem, Humana, or UnitedHealthcare to receive authorizations and reimbursement.

• BDS Provisional Approval: Required for CIH Waiver providers before final Medicaid enrollment is granted.
• MCE Contracting Requirement: PathWays for Aging providers must enroll and contract with at least one of the three designated MCEs (Anthem, Humana, UnitedHealthcare).
• Leadership Training Mandate: BDS requires the prospective provider's agency leadership (CEO, CFO, Waiver Administrator) to attend the in-person BDS Leadership Training Series at the Indiana Government Center within one year of pending provisional approval.
• Settings Rule Compliance: All applicants must demonstrate compliance with the HCBS Final Settings Rule, and facilities located inside or adjacent to institutional treatment centers are subject to heightened scrutiny review.
• No Standalone Licensure: There is no distinct state license for this service; applicants must qualify directly through the OMPP HCBS Certification pathway.

4. Licensure and Certification Requirements

Because Indiana does not issue a specific facility or agency license for Community Transition Services, the legal authority to operate is granted through OMPP HCBS Certification. Providers must submit their application through the OMPP Certification Portal.

The certification process requires the submission of specific operational policies, proof of insurance, and organizational documents. OMPP reviews these materials to ensure the agency has the administrative capacity to manage transition funds and coordinate services.

• Application Portal: OMPP Certification Portal (https://omppproviders.fssa.in.gov/)
• Required Document: Quotes or active templates for a comprehensive General Liability Insurance Policy.
• Required Document: A completed and accurate Organizational Chart detailing agency leadership and reporting structures.
• Policy Requirement: Submission of specific, targeted policies as defined in the OMPP Required Document Definitions, rather than a single massive operational manual.
• Initial Review Feedback: OMPP provides feedback during the initial review phase if document corrections are needed before final certification is granted.

5. Medicaid Provider Enrollment

After obtaining OMPP HCBS Certification, the agency must formally enroll as a billing provider with the Indiana Health Coverage Programs (IHCP). This is completed through the IHCP Provider Healthcare Portal.

During this step, providers link their OMPP certification to their Medicaid ID, set up Electronic Funds Transfer (EFT), and sign the IHCP Provider Agreement, legally binding them to state and federal Medicaid regulations.

• Enrollment System: IHCP Provider Healthcare Portal (https://portal.indianamedicaid.com)
• Provider Agreement: Must sign State Form 53870, agreeing to provide only authorized waiver services and maintain ongoing regulatory compliance.
• EFT Enrollment: Optional but highly recommended Electronic Fund Transfer setup during the initial application.
• Status Updates: Providers must notify FSSA or its agent within 10 days of any change in certification status or agency ownership.
• Waiver Pick List: Upon successful IHCP enrollment for H&W or TBI waivers, the agency is added to the DDRS pick list for case managers.

6. Staffing, Training and Background Checks

Community Transition Services are primarily administrative and coordinative, meaning direct care staffing ratios do not apply in the same way as residential habilitation. However, any staff member handling transition funds or interacting with the waiver participant must meet state background check and training standards.

Agency leadership is subject to strict training mandates under BDS, and all personnel must be trained on incident reporting, participant rights, and HCBS Settings Rule compliance.

• Leadership Training: CEO, COO/CFO, and Waiver Administrator must attend the quarterly BDS Leadership Training Series in Indianapolis.
• Background Checks: Current, unexpired criminal history background checks are required for all staff and leadership submitted during the OMPP certification process.
• HCBS Training: Staff must complete documented training on the HCBS Final Rule, community integration, and participant rights.
• Record Keeping: Training completion records must be maintained in personnel files and available for state auditors upon request.

7. Documentation, Policies and Records

OMPP and BDS require precise documentation to prove that transition funds were spent exclusively on allowable items. Providers must maintain a clear audit trail from the initial quote to the final receipt.

During the certification process, OMPP strictly prohibits the uploading of generic, bulk operational manuals. Providers must upload individual, customized policies that match the exact name of the applying agency.

• Financial Records: Must retain original receipts, invoices, and lease agreements for all transition expenses funded by the waiver.
• Policy Formatting: Policies uploaded to the OMPP portal must contain the exact agency name associated with the application; mismatched names result in rejection.
• Document Rejection: Full Operational Manuals uploaded multiple times across different application sections will not be reviewed and will cause the application to expire.
• Recipient Safeguards: Must maintain secure records of the recipient's name, address, social circumstances, and services provided, in compliance with HIPAA and state law.

8. Billing, Rates and Claims

Community Transition Services are billed as a one-time or milestone-based reimbursement rather than an hourly rate. The state establishes a lifetime maximum cap per participant for these expenses.

Providers must ensure that all expenses are prior-authorized by the waiver case manager and explicitly listed in the participant's approved Plan of Care before any funds are expended or billed to IHCP or the MCE.

• Prior Authorization: Services must be authorized by the waiver case manager or targeted case manager as set out in the Plan of Care prior to delivery.
• Reimbursement Model: Billed based on actual costs incurred up to the state-approved maximum limit, requiring submission of receipts.
• Payer Source (Aging): Claims for PathWays for Aging participants are submitted directly to the contracted MCE (Anthem, Humana, or UHC).
• Payer Source (DD): Claims for CIH Waiver participants are submitted through the IHCP Provider Healthcare Portal as fee-for-service waiver claims.

9. Approval Sequence and Timeline

The approval sequence in Indiana is strictly linear and cannot be completed concurrently. Providers must clear the OMPP certification hurdle before IHCP will process a Medicaid enrollment application.

The entire process from initial portal registration to being fully billable on a waiver pick list or MCE network typically spans several months, heavily dependent on the accuracy of the initial policy uploads.

• Step 1: Prepare required documents using the OMPP Required Document Definitions guide.
• Step 2: Submit the initial certification application through the OMPP Certification Portal.
• Step 3: Respond to OMPP initial review feedback and correct any deficient policies or expired documents.
• Step 4: Upon OMPP approval, submit the provider enrollment application via the IHCP Provider Healthcare Portal.
• Step 5: For PathWays, initiate credentialing and contracting with Anthem, Humana, and/or UnitedHealthcare.
• Step 6: For DD waivers, contact [email protected] to be added to the waiver pick list.

10. Common Denials and Survey Findings

OMPP frequently rejects initial certification applications due to administrative errors in the document upload process. The state explicitly warns against uploading blank documents or expired credentials.

Post-enrollment, providers face remediation or sanctions if they fail to maintain HCBS Settings Rule compliance or if they bill for transition expenses that were not explicitly authorized in the Plan of Care.

• Denial Reason: Uploading policies that contain a different agency's name from the associated application.
• Denial Reason: Submitting expired background checks or expired professional licenses.
• Denial Reason: Uploading blank organizational charts or blank document templates instead of completed forms.
• Survey Finding: Failure of agency leadership to attend the mandatory BDS Leadership Training Series within one year of provisional approval.
• Sanction Risk: Billing for unallowable transition expenses, such as ongoing rent or recreational items, leading to immediate recoupment.

11. Key Contacts and Resources

Providers must utilize the specific portals and helpdesks designated for their target waiver population. The IHCP customer service line is the primary contact for portal enrollment issues.

For waiver-specific operational questions, providers should direct inquiries to BDS Provider Services or the respective MCE provider relations departments.

• OMPP Certification Portal: https://omppproviders.fssa.in.gov/
• IHCP Provider Healthcare Portal: https://portal.indianamedicaid.com
• IHCP Customer Assistance: 800-457-4584
• BDS Provider Services Email: [email protected]
• Anthem PathWays Provider Page: https://providers.anthem.com/indiana-provider/patient-care/pathways-aging
• Humana Indiana Medicaid Page: https://www.humana.com/provider/medical-resources/indiana-medicaid
• UnitedHealthcare Indiana Community Plan: 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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