How to become a Certified HCBS Waiver Provider
After reviewing the information provided above you will need to complete an application for certification. A table indicating required documents
for each waiver service is available for you to review. Any additional questions or inquiries may be submitted to the Waiver Provider Specialist by phone at 317-232-4650 or by email at firstname.lastname@example.org
. You may click here
to access the HCBS Waiver Provider Packet.
Please note:The Division of Aging office in Indianapolis is not set up to accommodate walk-ins. We urge you to use the tools and information on the website first. Again, questions may be emailed to email@example.com, as most questions can be resolved by email or phone call. If it becomes necessary to have an in-person meeting, Division staff will schedule a meeting with you in advance.
The basic Medicaid Waiver Provider application for certification is available to download here and the required W-9 maybe be downloaded here.
Please submit final application and all required documents at firstname.lastname@example.org and paper applications will continue to be accepted and may be mailed o the address below:
ATTN: Waiver/Provider Analyst
Family and Social Services Administration
Indiana Health Coverage Programs (IHCP)
DA Home and Community-Based Services Waivers
402 West Washington Street, Room W454, MS 21
P.O. Box 7083
Indianapolis, IN 46027
Once all documentation and forms are received by the Division of Aging, the Waiver Provider Analyst will review your Provider Application packet. There may be some follow-up questions or additional information needed. You may be contacted via email or telephone. It is important that you reply as soon possible in order to avoid any unnecessary delays in processing your application. If the necessary documentation is not submitted in a timely manner, the application may be returned to you with the request to resubmit.
- If you are applying to be an Assisted Living provider or an Adult Day Services provider, you will also need to have an onsite survey conducted by the Division of Aging.
- Adult Day Services Certification Tool
- Assisted Living Services Certification Tool
- If you are applying to be an Assisted Living provider, you must complete a Disclosure for Housing with Services Establishments form, downloadable here.
- Upon completion of the application process through the Division of Aging, you will be notified by mail that your certification has been approved or denied. Information regarding the appeal process will also be included, in the event your application is denied.
- If approved, you will then be directed to download your Indiana Health Coverage Programs Waiver Billing Provider Application and Profile Maintenance packet through HP. (See HCBS waiver manual, Section 1. Helpful hints are also included). You will be notified by letter when the process is complete and your waiver billing number is assigned.
- NOTE: YOU MUST SUBMIT YOUR APPLICATION TO HP WITHIN 90 DAYS OF RECEIPT OF YOUR WAIVER PROVIDER CERTIFICATION FROM THE DIVISION OF AGING
- You may begin providing services when you receive you HP billing number, are activated in the waiver provider database and receive your Notice of Action.
STATE PROVIDER RESOURCES LIST
How to become a Certified Choice Provider
Below you will find the contract for CHOICE/SSBG/Title III funding sources to be a certified provider for Generations. As the Area 13 Agency on Aging, Generations serves Daviess, Dubois, Greene, Knox, Martin, and Pike counties in Indiana.
On the attached vendor specification form, please denote which of these counties your agency can serve. . This form is updated annually. As a provider you are subject to periodic Quality Assurance Compliance Reviews by our agency.
The FSSA requires providers to be both CHOICE and Medicaid Waiver providers. The CHOICE manual is maintained by the Indiana FSSA and can be mailed to you at your request.
Please see the attached checklist and complete the documents to partner with our agency so that we may offer more choices to our clients as they make the decision to age in place. Together I know that we will make a positive impact on the lives of our clients. Please don’t hesitate to call Cindi Trent Holloway at 812-888-4267 or email@example.com with any questions as you complete the application. Please mail the documents with original signature to:
Cindi Trent Holloway, RN
1019 N. 4th Street, PO Box 314
Vincennes, IN 47691 Checklist for New ProvidersVendor Memorandum of AgreementAttachment AVendor Contact SpecificationVincennes University w-9 BRAND NEW PROVIDERS ONLYAccounts Payable Direct Deposit BRAND NEW PROVIDERS ONLYPERS Attachment