Nursing Services in Indiana provide skilled care to individuals with complex medical conditions, disabilities, or recovery needs. These services help maintain participants’ health and safety in home and community-based settings, avoiding unnecessary hospitalization or institutionalization. Nursing Services are reimbursable under Indiana Medicaid State Plan and Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: Indiana Family and Social Services Administration (FSSA) — Office of Medicaid Policy and Planning (OMPP)
Role: Administers Medicaid funding for Nursing Services and manages provider enrollment, claims, and reimbursement

Agency: Indiana State Department of Health (ISDH)
Role: Licenses Home Health Agencies (HHAs), enforces nursing regulations, and oversees facility and provider compliance

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Nursing Services meet HCBS requirements, participant-centered standards, and Conditions of Participation (CoPs)

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2. NURSING SERVICE OVERVIEW

Nursing Services deliver skilled interventions under a physician’s order to support participants with medical conditions requiring ongoing clinical oversight.

Approved providers may deliver:

• Intermittent or continuous skilled nursing care (by RN or LPN)
• Medication administration, injections, and IV therapy
• Wound care and tracheostomy management
• Ventilator and enteral feeding tube support
• Catheter care and bowel program management
• Chronic disease management (e.g., diabetes, epilepsy, hypertension)
• Health monitoring, education, and coordination of medical services
• Emergency medical response and post-acute care follow-up

All services must be documented in the participant’s Plan of Care (POC) and approved through Medicaid authorization protocols.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business entity with the Indiana Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Obtain Home Health Agency License through the Indiana State Department of Health (ISDH)
• Apply for CMS certification if serving Medicare beneficiaries
• Enroll as a Medicaid provider through Indiana Medicaid Provider Enrollment Portal
• Maintain general liability, professional liability, and malpractice insurance
• Develop clinical policies for skilled care delivery, participant protection, emergency response, and infection control
• Ensure nursing staff meet licensure, background screening, and annual training requirements

4. INDIANA PROVIDER ENROLLMENT PROCESS

Initial Application and Licensure:

• Submit application for ISDH Home Health Agency licensure
• Prepare operational policies, staff training documentation, and facility compliance plans
• Undergo ISDH survey for license issuance

Medicaid & Medicare Enrollment:

• Enroll via Indiana Medicaid Portal and, if applicable, CMS PECOS
• Provide required documents: EIN/NPI, licenses, proof of insurance, policies, staffing plan

Billing Readiness:

• Set up billing infrastructure to handle hourly/unit billing for RN/LPN services and required documentation

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License
• IRS EIN confirmation
• NPI confirmation
• ISDH Home Health Agency License
• CMS Provider Number (if billing Medicare)
• Proof of general, professional, and malpractice insurance

Nursing Services Policy & Procedure Manual including:

• Participant assessment, intake, and Plan of Care procedures
• Skilled care documentation protocols
• Emergency preparedness and infection control measures
• HIPAA compliance, participant rights, and grievance policies
• Staff credentialing, licensure, and competency tracking
• Medicaid billing and audit-ready clinical records

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6. STAFFING REQUIREMENTS

Role: Director of Nursing (DON)
Requirements: Active Indiana RN license, supervisory and home health experience, background clearance

Role: Registered Nurses (RNs)
Requirements: Active Indiana RN license; CPR certification, clinical competency verification

Role: Licensed Practical Nurses (LPNs)
Requirements: Active Indiana LPN license, works under RN supervision, background screening clearance

Role (optional): Certified Home Health Aides (HHAs)
Requirements: State-approved training program completion, background clearance

All clinical staff must complete:

• HIPAA, abuse prevention, and confidentiality training
• Infection control, emergency procedures, and participant safety protocols
• Annual clinical evaluations and ongoing continuing education

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7. MEDICAID WAIVER PROGRAMS AND STATE PLAN COVERAGE

Nursing Services are reimbursable through:

• Indiana Medicaid State Plan Home Health Services
• Aged and Disabled (A&D) Waiver
• Traumatic Brain Injury (TBI) Waiver
• Community Integration and Habilitation (CIH) Waiver
• Family Supports Waiver (FSW) — limited skilled nursing services

Approved providers may deliver:

• Hourly skilled RN/LPN care
• Complex condition monitoring and chronic care management
• Medical intervention training for caregivers
• Coordination with physicians and interdisciplinary care teams

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8. TIMELINE TO LAUNCH

Phase: Business Formation, Licensing, and Policy Development
Timeline: 2–4 months

Phase: Staff Hiring, Credentialing, and Compliance Program Setup
Timeline: 2–3 months

Phase: ISDH Survey, Medicaid Enrollment, and CMS Certification (if applicable)
Timeline: 60–90 days

Phase: Billing System Configuration and Nursing Service Launch
Timeline: 30–45 days

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9. CONTACT INFORMATION

Indiana State Department of Health (ISDH) — Home Health Licensing
Website: https://www.in.gov/health/

Indiana Medicaid Provider Portal
Website: https://www.in.gov/medicaid/providers/

Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/

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10. SCOPE OF WORK

• Business registration, ISDH licensing, and CMS/Medicaid enrollment guidance
• Development of Nursing Services Policy & Procedure Manual
• Staff credentialing templates, care planning forms, and clinical documentation systems
• Medicaid billing system setup and audit-ready claims management
• Website, domain, and branding development
• Infection control, incident reporting, and clinical QA program setup
• Strategic partnership building with hospitals, discharge planners, and waiver case managers