• Occupational therapy 

• Speech therapy 

• Medical social services 

• Home health aide services 

• Community based palliative care 

2. Regulations 

The program is governed by: 

Indiana Code 16-27-1 

Indiana Administrative Code 410 IAC 17 

3. Licensing or Certification 

A license is required to operate a home health agency in Indiana. The license is issued by the Indiana Department of Health. 

4. Responsible State Agency 

The Indiana Department of Health is responsible for issuing licenses for home health agencies. 

5. Application Process 

Providers must submit: 

• Application for License to Operate a Home Health Agency (State Form 4008) 

• $250 non-refundable licensure fee 

• Required supporting documentation 

• Applications should be mailed to: 
  Indiana State Department of Health 
  2 North Meridian Street 
  Attention: Cashier's Office 
  Indianapolis, IN 46204 

6. Required Documentation 

Providers need to submit: 

• Notice of Affiliation 

• Home Health Agency Survey Report (CMS-1572) 

• Geographic Area Served form 

• Copy of Articles of Incorporation or Certificate of Assumed Business Name 

• SS-4 or comparable document showing corporation name and EIN 

• Copies of current valid Indiana licenses for staff 

• Limited criminal history checks for staff 

• Staff resumes 

7. Timeline for Approval 

The exact timeline for approval is not specified in the provided information. 

8. Pre-Application Process 

Before applying, providers should: 

• Ensure compliance with state regulations 

• Develop policies and procedures for service delivery 

• Hire qualified staff 

9. Pre-Application Training 

No specific pre-application training is mentioned. However, staff must meet qualifications set by state regulations. 

10. Additional Notes 

• Licenses expire one year after the date of issuance and must be renewed annually 

• Providers must submit renewal applications 60-90 days before license expiration 

• Changes in ownership require notification at least 30 days prior to the effective date 

• As of March 2025, providers should be aware of any updates to regulations or requirements that may have occurred