1.Program Definition and Services
Specialized Therapies in Indiana are services provided to individuals with developmental disabilities or mental health needs to address specific therapeutic goals that improve quality of life, independence, and functioning. These therapies include:
- Physical therapy
- Occupational therapy
- Speech-language therapy
- Behavioral therapy
- Visual and mobility therapy
- Assistive technology training and software
These services are typically funded through Medicaid Waivers or other state-supported programs and require documentation of medical necessity, including denials from Medicare, private insurance, or the Medicaid State Plan.
2. Regulations
The program is governed by Indiana Administrative Code 405 IAC 5-21.6-2 and Indiana Administrative Code 460 IAC 14-11-6. Providers must comply with Medicaid Waiver requirements and follow the guidelines outlined in the Therapy Services module of the Indiana Health Coverage Programs (IHCP).
3. Licensing or Certification
Licensing or certification is required depending on the type of therapy provided:
- Physical Therapy: Requires a license from the Indiana Professional Licensing Agency (IPLA).
- Occupational Therapy: Requires a license from the IPLA.
- Speech-Language Pathology: Requires a license from the IPLA.
- Behavioral Therapy: May require certification in Applied Behavior Analysis (ABA) or other relevant credentials.
- Additionally, providers must be enrolled with IHCP for Medicaid reimbursement.
4. Responsible State Agency
The Indiana Family and Social Services Administration (FSSA) oversees Medicaid Waiver services, while the Indiana Professional Licensing Agency (IPLA) is responsible for issuing licenses for therapy professionals.
5. Application Process
The application process involves multiple steps:
- Licensure: Obtain the appropriate professional license from IPLA.
- IHCP Enrollment: Complete the IHCP Provider Enrollment Application online, which includes submitting required documentation.
- Waiver Certification: Apply for Medicaid Waiver provider certification through FSSA if serving waiver clients.
6. Required Documentation
The following documents are typically required:
- Professional license (e.g., physical therapist, occupational therapist, speech-language pathologist)
- Federal W-9 form
- Proof of liability insurance
- IHCP Provider Agreement
- Documentation of medical necessity for specialized services
- Any additional certifications (e.g., ABA certification for behavioral therapy)
7. Timeline for Approval
The timeline varies based on licensure processing and IHCP enrollment but can take several weeks to months:
- Licensure processing through IPLA may take 4–6 weeks.
- IHCP enrollment approval typically takes up to 30 days after submission of all required materials.
- Waiver certification timelines depend on FSSA review processes.
8. Pre-Application Process
Before applying, providers should:
- Obtain the necessary professional licenses.
- Ensure compliance with Medicaid Waiver requirements.
- Develop policies and procedures for service delivery.
9. Pre-Application Training
No specific pre-application training is mandated; however, providers may need to complete continuing education requirements as part of their professional licensing obligations.
10. Additional Notes
- Specialized therapies must be provided in accordance with an Individualized Integrated Care Plan (IICP) that reflects the member's goals and needs.
- Providers must demonstrate compliance with IHCP billing guidelines and prior authorization requirements.
- Assistive technology services require an evaluation, recommendation, and letter of medical necessity before funding approval.
- Providers should be aware of updates to Medicaid Waiver rules and IHCP guidelines as they evolve.
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