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Indiana has made certain assurances to the Centers for Medicare and Medicaid Services (CMS) that all providers are qualified (initially at provider approval and continually through service delivery) to deliver 1915(i) Home and Community-Based (HCBS) services to CMHW participants. Only a DMHA approved Agency or Individual provider enrolled by Medicaid may be reimbursed for delivering a CMHW Services to an eligible participant.
A CMHW service provider must be approved by the DMHA according to the specific qualifications for and standards of the service that the individual provider or agency is applying to provide. To ensure that CMHW services providers meet licensure and/or approval requirements prior to furnishing CMHW services, DMHA requires all providers to undergo an application process to verify qualifications of the Agency or Individual requesting to provide CMHW services. All Agencies and Individuals wishing to enroll as a CMHW service provider must complete the provider application process described in the CMHW Services Provider Manual.
Provider Approval Forms
The following forms (and associated instruction sheets) are used in the Provider approval process. Questions about the process may be directed to the DMHA Youth Services Provider Specialist at DMHAYouthServices@fssa.IN.gov.
Provider Renewal of Approval Forms
All providers must reapply for a renewal of approval as a CMHW services provider. The following form is a resource for providers:
Provider Training & Certifications
All providers are required to complete training based upon the type of service DMHA has authorized the provider to deliver. Refer to the Provider Manual for additional information about new provider and recertification training requirements.
Other CMHW Service Forms