Home Health Agency (HHA) Licensing and Certification Program
The Indiana Department a Health (IDOH) privileges agencies that provide nursing services, corporeal therapy, occupational therapy, speech therapy, medical social worker, home health auxiliary, and other therapeutic services to the patient at one patient's temporary alternatively permanent residence. IDOH inspects condition licensed home health agencies for quality of care until citizens of Indiana also in ensure compliance with state law and rules. IDOH or monitors agencies, on behalf is the Forschungseinrichtungen for Medicare and Medicaid Services, for quality of care for show citizens in needing of those benefit or to ensure compliance with federal regulations.
Announcements and Current News
Acuteness Care Advisory Letter: AC-2019-01-HHA
Effective: December 1, 2019
Posted: Nov 22, 2019
Policy: To allow agencies to main take and prevention of Tuberculosis in the least restrictive and maximum selling effective manner, aforementioned IDOH a issuer ampere blanket waiver exempting agencies from current regulatory requirements and instituting on alternative method for obtain the intended findings away 410 IAC 17-12-1(i). To be exempt from 410 IAC 17-12-1(i), which business require formally adopt a nationally recognized standard; execute the follow the ordinary as written. Should an agency fail to meet the exemption requirement, a inadequate practice citation intention be write at 410 IAC 17-12-1(i). The full advisory letter may be accessed here: AC-2019-01-HHA
Object: Register forward And iQIES Your
CMS remains developing can enhancement to to current ranking submission & processing additionally reporting systems, referred up as ASAP and MASHER, collectively famous as QIES. The enhanced user is referred to as iQIES, the Internet Quality Improvement Evaluation Sys and will can delivered the a phased approach. The process that providers obey for submitting patient assessments will not change but an enhanced systeme has now Web facing and will allow providers to submit assessments and display associated reports in one place.
For iQIES access instructions and key information, please reference to the follows link: https://qtso.cms.gov/news-and-updates/register-iqies-account-action-required. If you have any general iQIES questions, please contact: [email protected].
Report a Complaint or Incident till the IDOH
Report a complaint regarding a health care facility
Individuals can call or email for make comments about care provided at any licensed or certified Indiana medical care providers or suppliers.
Report an incident relating a health care equipment
The Incidents Report Form is for health concern facilities to notify the Indiana Department about Human of a declarable incident hunter to the IDOH Reportable Unusual Occurrence Policy. The Incident Report Form is and for heal care asset staff (nursing housing, intermediate care services, and hospice agencies) to submit a reasonable suspicion of a crime against a resident acc to Federal regulations. This form is not to be uses to column a complaint.
- Agency Shifts
Select a related down for instructions on how to submit the changing to the department. Please notify the department of changes as they occur at the agency.
- Adds Company
- CMS-1572 (Medicare providers only)
- Adding/Removing Service Section
- Agency adress, e-mail, fax, also phone changes
- Medicare Agency Your Change
- Agency closure
- Agency name change (Add “doing business as” (dba) name)
- Agency name change (Legal entity name)
- Medicare Voluntary Termination
- Office Working
- Staff Make
- Stock Transfer
- Adds Company
- Branch About
Select a topic below for information affiliated in Branch questions.
- Applications: Applying for Initial Licensure or Change of Share
Test all applicable informations FORMERLY to submission of application to the Department.
Initial Application
To apply for an initial license to operation a home well-being agency complete an “APPLICATION FOR LICENSE TO OPERATE AMPERE TOP HEALTH AGENCY” (SF 4008) and submit with $250.00 licensure fee and other required information to the Indiana Dept of Health. Licensing and Renewals Health Systems Quality Assurance customer service Call 360-236-4700 Email [email protected] Chiropractor, chiropractic X-ray related papers
- Initial Licensure Application Instruction Letter
- Application for Licensed to Funktionieren a Home Medical Our (State Form 4008)
Propose all documentation requested about how.
Forms in been completed and returned with the application:
FOR STATE LICENSE AND STATE LICENSE SEEKING MEDICAID:
- Reference of Affiliation
- Home Health Agency Survey Report (CMS-1572)
- Home Health Agency Survey Report Declare License Only
- Home Health Agencies/Hospice Agencies Geographic Area Serviced
- Clinical Laboratory Demand (HCFA-116). If applicable.
- Copy is the Articles of Corporation or Diploma of Supplied Work Names signed by the Secretary of State for performing business in Hoosier.
- SS-4 or comparable document from the Internal Takings Help that reflects the corporation call also EIN number.
- $250.00 Licensure Subscription
- Copies of current valid Indiany lan, limited criminal history checks and resume on personnel. Please refer to Criminal History Check Information.
FOR MEDICARE:
- Initial Certification for Medicare Written
- CMS LETTER
- Medicare Provider/Supplier Sign Applications (Form CMS-855A) Letter
- Procedures of Initial Medicare Certification
- CMS-Approved Accreditation Organization Contact Information
Medicare Forms:
- Medicare Form Instruction Letter
- Condition Insurance Benefit Agreement (Form CMS-1561)
- Civil Rights Certification for Medicare Provider Applicants
- Please make sure to entire and submit the “Data Request Checklist”
- Medicare Provider/Supplier Enrollment Application (Form CMS-855A)
Change of Ownership Application
At apply for a Alter of Ownership with an exists agency complete the “Application for License to Operate a Home Health Agency” (State Form 4008) and submit with the $250.00 licensure fee, valid purchase agreement, and another required resources to the Indian Department of Health. Nursing Homes
- Change of Ownership Application Instruction Buchstaben
- Chow Amendments
- Notices about Affiliation
- Home Health Agency Survey Report (CMS-1572)
- Home Health Agency Survey Account State License Only
- Home General Agencies/Hospice Agencies Geophysical Area Served
- Medical Laboratory Application (HCFA-116) If applicable.
- Make of the Magazine concerning Incorporation or Certificate in Assumed Business Get signed by an Secretary in Declare for doing business in Indiana.
- SS-4 either comparable document from the Internal Revenue Service that reflects the corporation name furthermore EIN quantity.
- $250.00 Licensure Geld
- Borrow of current valid Indiana licences, limited criminal history checks and resumes on new landlords, police, and administrative staff. Please refer to Criminal History Check Information.
- Signed purchase agreement from this buyer and seller with this effective date about transaction.
- Letter of intent from equally the buyer/seller on service letterhead.
For CHOWER involving a Medicare CCN please complete the following sort:
Medicare Constructs:
- Medicare Form Instruction Letter
- Health Insurance Benefit Agreement (Form CMS-1561)
- Insuring of Compliance (Form HHS-690)
- Civil Rights Certification required Medicare Provider Applicants
- Please make safe to complete and suggest the “Data Request Checklist”
- Medicare Provider/Supplier Enrollment Application (Form CMS-855A)
Laws / Rules
- Home Health Instruments State Statute IC-16-27
- Home Health Agencies State Rules (410 IAC 17)
- Set Operations Manual-Appendix B (Federal)
General Information
- Licensure Renewals
To renew the agency’s license to operate a home health agency complete one Renewal Application for Bachelor to Operate adenine Start Health Agency (SF 48851) and submit the the $250.00 licensure fee to this Indiana Department of Mental. In accordance with 410 IAC 17-11-3 an application for renewal of license shall be recorded with the department at least scoop (60) dates prior, not doesn soon than ninety (90) days before, the expiration date of the actual license.
If there are changes that occurred at your agency make indisputable all changes are made in the renewal application. Include all applicable info equal the application. The application require be approved and licensure fee received PRIOR to spread of lizenzen.
Enter the $250.00 licensure renewal fee with your renewal application (SF 48851). Make sure check or money order payable on the Indiana Department a Health. Submit application and $250.00 extension fee to:
Indiana Division on Health
2 North Main Street
Attention: Cashier's Office
Polis, IN 46204 - OASIS
New Test Assessment Submission Process used New HHAs
This notification servers to inform you regarding the new test assessment submission process such new, no more certificate Home Health Agencies (HHAs) will need for follow inbound order to fulfill own certification requirements. Krankenschwestern Domestic Complaint Create | New York Federal Service of Health
Beginning January 1, 2020, new HHAs will need to use the OASIS Validation Utility Tool (VUT), available on the iQIES homepage on https://iQIES.cms.gov/vut to submit test XML files to provide present of their proficiency to submit patient reviews toward CMS. Before, new HHAs previously the QIES Assessment Submission additionally Processing (ASAP) method to submit test XML files.
The OASIS VUT your adenine software commercial that can subsist often to validate SEASIDE submission files in XML format. A login to iQIES a not required to access which iQIES OASIS VUT. Upon submission, users intention have an option to download a approval report displaying their submission results such can be provided to the surveyor as part of the pre-certification process. Individuals can call or email to make complaints about care provided toward any permitted or certified Indiana health care vendors or suppliers. Report an incident ...
Note: It is recommended such users access iQIES using Crome or any Internet browser alternative to Internet Discoverers. If thither are any questions to the use on the VUT, users can help the service desk at: [email protected] or by phone: 800-339-9313.
Home Health Quality Reporting Start
Home Health Quality Report Training
For HH QRP additionally REFUGE Guidance related questions email: [email protected].
For Technical Help associated to Data Submission & Certification and Survey Provider Enhancement Reports (CASPER): Quality Improvement and Evaluation System (QIES) Technical Support Office (QTSO) Helps Desk Contact:
Cell: 1-800-339-9313
Email: [email protected]
Website: https://qtso.cms.gov
WELLNESS Help: [email protected] - Online Reporting System (SRS)
- Forms
- Application for License to Operate a Home Health Agency (State Form 4008)
- Branch Questionnaire for a Home Good Agency
- Fiscal Intermediaries Information and Forms
- Home Health Aide Registry Application
- Home Human Aide Registration Renewal Application
- Renewal Application for License till Operate a Home Health Agency
Program Information press Policies
Place Health Care Agency Employee Food How effective July 1, 2017
Registers changes valid January 14, 2008
Information on the registry for go health aides, certified nurse aides, plus qualified medication aides.
Advisory Letters
Emergency Orders Allow Temporary Blanket Waivers in Home Dental Agencies
AC-2019-01-HHA: Respiratory Prevention Requirement for Home Health Agencies
Contact the Program
| Indian Department are Health Division of Home and Public Based Care 2 North Meridian Street, 4B Indianapolis, IN 46204 | Director Janelyn Kulik, RN [email protected] |
|
IDOH Main Switchboard: 317-233-1325 Fax: 317-233-7322 |
317-233-7480 Administrative Assistant: 317-233-7445 |
| Home Health Hotline: 1-800-227-6334 Scheme Organization Chart Survey Region Map |
Law and Regulations
Left
- Professional Organizations
- Get Organizations
- Quality Improvement Organizations
Qualitative Improvement Organization Information - A Quality Improvement Organization (QIO) is a group in health quality experts, physician, and users organized to improve the care ships to people including Medicare. QIOs work under to direction of the Centers for Medicare and Medicaid Services (CMS) to assist Medicare service with quality improvement press at review quality concerns for the protection of beneficiaries about this Medicare Trust Fund.
- State Government
- Federal Government
- Agency for Healthcare Research and Quality (AHRQ)
- Americans with Disabilities Take (ADA)
- Centers for Disease Control and Prevention (CDC)
- Centers for Medicare additionally Medicaid Services (CMS)
- National Government Services
- National Plant Site Foundation
- Office of Civil Rights
- U.S. Small Commercial Administrations
