Section 455 IAC 3-1-3 - Provider approvalAuthority: IC 12-9.1-2-3
Affected: IC 12-10-15; IC 12-15; IC 16-28
Sec. 3.
In order to be approved by the division to provide assisted living Medicaid waiver services, an applicant shall do the following:
(1) Complete an application form prescribed by the division.(2) Submit evidence that the applicant:(A) Has a license required by IC 16-28 and 410 IAC 16.2-5 for each facility at which assisted living Medicaid waiver services will be provided.(B) Has registered each facility at which assisted living services will be provided as a housing with services establishment under IC 12-10-15.(3) Indicate what level of services the applicant will provide.(4) Submit a written and signed statement that the applicant will comply with the provisions of this article.(5) Submit a written and signed statement that assisted living Medicaid waiver services will not be provided at a facility that is not licensed pursuant to IC 16-28 and 410 IAC 16.2-5.(6) Submit a written and signed statement that assisted living Medicaid waiver services will not be provided at a facility that is not registered as a housing with services establishment under IC 12-10-15.(7) Submit a written and signed statement that the applicant will provide services to a recipient as set out in the recipient's plan of care.Division of Aging; 455 IAC 3-1-3; filed Apr 8, 2004, 3:15 p.m.: 27 IR 2491; readopted filed May 27, 2010, 10:11 a.m.: 20100609-IR-460100196RFAReadopted filed 5/10/2016, 11:21 a.m.: 20160608-IR-455160133RFAReadopted filed 11/4/2022, 4:00 p.m.: 20221130-IR-455220277RFATransferred from the Division of Disability and Rehabilitative Services (460 IAC 8-1-3) to the Division of Aging (455 IAC 3-1-3) by P.L. 153-2011, SECTION 21, effective July 1, 2011.