Adult Day Care Regulations in Indiana

Who regulates adult day care in Indiana

Indiana's Family and Social Services Administration (FSSA) sets the standards for adult day centers that serve Medicaid waiver participants. FSSA's Office of Medicaid Policy and Planning (OMPP) certifies adult day service (ADS) providers for the Indiana PathWays for Aging, Health and Wellness and Traumatic Brain Injury (TBI) waivers. Certified providers then enroll with the Indiana Health Coverage Programs (IHCP).

General rules for home and community-based services providers are in 455 IAC 2 (FSSA's posted copy, readopted 2018), which lists adult day as a covered service and sets approval, staffing and compliance review requirements. OMPP's Adult Day Service definition, last updated August 2025, sets the service levels and facility standards.

Types of adult day programs in Indiana

ADS offers a social environment for older adults through planned activities, supervision, meals and snacks, and help with personal care. OMPP recognizes three levels. All three monitor activities of daily living and give hands-on help as needed.

• Level 1: therapeutic activities and medication monitoring, with a minimum staff ratio of 1:8.
• Level 2: adds help with medication and requires at least one full-time LPN with monthly RN supervision, with a minimum ratio of 1:6.
• Level 3: adds direct health interventions, the same LPN requirement, a qualified full-time staff person for psychosocial needs and access to rehabilitation and restorative therapies, with a minimum ratio of 1:4.

Every level needs a registered nurse consultant to conduct health assessments and be available as needed.

How to get certified in Indiana

1. Apply through the OMPP Certification Portal. Once you start, you have 30 calendar days to submit a complete application, and only one application can be under review at a time. Each adult day location is certified individually.
2. Upload required documents, including background check results, negative TB test or chest x-ray results, proof of liability insurance and operations policies. Staff must be hired and their licenses uploaded at certification.
3. Pass an on-site visit that checks compliance with the federal home and community-based settings rule.
4. After you receive your OMPP certification letter, submit your IHCP enrollment application within 90 calendar days. Each location needs its own IHCP enrollment and provider ID.
5. To serve PathWays members, enroll with the PathWays managed care entities (MCEs): Anthem, Humana and UnitedHealthcare.

Key requirements

• At least 100 square feet per participant with office space, or 60 square feet per participant without office space.
• A multipurpose room for activities and dining, a kitchen, an exam or medication room, a quiet room, bathing and toileting facilities, a counseling room, outdoor space and accessible areas.
• Direct care staff who are at least 18, competent to deliver the plan of care and have an annual negative TB test or chest x-ray, plus criminal background and nurse aide registry checks (455 IAC 2).
• Cooperation with compliance monitoring, including information requests, on-site inspections and record reviews, with requested documents due within 10 days and corrective action plans generally due within 10 days.

Medicaid funding for adult day in Indiana

• Indiana PathWays for Aging. Effective July 1, 2024, this 1915(c) waiver runs alongside a 1915(b) managed care waiver and serves people 60 and older who meet a nursing facility level of care. OMPP oversees it, MCEs assign service coordinators, and providers bill the member's MCE. Members exempt from PathWays managed care receive waiver services fee-for-service.
• Health and Wellness waiver. This 1915(c) waiver serves people 59 and under and covers adult day. It is operated by FSSA's Division of Disability, Aging and Rehabilitative Services (DDARS), which also operates the TBI waiver. Both are paid fee-for-service.

Billing basics

PathWays adult day is billed with procedure code S5100, modifier U7 and a level modifier (U1 for Level 1, U2 for Level 2, U3 for Level 3) in 15-minute units. The PathWays rate table also shows a UC modifier on some lines. At least eight minutes must be provided to bill one 15-minute unit.

Waiver services are billed as professional claims. For PathWays members, use the MCE's claim portal, an 837P transaction or a CMS-1500 form. For fee-for-service waivers, bill Gainwell Technologies through the IHCP Portal, an 837P transaction or a CMS-1500 form. Do not deliver or bill services without an approved NOA or service authorization, and bill with your IHCP Provider ID rather than an NPI.

Indiana requires electronic visit verification (EVV) for personal care and home health services. IHCP's EVV page does not mention adult day, so check its list of service codes that require EVV.

Other ways centers are paid

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• OMPP HCBS Certification Process
• OMPP Adult Day Service definition
• 455 IAC 2: Home and Community Based Services
• IHCP Provider Reference Module: Indiana PathWays for Aging Waiver
• IHCP Provider Reference Module: DDARS HCBS Waivers
• IHCP HCBS Billing Guidelines
• FSSA Medicaid Home and Community-Based Services

Frequently asked questions

Do I need a license to open an adult day center in Indiana?

The Indiana sources in this guide cover certification of Medicaid waiver providers. To serve PathWays, Health and Wellness or TBI participants, each location must be certified by OMPP and enrolled with IHCP. 455 IAC 2 also requires proof of any license your service needs, so confirm state and local requirements before you open.

Does Indiana Medicaid pay for adult day care?

Yes. Adult day is covered under the PathWays for Aging waiver for people 60 and older and under the Health and Wellness and TBI waivers. PathWays services are billed to the member's MCE.

Who inspects adult day centers in Indiana?

OMPP verifies settings rule compliance with an on-site visit during certification, and FSSA monitors waiver providers under 455 IAC 2-6-4 through information requests, on-site inspections and record reviews.