Section 455IAC3-1-3. Provider approval

   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-460100196RFA; readopted filed May 10, 2016, 11:21 a.m.: 20160608-IR-455160133RFA) NOTE: Transferred 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.