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Indiana State Department of Health

ISDH Home > Health Care Quality & Regulatory > Acute Care/Hospitals > Providers of Outpatient Physical Therapy and/ or Outpatient Speech Pathology Services Certification Program Providers of Outpatient Physical Therapy and/ or Outpatient Speech Pathology Services Certification Program

Program Overview

(Note: Items below that are underlined and in italics are links to additional information)

Welcome to the Providers of Outpatient Physical Therapy and /or Outpatient Speech Pathology Services Certification Program Homepage. The types of therapy services provided under this program include Outpatient Physical Therapy, Outpatient Speech Pathology Services, and Outpatient Occupational Therapy (only in combination with Physical Therapy and/or Speech Pathology Services).

In the State of Indiana, providers of Outpatient Physical Therapy and /or Outpatient Speech Pathology Services are not licensed.  However, individuals performing therapy (Physical Therapist, Speech Pathologist, Occupational Therapist, etc) are licensed or certified as appropriate for the types of services they provide.  Please see the Indiana Professional Licensing Agency (IPLA) for further information: http://www.in.gov/pla/

To be reimbursed by Medicare in the State of Indiana for Outpatient Therapy Services you must be a Therapist in Private practice or Group Practice certified for Medicare, certified as a Provider of Outpatient Physical Therapy and /or Outpatient Speech Pathology Services, or be certified in one of the Other Certification Programs and follow Medicare requirements for that provider type:

Therapist in Private Practice or Group Practice

Other Certification Programs

To be reimbursed by Medicaid you must either be certified as a provider or supplier for Medicare as listed above or apply for Medicaid only using the same forms.  The only form you would not complete is the 855 application and you would send documents to the Indiana State Department of Health (ISDH).  Please go to the Indiana Medicaid Provider website for additional forms that must be completed to enroll as a provider:   http://provider.indianamedicaid.com/.

Contact the Program

Indiana State Department of Health
Division of Acute Care
2 North Meridian Street, 4A
Indianapolis, IN 46204
(317) 233-7474 (Acute Care Receptionist)
(317) 233-1325 (ISDH Main Switchboard)
Map

Program Manager
Lorraine Switzer
lswitzer@isdh.in.gov
(317) 233-7502
(317) 233-7472  [Administrative Assistant]

Program Information and Policies

Select a topic below.

Administrator requirements

Definitions

Directory of Current Certified Outpatient Therapy Rehabilitation Facilities (ORF)

Providing therapy in a patient’s home

Regulations for Providers of Outpatient Physical Therapy and /or Outpatient Speech Pathology Services Certification Program

Safety of Patients

State Operations Manual

Two persons on duty requirement 

Medicare Resources from the Medicare Learning Network (MLN)

Select a topic below.

Medicare Learning Network (MLN) Guides: Pathways to Medicare Resources Provider Specific Booklet

Outpatient Rehabilitation Therapy Services: Complying with Documentation Requirements Fact Sheet

Forms

Select a topic below for instructions on what forms to use for changes.

Summary of when to use what forms

  • Form CMS-1856 (Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy and/or Speech Pathology Services)
  • Form CMS-381 (Model Letter Requesting Identification of Extension Units)
  • Form 55642 (Extension Site Questionnaire)
  • Form CMS-1561 (Health Insurance Benefits Agreement)
  • Form OMB No. 0990-0243  (Civil Rights Information Request)
  • Form HHS 690 (Assurance of Compliance)

Applying for Initial Licensure

Select a topic below for instructions on how to submit an application for Certification as an Outpatient Physical Therapy and /or Outpatient Speech Pathology Services Provider.

Initial Certification

Organization Changes

Select a topic below for instructions on how to submit the change to ISDH.  Please notify ISDH of changes as they occur.

Adding an Extension site

Changing Address for Main Site

Changing Address of Extension Site

Changing of Administrator

Report a Complaint or Incident to the ISDH

Report a complaint regarding a health care facility
Individuals can call or email to make complaints about care provided at any licensed or certified Indiana health care providers or suppliers.

Report an incident regarding a health care facility
The Incident Report Form is for health care facilities to notify the Indiana State Department of Health of a reportable incident pursuant to the ISDH Reportable Unusual Occurrence Policy.  The Incident Report Form is also for health care facility staff (nursing homes, intermediate care facilities, and hospice agencies) to report a reasonable suspicion of a crime against a resident pursuant to Federal regulations.  This form is not to be used to file a complaint.

Consumer Information

Your Medicare Rights and Responsibilities

Advance Directives

Directivas Anticipadas

Out of Hospital Do Not Resuscitate Declaration and Order

Employment Opportunities

Learn more about Employment Opportunities with the Indiana State Department of Health

Laws and Regulations

Federal Laws and Regulations

42 CFR 485 (starting at 42 CFR 485.701)

Code of Federal Regulations (CFR) Homepage

State Operations Manual  Appendix E (Outpatient Physical Therapy)

State Laws and Rules

Indiana Law and Rules Homepage

Indiana Register

Links

State Government

Indiana Professional Licensing Agency

Indiana Public Access Counselor

Office of Medicaid Policy and Planning (FSSA)

Federal Government

National Government Services

Agency for Healthcare Research and Quality (AHRQ)

Americans with Disabilities Act (ADA)

Centers for Disease Control and Prevention (CDC)

Centers for Medicare and Medicaid Services (CMS)

Health Care Excel (HCE)

National Patient Safety Organization

Office of Civil Rights