Bureau of Developmental Disabilities (BDDS) Provider Services

BDDS Provider Application Process

Applications to provide Indiana’s Home and Community Based Services (HCBS) waiver services through BDDS may be made year around. All components of the new provider application packet must be completed. Once a completed application is received, the information submitted is reviewed by the provider services department. Provider applicants may receive a written Request for Information if the application components are not clear or questions exists. If the provider applicant meets the requirements of 460 IAC Article 6 and DDRS policies, the application will be moved forward as authorized to start the process of applying for enrollment with Indiana Health Coverage Programs (IHCP) (outlined below). If the application packet is not completed in its entirety, or the applicant does not meet the requirements outlined for the service(s), the application will be denied by DDRS Provider Services.

Please note, provider application documents submitted will not be returned to the applicant and copies will not be produced and returned to the applicant. The documentation becomes the property of the state. The mailing address for the completed application is:

Director of Provider Services
DDRS - Division of Disability and Rehabilitative Services
402 W. Washington St., RM 453, MS 18
Indianapolis, IN 46204-2243
BDDSprovider@fssa.IN.gov

As referenced above, becoming a BDDS waiver provider is a two part process. Once a provider application is authorized by the DDRS Provider Services Department, the applicant must then apply to enroll with IHCP. To view the IHCP requirements, please reference IndianaMedicaid.com. 

When a provider applicant receives the BDDS letter authorizing the applicant to start the IHCP enrollment process, the applicant must submit the IHCP enrollment application within 90 days of the BDDS letter of authorization. A provider applicant may complete an online application or obtain an IHCP provider enrollment application by downloading it from the provider enrollment page at IndianaMedicaid.com. 
 

BDDS Case Management Application Packet and Requests to Add Counties (Effective July 3, 2017)

Applications to provide HCBS Case Management waiver services through BDDS are available from the DDRS Provider Services Department. Please contact them by email at debra.running@fssa.in.gov.

Existing approved Case Management organizations may add counties by completing the Existing Provider Request to Add Counties and Services form. This form serves all provider types and the addition of services is not applicable for Case Management organizations. Completed forms should be emailed to BDDSprovider@fssa.IN.gov.

BDDS Service Provider Application Packet (excluding Case Management Providers)

  1. Provider Requirements for Medicaid Home and Community Based Waiver Services  (01/13)
  2. Application For Approval to Become a Provider of BDDS Service - State Form 53869 (rev.11/10)
  3. FSSA Provider Data Form
  4. Division of Disability and Rehabilitative Services Provider Agreement State Form 55006 (06/12)
  5. W9 - Request for Taxpayer Identification Number and Certification - IRS Form (12/14)

References

BDDS existing providers

Survey Data