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Nursing Facility
LTCIS Reports
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LTCIS Report
Other Reports
Cumulative Rate Listing - July 1, 2019 and forward
Cumulative Rate Listing - Prior to July 1, 2019
Semi-Annual Statistical Report - NF - Section 1
Semi-Annual Statistical Report - NF - Section 2
Semi-Annual Statistical Report - NF - Section 3
Special Care Unit Add-On
Report Card Score
RUG-IV Distribution Report
Medicare Cost Report Statewide Averages Report
Cumulative Rate Listing - State Nursing Facility
Nursing Facility Quality Score Reports
Notice of Approved ACP Training Courses
Nursing Facility Total Quality Score
Forms
Nursing Facility Cost Report
Nursing Facility Cost Report - Instructions
Nursing Facility Cost Report - Home Office
Nursing Facility Cost Report - Home Office - Instructions
Nursing Facility Quality Assessment Data Collection Form
Nursing Facility Quality Assessment Data Collection Form - Instructions
Nursing Facility Medicare/Medicaid Reconciliation Form
Nursing Facility Medicare/Medicaid Reconciliation Form - Instructions
Change in Ownership - Checklist of Management's Representations
Certification for Non-Medicare Certified Facilities
Nursing Facility Cost Report - State
Nursing Facility Cost Report - State - Instructions
Nursing Facility Schedule of Staff Retention and ACP - Schedule X
Nursing Facility Schedule of Staff Retention and ACP Instructions - Schedule X
Nursing Facility SCU Qualifications (Schedule Z) Instructions
Nursing Facility SCU Qualifications (Schedule Z)
IQ - Nursing (w Home Office) - Electronic
IQ - Nursing (No Home Office) - Electronic
Indiana Laws & Administrative Rules
TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICE
Tables
Owner/Related Party/Management - State NF
CMS Nursing Home Without Capital Market Basket
Mortgage Index Table
R.S. Means Index
Weighted Median
Summary of Statewide Averages
Cost Report Due Dates
Cost Report Due Dates - Nursing Facility
Cost Report Due Dates - State Owned Nursing Facility
NSGO UPL Documents
IN NSGO UPL Payment SFY 2018 Final Payment (07012017 - 06302018)
IN NSGO UPL Report - SFY 2019 Final Payment (07012018 - 06302019)
IN NSGO UPL Report - SFY 2020 Q1 (07012019 - 09302019)
IN NSGO UPL Report - SFY 2020 Q2 (10012019 - 12312019)
IN NSGO UPL Report - SFY 2020 Q3 (01012020 - 03312020)
IN NSGO UPL Report - SFY 2020 Q4 (04012020 - 06302020)
IN NSGO UPL Report - SFY 2020 Final Payment (07012019 - 06302020)
IN NSGO UPL Report - SFY 2021 Q1 (07012020 - 09302020)
QAF Appeal Reduction Plan
Address List
FAQ
CRF/DD ICF/IID
LTCIS Reports
CRF/DD Provider Index (All Providers)
CRF/DD Provider Index by Provider
CRF/DD Statistical Data/Total Revenues, Expenses and Hours
CRF/DD Recap of Patient Expense and Rate Calculation
CRF/DD Total Historical Cost of Property
CRF/DD Percentage of Total Expense
CRF/DD Statistical Data/Per Hour and Per Patient Day Calculations
CRF/DD Recap of Expenses Per Patient Day and Rate Calculation
CRF/DD Historical Cost of Property Per Facility
Other Reports
CRF/DD Cumulative Rate Listing - for REDs 10/1/2016 and later
CRF/DD Cumulative Rate Listing - for REDs prior to 10/1/2016
Non-State ICF/IID Cumulative Rate Listing
State ICF/IID Cumulative Rate Listing
Forms
IQ - Group Homes - Electronic
IQ - Group Homes - Printed
Non-State ICF/IID & CRF/DD Cost Report - Facility
Non-State ICF/IID & CRF/DD Cost Report - Facility (Instructions)
Non-State ICF/IID & CRF/DD Cost Report - Home Office
Non-State ICF/IID & CRF/DD Cost Report - Home Office (Instructions)
Change in Ownership - Checklist of Management's Representations
Indiana Laws & Administrative Rules
TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICE
Tables
50th Percentiles
CPI-U
CMS Nursing Home Without Capital Market Basket Index
Gross National Product - Implicit Price Deflator (GNP-IPD)
Maximum Property Basis
Mortgage Index Table
Owner/Related Party/Management - CRF/DD and Non-State ICF/IID
U.S. Treasury Bond Ten (10) Year Amortization
Weighted Median
Cost Report Due Dates
Cost Report Due Dates - Private Annual
Cost Report Due Dates - Private Historical
Home Health Agency
Forms
Indiana Medicaid HHA Cost Survey
Indiana Laws & Administrative Rules
TITLE 405 OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICE
Tables
Inflation Index (Home Health Agency Market Basket)
Frequently Asked Questions
HHA Frequently Asked Questions
Cost Report Due Dates
Cost Report Due Dates - Home Health
Webinar
HHA Webinar 5/5/2016 Announcement
HHA Webinar 5/5/2016 Slides
HHA Webinar 5/5/2016 Presentation
State Psychiatric Hospital
Other Reports
State Psychiatric Hospital Cumulative Rate Listing
Billing Guidelines
State Psychiatric Hospital Billing Guidelines - Effective 7/1/2012
Forms
State Psychiatric Hospital Cost Report
State Psychiatric Hospital Cost Report (Instructions)
Tables
Owner/Related Party/Management - State Psych Hospital
Cost Report Due Dates
Cost Report Due Dates - State Owned Psychiatric Hospital
Web Portal
Forms
Third Party Disclosure Authorization Form
Web Portal Sign Up Form - Facility - IN LTC
Web Portal Sign Up Form - Home Office (Mgmt Co) - IN LTC
Web Portal Update Form - Facility - IN LTC
Web Portal Update Form - Home Office (Mgmt Co) - IN LTC
Guidelines/Frequently Asked Questions
Web Portal User Guide - IN LTC
Web Portal Frequently Asked Questions - IN LTC
Third Party Disclosure Memo
