Info Agency Main Banner Content
Article
Provider Certification and Licensure
Addiction Certifications
Addiction Treatment Services Provider (Outpatient) - an agency of ten or fewer direct service staff/volunteers/contract workers
- Required attachments for addiction services providers - (ASO) outpatient certification
- Application for certification of addiction providers - State form 55376
- Documentation of direct services providers - State form 52810
- Article 4.4: Addiction treatment services provider certification
- Statement of understanding
Addiction Treatment Services Provider (Regular) - an agency of eleven or more direct service staff (requires accreditation)
- Required attachments for addiction services providers - (ASR) regular certification
- Application for certification of addiction providers - State form 55376
- Article 4.4: Addiction treatment services provider certification
Community Mental Health Centers (CMHC)
- Required attachments for CMHC renewal
- Application for certification/licensure of CMHC - State form 48161
- Summary sheet of contracted services - State form 53365
- Chart of providers sites and services - State form 53360
- Request for approval to subcontract with for profit - State form 53366
- Direct care staff report - State form 53359
- Facility facts record - State form 48160
- Article 4.1: Community mental health centers certification
- Article 9: Minimum standards for the provision of services by community mental health centers and managed care providers
Opioid Treatment Program (OTP)
- Required attachments for OTP renewal
- OTP: Application for certification as an addiction services provider
- Article 10: Minimum standards for the provision of services by opioid treatment facilities and programs
Private Mental Health Institute (PIP)
- PIP required attachments
- Application for certification/licensure of PIP - State Form 52871
- PIP annual attestation
- Facility facts record - State form 48160
- Article 1.5: Licensure of private mental health institutions
Residential Care Provider (RCP)
- Required attachments for residential care provider
- Required attachments for supervised group living facility (SGL) or sub-acute stabilization facility (SUB)
- Required attachments for transitional residential facility (TRS)
- Facility facts record - State form 48160
- Article 7.5: Residential living facilities for individuals with psychiatric disorders or addictions
Additional Certification Forms
- Indiana Division of Mental Health and Addiction approved addictions counseling credentials
- Indiana Division of Mental Health and Addiction approved accreditation
Additional Rules
- 42 CFR part 2
- Article 27 Human services
- Article 39 Health records
You may access rules and regulations through the State of Indiana website: http://www.in.gov/legislative/. Click on "Administrative Code" in the publications column, then click on "Title 440".