The initial approval process is comprised of submitting the information requested on the application, as specified in 655 IAC, Chapter 5. Please organize the information in the sequence as listed on the application, with each item numbered, titled and paginated. Responses 5 – 14 and 16 must be submitted in policy format.
NOTE: All of the application materials must be submitted in triplicate.
Click here for the application to obtain approval as an Provider Application
If you have questions while completing this application please contact 515.281.8808, or e-mail Laura Hudson
There is no application fee.
Once the completed application has been received by the board, it will be scheduled for review within 60 days. Within approximately two weeks of the review, a letter will be sent that will detail any additions and/or revisions that might be necessary. The administrative rules allow the applicant three committee reviews or one year to meet provider criteria, whichever comes first. If the provider approval is denied, there is a waiting period of one year before the application process can be initiated again.
If the provider applicant is approved, provider approval is awarded for five years. The application for provider reapproval is sent six months before the expiration of the current approval.
Reference: IAC 655, Chapter 5 - 5.3(3)
Last updated: 03/15