HOME HEALTH SERVICES PROVIDER IN WISCONSIN

DELIVERING MEDICALLY NECESSARY CARE TO INDIVIDUALS IN THEIR HOMES TO SUPPORT HEALTH, RECOVERY, AND INDEPENDENT LIVING

Home Health Services in Wisconsin provide skilled, intermittent care to individuals with medical needs who require services delivered in their homes. These services support recovery after hospitalization, management of chronic health conditions, and avoidance of institutional placement by offering nursing and therapeutic care in a familiar environment. Home Health is covered under Wisconsin Medicaid’s State Plan, and may also be authorized through Home and Community-Based Services (HCBS) Waivers such as IRIS, Family Care, and the Children’s Long-Term Support (CLTS) Waiver. Services must be ordered by a physician and tied to a medically necessary Plan of Care (POC).

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1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)

Role: Establishes state regulations and oversees Medicaid policy for home health agencies.

Agency: ForwardHealth

Role: Manages Medicaid provider enrollment, prior authorization, and reimbursement.

Agency: Wisconsin Department of Safety and Professional Services (DSPS)

Role: Licenses Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and therapists.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Oversees federal home health conditions of participation for agencies seeking Medicare certification.

2. HOME HEALTH SERVICES OVERVIEW

Home Health Services are provided by a licensed agency and must be medically necessary, intermittent, and ordered by a physician. Services are delivered in the client’s home and are focused on clinical and rehabilitative care.

Covered services include:

• Skilled nursing (wound care, injections, medication management)

• Physical therapy, occupational therapy, and speech-language pathology

• Medical social work services

• Home health aide services (under nurse or therapist supervision)

• Patient and caregiver education

• Chronic disease management and monitoring

• Coordination with physicians and specialists

Each service must be documented within a physician-certified Plan of Care and updated regularly.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your agency with the Wisconsin Department of Financial Institutions (DFI)

• Obtain a Federal EIN and Type 2 NPI

• Employ or contract licensed RNs, LPNs, and therapists

• Apply for ForwardHealth enrollment as a Home Health Agency

• Develop a Home Health Services Policy & Procedure Manual in compliance with DHS and CMS guidelines

• Maintain required insurances: general liability, malpractice, and workers’ compensation

• Secure Medicare certification (optional but often pursued for dual funding)

Home health agencies must also comply with infection control, emergency preparedness, and quality improvement regulations.

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN/NPI

Step 2: Apply to ForwardHealth as a Home Health provider

Step 3: Submit agency credentials, licenses, staff rosters, and P&P Manual

Step 4: (Optional) Apply for Medicare certification if seeking dual reimbursement

Step 5: Enroll with MCOs and IRIS FEAs if serving waiver participants

Step 6: Begin services after Plan of Care approval and prior authorization (if required)

5. REQUIRED DOCUMENTATION

• ForwardHealth enrollment documents

• Home Health Policy & Procedure Manual covering:

  • Physician orders and Plan of Care development

  • Nursing and therapy documentation standards

  • Medication administration, infection control, and safety protocols

  • Supervision and scheduling of aides and therapists

  • Emergency response and on-call procedures

  • HIPAA compliance and participant rights

  • Clinical charting templates and visit notes

  • Quality assurance and incident tracking policies

• Staff files, including licenses, background checks, and continuing education logs

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements:

• Licensed in Wisconsin through DSPS

• Develops care plans, supervises LPNs and aides, and performs direct clinical care

• Must complete infection control, HIPAA, and documentation training

Role: Licensed Practical Nurse (LPN)

Requirements:

• Wisconsin LPN license

• Works under RN supervision to deliver delegated care (e.g., wound care, vitals)

Role: Therapist (PT, OT, SLP)

Requirements:

• Wisconsin licensure in respective discipline

• Provides therapy based on physician referral and Plan of Care

Role: Home Health Aide

Requirements:

• Completion of state-approved training (minimum 75 hours)

• Provides personal care and support under RN or therapist supervision

7. MEDICAID PROGRAMS THAT COVER HOME HEALTH SERVICES

• ForwardHealth Medicaid State Plan: Covers physician-ordered home health services for individuals with qualifying medical needs

• IRIS Waiver: Allows participant-directed home health services if included in budget and authorized by the FEA

• Family Care / Partnership: MCO-authorized home health services based on participant’s clinical assessment

• Children’s Long-Term Support (CLTS) Waiver: Home health nursing and therapy services for children with complex medical needs

• Katie Beckett Program: Allows medically fragile children who don’t otherwise qualify for Medicaid to receive in-home services

Note: All services must be documented within a Plan of Care, reviewed regularly, and provided by qualified, licensed staff.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Development

Timeline: 2–4 weeks

Phase: Licensing, Staffing & Compliance Setup

Timeline: 45–60 days

Phase: Medicaid/MCO/IRIS Enrollment & Medicare (if applicable)

Timeline: 2–4 months

Phase: Start of Services

Timeline: Begins after care plan approval and staff onboarding

9. CONTACT INFORMATION

ForwardHealth Medicaid Portal

Website: https://www.forwardhealth.wi.gov

Wisconsin DHS – Home Health Agency Resources

Website: https://www.dhs.wisconsin.gov/regulations/home-health-agencies.htm

DSPS License Lookup

Website: https://dsps.wi.gov

Medicare Certification – CMS

Website: https://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center

IRIS Waiver Program

Website: https://www.dhs.wisconsin.gov/iris

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN HOME HEALTH PROVIDER

WCG helps home health agencies set up high-quality, compliant operations across Wisconsin’s Medicaid and waiver programs, supporting both clinical excellence and regulatory readiness.

Scope of Work:

• ForwardHealth, Medicare, and waiver enrollment

• Home Health P&P Manual development

• Care plan templates and charting systems

• Staff onboarding tools and supervision trackers

• Infection control, emergency response, and HIPAA compliance tools

• Billing guidance, prior authorization checklists, and audit readiness

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.