Wisconsin - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Wisconsin Department of Health Services (DHS), Division of Quality Assurance (DQA), licenses Home Health Agencies (HHAs) under Wis. Stat. § 50.49 to deliver intermittent skilled nursing and therapy services. Agencies must comply with Wis. Admin. Code ch. DHS 133 and utilize the DHS DQA Provider Portal to submit the Wisconsin Home Health Agency License Application (F-62674).

Wisconsin Medicaid requires an agency to obtain federal Medicare certification before it can enroll as a Medicaid Home Health provider through the ForwardHealth portal. Applicants must first secure a provisional state license, operate long enough to serve 10 skilled-care patients without Medicare or Medicaid billing privileges, and pass an initial survey by an approved accrediting organization or the state.

1. Service Definition and Scope

In Wisconsin, a Home Health Agency (HHA) provides skilled nursing and other therapeutic services to patients in their homes. Skilled care includes complex wound care, urinary catheterization, medication management, and therapy services.

HHAs are distinct from Personal Care Agencies (PCAs). Agencies providing only non-medical help with activities of daily living or housekeeping do not apply for an HHA license and must instead seek PCA certification under DHS 105.17.

• Statutory Authority: Wis. Stat. § 50.49(1)(a) defines the scope of Home Health Agencies in Wisconsin.
• Regulatory Code: Wis. Admin. Code ch. DHS 133 governs the operational and clinical standards for HHAs.
• Skilled Care Definition: Specific skilled nursing tasks are outlined in DHS publication P-01212.
• Excluded Services: Non-medical personal care requires separate Medicaid PCA certification and is not covered under the HHA license.

2. Regulatory and Oversight Agencies

The Division of Quality Assurance (DQA) within the Wisconsin Department of Health Services (DHS) is the primary state regulatory body responsible for licensing HHAs and conducting surveys.

Medicaid enrollment and claims processing are managed by ForwardHealth, while federal Medicare certification is overseen by the Centers for Medicare & Medicaid Services (CMS) in conjunction with approved accrediting organizations.

• Licensing Agency: Wisconsin Department of Health Services, Division of Quality Assurance (https://www.dhs.wisconsin.gov/dqa/index.htm)
• Medicaid Authority: ForwardHealth (https://www.forwardhealth.wi.gov/WIPortal/Default.aspx)
• Federal Oversight: Centers for Medicare & Medicaid Services (CMS) (https://www.cms.gov/)
• Approved Accreditor: Accreditation Commission for Health Care (ACHC) (https://achc.org/)
• Approved Accreditor: Community Health Accreditation Partner (CHAP) (https://chapinc.org/)
• Approved Accreditor: The Joint Commission (TJC) (https://www.jointcommission.org/)

3. Gatekeeping Prerequisites: Who Can Even Apply

Wisconsin imposes strict structural prerequisites before an agency can bill Medicaid for home health services. The state mandates that an HHA must be Medicare-certified before ForwardHealth will accept a Medicaid enrollment application.

To achieve this, new agencies must operate under a provisional license without federal funding. They must secure an accreditor's acceptance, fund their own operations, and serve a minimum patient census before full licensure and certification are granted.

• Medicare Prerequisite: ForwardHealth requires active Medicare certification prior to Medicaid enrollment.
• Provisional Operation: Agencies must operate under a 3-month provisional license (extendable up to 1 year) to serve 10 skilled-care clients before full certification.
• Accreditor Acceptance: Applicants must secure a letter of acceptance from a CMS-approved accrediting organization (ACHC, CHAP, or TJC) before applying for the provisional license.
• Financial Runway: Providers must fund operations during the provisional period without Medicare or Medicaid reimbursement.

4. Licensure and Certification Requirements

Agencies must apply for state licensure through the DHS DQA Provider Portal. The process requires submitting a formal application, fees, and detailed organizational documentation.

For simultaneous Medicare certification, agencies must also submit federal enrollment forms to their Medicare Administrative Contractor (MAC) while coordinating with their chosen accrediting organization.

• Application Form: Wisconsin Home Health Agency License Application, F-62674.
• State Fee: $300 non-refundable application fee payable to the Division of Quality Assurance.
• Federal Form: CMS-855A Medicare Enrollment Application submitted to the MAC.
• Submission Method: Initial applications must be submitted via the DHS DQA Provider Portal.

5. Medicaid Provider Enrollment

Once permanent state licensure and Medicare certification are achieved, the agency applies for Medicaid enrollment through the ForwardHealth portal.

The Division of Medicaid Services (DMS) and the Office of the Inspector General (OIG) review the application and issue a Medicaid certification number upon approval.

• Enrollment Portal: ForwardHealth Portal.
• Prerequisite Verification: Agencies must supply proof of active Medicare certification.
• Dual Enrollment: Agencies providing personal care must separately enroll as PCAs under DHS 105.17.
• Contracting Authority: Division of Medicaid Services (DMS) and Office of the Inspector General (OIG) finalize the Medicaid contract.

6. Staffing, Training and Background Checks

Wisconsin enforces strict background check requirements for all caregivers under the state's Caregiver Law. Checks must be processed online with associated fees.

Agency leadership must meet specific credentialing standards. The administrator and a designated substitute administrator must satisfy the qualifications outlined in state administrative code.

• Background Checks: Wisconsin Caregiver Law (Wis. Stat. §§ 50.065, 48.685) requires checks for all caregivers.
• Check Fee: $15 per individual processed online.
• Administrator Qualifications: Must meet credentials specified in Wis. Admin. Code § DHS 133.06.
• Substitute Administrator: Must be formally designated and meet the same qualifications as the primary administrator.

7. Documentation, Policies and Records

Initial applications require a comprehensive letter of intent and an organizational chart detailing ownership structures. Agencies must maintain strict clinical and administrative records.

State law also mandates specific incident reporting, such as notifying the DQA Fire Authority of any facility fires within a strict timeframe.

• Letter of Intent: Detailed description of the proposed HHA submitted on business letterhead.
• Organizational Chart: Must include any other entities owned by the proposed HHA.
• Fire Reporting: Health Care Facility Fire Report, F-62500, required within 72 hours of any fire.
• Physician Orders: Must comply with physician signature requirements per Wisconsin Administrative Code to avoid payment recovery.

8. Billing, Rates and Claims

Medicaid claims for home health services are processed through the ForwardHealth interChange MMIS. Agencies must adhere to strict assessment timelines to justify billing periods.

Services billed include skilled nursing, physical therapy, occupational therapy, and home health aide visits, with separate policies governing durable medical equipment.

• Billing System: ForwardHealth interChange MMIS.
• Covered Services: Skilled nursing, physical therapy, occupational therapy, speech therapy, and home health aides.
• Supplies: Durable medical equipment (DME) and disposable medical supplies (DMS) are billed under specific ForwardHealth policies.
• OASIS Timing: Assessments dictate payment periods and are required between days 55 and 60 of the 60-day certification period.

9. Approval Sequence and Timeline

The approval sequence is a multi-stage process beginning with accreditor enrollment and provisional state licensure. The provisional phase is designed to build a patient census.

Once the census is met, an unannounced onsite survey triggers the final issuance of permanent state licensure and federal Medicare certification, clearing the way for Medicaid enrollment.

• Step 1: Enroll with a CMS-approved accrediting organization and obtain an acceptance letter.
• Step 2: Submit form F-62674 and the $300 fee to DQA for a provisional license.
• Step 3: Operate provisionally (3 to 12 months) to serve 10 skilled-care clients.
• Step 4: Undergo an unannounced onsite survey by the accrediting organization.

10. Common Denials and Survey Findings

Applications and provisional licenses frequently fail if an agency cannot meet the required patient volume within the maximum allowable timeframe. Background check violations are also a primary source of enforcement action.

During surveys, missing physician signatures on plans of care and failure to report administrative changes to the state are common citations.

• Volume Failure: Inability to serve 10 skilled-care patients within the 1-year maximum provisional period.
• Background Exclusions: Hiring individuals barred by the Wisconsin Caregiver Law.
• Signature Lapses: Missing physician signatures on plans of care resulting in payment recovery.
• Unapproved Changes: Failure to notify DQA within 10 days of address or administrator changes.

11. Key Contacts and Resources

Providers should direct licensing and certification questions to the DQA Licensing, Certification, and CLIA Section. Medicaid enrollment inquiries are handled by ForwardHealth Provider Services.

The DHS DQA Provider Portal is the central hub for submitting applications, renewals, and reporting organizational changes.

• DQA Licensing Section: [email protected] or 608-266-8481 (https://www.dhs.wisconsin.gov/dqa/index.htm)
• ForwardHealth Portal: (https://www.forwardhealth.wi.gov/WIPortal/Default.aspx)
• State Licensure Contact: Thomas Rylander, [email protected]
• Survey Inspection Process: Denise Balboa, [email protected]

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