Home health agencies (HHAs) primarily provide skilled nursing and other therapeutic services to people in their homes. Read Wis. Stats. § 50.49(1)(a) for the full definition of HHAs. See Defining "Skilled Care" for Wisconsin Home Health Agency (HHA) Licensure, P-01212 (PDF) for more information on skilled nursing services.
HHAs in Wisconsin can work with outside accrediting organizations for:
Accrediting organizations must be approved by both the Division of Quality Assurance (DQA) and CMS (Centers for Medicare & Medicaid Services). See 2017 Wisconsin Act 59 for more information.
HHAs can complete both state licensure and Medicare certification in one streamlined process. If you're looking to complete both, follow the process under the "Combined application" heading below.
HHAs not applying for Medicare certification should follow the instructions under the "State licensure application" heading. Please note that Medicare certification and licensure are requirements for Medicaid certification. It is not possible to only maintain Medicaid certification as an HHA without Medicare certification.
Do not complete an HHA application if you're only providing personal care services like:
Medicare-certified and state-licensed HHAs need to meet all the regulations listed below. Review these regulations before applying:
The following accrediting organizations are approved to provide this combined survey process:
Follow this process for the combined application:
Note: Wisconsin provisional licensure is good for three months. It is extendable up to three times (one year total). Send a letter to DQA requesting extensions if necessary.
The now-provisional HHA can begin serving clients.
Once you've served 10 clients with skilled nursing care (including seven active clients), send a letter and 10 patient care plans to DQA and the accrediting organization. The accrediting organization will start a combined unannounced Wisconsin licensure and Medicare certification survey. The accrediting organization will notify HHA and DQA once the survey is complete and the HHA is approved.
During the provisional licensure period, begin submitting required Medicare certification documents, including:
Once DQA has these documents and the accreditation organization survey, it can issue permanent state licensure and recommend Medicare certification to CMS.
Note that state licensure should be completed at the same time or before Medicare or Medicaid certification. State licensure does not guarantee Medicare certification.
As a prospective HHA, you must complete an application, pay fees, and submit supporting documentation that shows your compliance with Wis. Admin. Code ch. DHS 133 before receiving a license.
Send the following to DQA:
Wisconsin has a two-step application review process once DQA receives all materials. The first review determines whether an applicant is fit and qualified and includes a review of factors like:
Once DQA deems a prospective HHA fit and qualified, a registered nurse will review policies and procedures to determine whether they meet Wisconsin codes.
Once approved, DQA will grant provisional state licensure.
Note: Wisconsin provisional licensure is good for three months. It is extendable up to three times (one year total). Send a letter to DQA requesting extensions if necessary.
The now-provisional HHA can begin serving clients.
Once you have served 10 clients with skilled nursing care (including seven active clients), send a letter and 10 patient care plans to DQA. State surveyors will then conduct an unannounced Wisconsin licensure survey. Once the survey is complete, including any necessary corrections, DQA may grant permanent HHA licensure.
If you're applying for an optional Medicare certification, DQA advises submitting application materials and supporting documentation at the same time as your Wisconsin state licensure.
Note that state licensure should be completed at the same time or before Medicare or Medicaid certification. Your Medicare certification also should be completed before your Medicaid certification. State licensure does not guarantee Medicare certification.
To become Medicare Program certified, an HHA must first meet state licensing requirements and obtain a provisional license.
To get Medicare certification:
Once DQA has issued your HHA license, DQA will provide these documents to CMS and recommend Medicare certification approval.
To become Medicaid certified, an HHA first must meet state licensing requirements and obtain a provisional license.
If you're interested in becoming a Wisconsin Medical Assistance (Medicaid) Program certified provider, DQA recommends applying while you apply to Medicare. See Wisconsin Medicaid provider certification on ForwardHealth.
You must contact DQA if your existing HHA is undergoing a:
You may contact a licensing specialist directly by phone at 608-266-7297 or email at dhsdqalccs@dhs.wisconsin.gov.
Note: If HHA operation is transferred to another owner, ownership group, or lessee, the Health Insurance Benefits Agreement will be transferred. You're required to notify DQA when planning a CHOW, since your license is non-transferable. DQA will provide instructions regarding the CHOW process.
You may find the following forms useful when conducting an agency self-evaluation of compliance with Wisconsin administrative rules. Surveyors use these forms during on-site state licensure surveys.
Direct any questions to Thomas Rylander: