Skip to Main Content

Wisconsin Department of Health Services

Aging & Long Term Care Resources

Brain Injury Waiver

Children's Long Term Support Programs

Community Integration Program

Community Options Program

Developmental Disability Programs

ICF/ID Restructuring Initiative

IRIS (Include, Respect, I Self-Direct)

Medicaid HCB Waivers Manual

Disability Rights Wisconsin (exit DHS)

Bureau of Long-Term Support
Medicaid Home & Community-Based
Waivers Manual

APPENDIX P: Provider Issues

P-1	Provider Agreement and Acknowledgement of Terms of Participation Agreement for Service Provider Entities (MSWord, 23 KB)
P-2	Provider Agreement and Acknowledgement of Terms of Participation Agreement for Agencies or Individuals – Self-Directed Supports (MSWord, 22 KB)
P-3	Provider Agreement and Acknowledgement of Terms of Participation Agreement for Individual or Non-Specified Service Providers (MSWord, 20 KB)
P-4	Medicaid Waiver Provider Online Registration Specifications SAMPLE - FOR PREVIEWING ONLY (PDF, 316 KB)
P-5	Medicaid Waiver Provider Online Registration This link launches the actual registration form

PDF: The free Acrobat Reader^® software is needed to view and print portable document format (PDF) files. Learn more.

Last Revised: April 17, 2013