If You Have Complaints about Wisconsin Health Care

Information about Division of Quality Assurance (DQA)

DQA Web Pages Information

Provider Types Regulated by DQA

DQA Listservs

Consumer Information

Provider Search

DQA Facility Directories

DQA Provider Training

DQA Numbered Memos

DHS Forms

Construction/
Remodeling of Health Care Facilities

WI Nurse Aide Training and Registry Info

Caregiver Program/ Background Checks

WI Adult Programs Caregiver Misconduct Registry

Home Health Agencies (HHAs)
Medicare Certification Materials

For questions regarding these materials, you may E-mail the 
Division of Quality Assurance

For a home health agency to be certified for Medicare and Medicaid billing, it must first secure its Wisconsin license to operate. Please see Wisconsin HHA Application and Certification Process

Wisconsin Medicaid provider certification packets - ForwardHealth website

For federal Medicare certification requirements, review the following:

• Code of Federal Regulations - Conditions of Participation, Home Health Agencies (exit DHS)
  

• CMS State Operations Manual (exit DHS)

  • Chapter 2 (exit DHS; PDF) - Go to section 2202, page 157 OASIS Requirements

    • OASIS - HHAs seeking Initial Certification should review 2202.10 A thru F

  • Appendix B - Guidance to Surveyors: Home Health Agencies (exit DHS; PDF)
    

  Forms - Complete and send to (Do NOT send anywhere else): 
  Home Health Licensing Specialist
  Bureau of Technology, Licensing & Education
  Division of Quality Assurance
  P.O. Box 2969
  Madison, WI 53701-2969
  

  • Home Health Agency Survey and Deficiencies Report (CMS-1572) (exit DHS; PDF, 50 KB)

  • Health Insurance Benefit Agreement (CMS-1561) (exit DHS; PDF)

  • Expression of Intermediary Preference (PDF, 12 KB)

  • Medicare Certification Civil Rights Information Request Form (exit DHS; Word) - Please review carefully and fill out and submit all requested items
    

• OASIS Information

   

• CMS Survey & Certification Letters - ongoing federal updates for Home Health Agencies including OASIS information

Return to Home Health Agency - Information for Providers

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Last Updated: April 10, 2012