Wisconsin Home Health Agency Application and Certification Processes

The home health agency application process is for entities providing skilled nursing and other therapeutic services. Please review Chapter DHS 133 for requirements before seeking this application. For questions regarding home health agencies, or to obtain an application, you may email the Division of Quality Assurance (DQA).

Do not complete a home health agency application if the intent is to provide only personal care services that include assistance with activities of daily living, housekeeping activities, and/or accompanying client to medical appointments. If you are interested in personal care agency information please visit Personal Care Agencies (PCAs).

Defining "Skilled Care" for Wisconsin Home Health Agency (HHA) Licensure, P-01212 (PDF, 62 KB)

Reporting Agency Changes

If your existing home health agency is undergoing name, address, administrator, accreditation status, change of ownership (CHOW), or change of ownership information (CHOI) you must contact DQA. You may contact a licensing specialist directly at 608-266-7297 or email the DQA.

Change of Ownership – If operation of the home health agency is later transferred to another owner, ownership group, or to a lessee, the Health Insurance Benefits Agreement will be transferred.

  • You are required to notify the DQA at the time you are planning a change of ownership transfer as your license is non-transferable. DQA will provide instructions regarding the CHOW process.

State Licensure
Application Process

You must complete the state licensure process at the same time or before you complete the Medicare and Medicaid certification processes. Similarly, you must complete the Medicare certification at the same time or before you complete the certification process for Medicaid.

The issuance of a license to operate a home health agency in the state of Wisconsin is not part of the Medicare provider enrollment process and therefore will not automatically assure either certification in the Medicare program or Medicare payment.

Provisional License

As a home health agency applicant, you are required to complete an application, pay fees and submit supporting documentation in the form of policies and procedures that will demonstrate your compliance with Wisconsin Administrative Rule Chapter DHS 133 for Home Health Agencies before a license will be issued.

The following must be completed as part of the state licensure process:

  1. Application and Fees: You must complete an application and submit the application fee. An application may be obtained from the home health licensing specialist who can be reached at 608-266-7297.

  2. Entity Caregiver Background Check:  Demonstrate compliance with Caregiver Background Check process.  A caregiver background check (CBC) is required to be completed for all applicants/legal representatives prior to the approval of any new license, certification or registration of a DQA regulated entity. Also review information on the requirement for your Employee Background Checks found on the Caregiver Background Check Process web page.

  3. Fit and Qualified:  Demonstrate compliance with Wisconsin Statutes, Chapter 50.49(6), licensing requirements for fit & qualified.

  4. Policies and Procedures:  Demonstrate, via submission of agency policies and procedures and patient care documentation, your compliance with Wisconsin Administrative Rule Chapter DHS 133 for Home Health Agencies. Also, demonstrate via submission of agency policies and procedures, your compliance with Wisconsin Administrative Rule Chapter DHS 13 Reporting and Investigation of Caregiver Misconduct. Refer to Chapter 6 of the Wisconsin Caregiver Program Manual, P-00038 (PDF, 320 KB).

Once all of the requested application materials are received an application is considered complete. Wisconsin has a two-step application review process. The first review determines whether an applicant is fit and qualified and includes an analysis of a variety of factors including financial solvency, personnel qualifications, criminal background clearance, payment of required fees, history of operating health care agencies in other states, and documentation that demonstrates the provision of the following required services to patients in their homes:

  • Skilled nursing, and 
  • Therapeutic Services (physical therapy, speech therapy, occupational therapy, medical social services or home health aide).

Following a determination the applicant meets the fit and qualified criteria, the second review is completed by a Registered Nurse (RN) who will review the applicants policies and procedures to determine whether they meet administrative rule requirements of DHS 133 and DHS 13. The RN will consult with the applicant during this review process if needed.  When both review steps are complete and a determination is made that the applicant satisfies all policy code requirements, a 90-day provisional license will be issued.

Following issuance of the provisional license, the agency has up to 90 days in which to receive an unannounced on-site state licensure survey that is used to evaluate the level of care provided to patients. This on-site survey will consist of a review of patient care, review of records and documentation, interviews with staff, and observation of cares being given in the home setting. The on-site survey for state licensure will NOT be conducted unless the licensee can demonstrate they meet the following criteria:

  • Admitted and cared for at least ten skilled nursing level patients; and retain on active service of seven skilled nursing patients at the time the written request for on-site survey is requested.  At least three patients shall be receiving skilled nursing services at the time of the on-site state licensure survey.

When the applicant can demonstrate readiness for the on-site survey the following need to be submitted to DQA:

  • Full Operation Letter and Patient Documentation – Prepare and submit a written notification once you are in "full operation," i.e., the agency has provided services to patients and has records to review. Also include copies of ten patient care plans and physician orders for patients that have received skilled nursing care. It is important to remember that a survey will not be scheduled until the notification of full operation is received.

Failure to meet these minimum on-site state licensure survey standards, by the expiration date of the 90-day provisional license, may result in license revocation.

Send the written request for the on-site survey to:

Division of Quality Assurance
Home Health Licensing Specialist
P.O. Box 2969
Madison, WI 53701-2969

Compliance Review Tools: You may find the following forms useful in conducting an agency self-evaluation of compliance with Wisconsin administrative rule requirements. These forms are used by surveyors during on-site state licensure surveys.

F-62536 Prelicensure Desk Review Checklist (Word 150 KB)

F-62653 Licensure Survey Entrance Conference Guide (PDF, 14 KB)

F-62654 Licensure Survey Exit Conference Guide (PDF, 14 KB)

F-62601 Rights of Home Health Agency Patients (PDF, 29 KB)

F-62646 Patient Rights Statement Review (PDF, 22 KB)

F-62651 Calendar Worksheet - Prescribed Visits (PDF, 13 KB)

F-62657 Contract Review Worksheet (PDF, 12 KB)

F-62658 Program Evaluation Review Worksheet (PDF, 38 KB)

F-62680 Clinical Record Review (PDF, 13 KB)

F-62231 Personnel Record Review (PDF, 10 KB)

F-62520 Caregiver Program Compliance Check (PDF, 22 KB)

F-62652 Licensure Survey Home Visit Guide (PDF, 20 KB)

Medicare Certification
Process

If you are seeking Medicare certification, you are advised to submit application materials and supporting documentation at the same time you seek Wisconsin state licensure.

You must complete the state licensure process at the same time or before you complete the Medicare and Medicaid certification processes. Similarly, you must complete the Medicare certification at the same time or before you complete the certification process for Medicaid.

The issuance of a license to operate a home health agency in the state of Wisconsin is not part of the Center for Medicare and Medicaid (CMS) Medicare provider enrollment process and therefore will not automatically assure either certification in the Medicare program or Medicare payment.

Medicare Certification (Optional)

In order to become certified in the Medicare Program, a home health agency must first meet State of Wisconsin licensing requirements and obtain a provisional license.

Steps to obtain Medicare certification:

  1. Review the following CMS Medicare information for home health agencies:
  1. Contact your Fiscal Intermediary to have a Medicare General Enrollment Health Care Provider/Supplier Application (CMS- 855A) completed and submitted. This separate Medicare enrollment requirement must precede survey and certification. In Wisconsin, the fiscal intermediary is National Government Services unless your facility is affiliated with a CMS-designated chain, in which case, it may have a designated single U.S. fiscal intermediary. A copy of the approval letter and application from the fiscal intermediary must be sent to the Wisconsin State Agency by the fiscal intermediary.
  2. Contact a CMS Approved Accrediting Organization to perform the Medicare Certification survey (this is separate from the Wisconsin state licensure survey). 
  3. Contact the DQA to notify of intent to become a Medicare certified home health agency. Submit the following federal forms to DQA:

Send all required documentation to: 

Division of Quality Assurance
Home Health Licensing Specialist
P.O. Box 2969
Madison, WI 53701-2969

Medicaid Certification
Process

Medicaid Certification (Optional)

In order to become Medicaid certified, a home health agency must first meet State of Wisconsin licensing requirements and obtain a provisional license.

If you are interested in becoming a certified provider with Wisconsin Medical Assistance (Medicaid) Program, you are encouraged to apply at the same time that you apply to Medicare. See Wisconsin Medicaid provider certification on the Wisconsin ForwardHealth website

Refer to Medicaid Contacts for additional contact information.

Last Revised: June 23, 2016