Home and Community-Based Services (HCBS) Waiver - Provider Information

Waiver Provider Registration: If you are a provider interested in registering with the Department of Health Services (DHS) as the first steps to deliver HCBS waiver services for programs serving adults or children, please complete the following steps:

  1. Complete the online Wisconsin Medicaid Waiver Provider Registration process.
  2. Complete and sign the appropriate Medicaid Waiver Provider Agreement form.

Both steps must be completed as detailed below.

Medicaid Waiver Provider Agreement forms: The following agreement forms have each been designed for a specific provider type:

  • Form F-00180 (Word) is for Medicaid waiver service provider organizations. Organizations include waiver providers such as personal care agencies, adult or child day care agencies, supportive home care agencies, transportation agencies, and other organizations or agencies that have been specifically identified as covered service providers.
  • Form F-00180A (Word) is for providers who are individual, sole proprietors, unaffiliated with an agency or service organization. It is also to be used for a company that provides waiver-funded services not typically covered by Medicaid providers. Examples include carpenters and other skilled trades completing home modifications or specialty work such as vehicle modifications.
  • Form F-00180B (Word) is used for provider agencies or individuals who are employed by the waiver participant under a self-directed support and service plan and paid through a fiscal agent or fiscal intermediary.

Providers must complete and sign the appropriate Medicaid Waiver Agreement. Submit the completed Medicaid Waiver Agreement electronically to the DHS Provider Registry.

Placement on the registry does not establish approval as a qualified provider.

County waiver agencies must verify providers have registered with DHS and submitted a signed and completed Medicaid Waiver Provider Agreement, in addition to conducting caregiver background checks and verifying provider service qualifications. For more details, see Ch. IV of the HCBS Waiver Manual.

HCBS Waiver Provider Registry: County waiver agency staff can access the Provider Registry to verify providers have registered and submitted a completed Medicaid Waiver Provider Agreement to DHS as of 2014. Records are updated weekly. The registry requires a WAMS ID and a passcode. The passcode can be obtained from the DHS Provider Registry.

Please contact the DHS Provider Registry with questions, updates, or edits to the registry.

Waiver Service Rates Initiative: The State of Wisconsin is creating a uniform rate-setting methodology for most waiver services. Please see the Waiver Service Rates Initiative page for more information.

Last Revised: August 21, 2017