RESPITE CARE SERVICES PROVIDER IN WISCONSIN
OFFERING TEMPORARY RELIEF FOR CAREGIVERS WHILE ENSURING SAFE, COMPASSIONATE SUPPORT FOR INDIVIDUALS WITH DISABILITIES OR COMPLEX HEALTH NEEDS

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Respite Care Services in Wisconsin provide temporary relief for unpaid primary caregivers of individuals with disabilities, serious illnesses, or functional limitations. These services can occur in-home or in community-based settings and aim to reduce caregiver burnout while promoting the individual's health, safety, and routine continuity.

Respite is available under various Home and Community-Based Services (HCBS) Medicaid waiver programs, including Children’s Long-Term Support (CLTS), IRIS (Include, Respect, I Self-Direct), and Family Care. Oversight is provided by the Wisconsin Department of Health Services (DHS), with local coordination by Managed Care Organizations (MCOs), IRIS Consultant Agencies (ICAs), and county waiver agencies.

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Administers HCBS waivers, sets standards for respite delivery, and licenses certain facilities.

Agency: IRIS Consultant Agencies / MCOs / County Waiver Agencies
Role: Authorize respite care, approve providers, and coordinate service plans.

Agency: ForwardHealth
Role: Handles Medicaid provider enrollment and billing systems for eligible services.

2. RESPITE CARE SERVICES OVERVIEW

Respite provides short-term, intermittent care to waiver participants when their regular caregivers are unavailable or need relief. It must be consistent with the participant’s Individual Support Plan (ISP) or Long-Term Care Functional Screen (LTCFS) and delivered in a safe, supervised environment.

Covered formats may include:

In-Home Respite Care – Temporary support in the participant’s residence

Facility-Based Respite – Delivered in licensed Adult Family Homes, CBRFs, or respite centers

Overnight or Weekend Respite

Emergency or Crisis Respite

Planned Respite During Vacations, Medical Visits, or Family Emergencies

Respite care does not replace daily supports or long-term services, and must be documented according to waiver program expectations.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI (if billing ForwardHealth)

For facility-based providers: Obtain a residential license from DHS (e.g., AFH or CBRF)

Enroll with IRIS FEAs or MCOs for waiver-based respite

Complete ForwardHealth Medicaid enrollment if billing Medicaid

Develop a Respite Care Policy & Procedure Manual

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN/NPI
Step 2: Apply to become a waiver-approved respite provider through local MCOs or IRIS Consultant Agencies
Step 3: If billing Medicaid, enroll via ForwardHealth
Step 4: Submit credentials, background checks, and service plan templates
Step 5: Ensure staff training and safety compliance
Step 6: Begin service delivery upon ISP approval

5. REQUIRED DOCUMENTATION

Business registration and Medicaid provider enrollment (if applicable)

Respite Care P&P Manual including:

Staffing policies and supervision requirements

Participant intake and routine tracking forms

Emergency and health escalation procedures

Behavior management and de-escalation plans

Transportation protocols (if offsite activities occur)

Incident reporting and caregiver communication logs

Billing documentation and daily service notes

6. STAFFING REQUIREMENTS

Role: Respite Care Worker / Direct Support Professional (DSP)
Requirements:

18+ years old with background check under Wisconsin Caregiver Law

CPR and First Aid certified

Trained in personal care, safety, and emergency response

For facility-based care: must meet CBRF or AFH staff training requirements

Role: RN / Behavioral Specialist (if needed)
Requirements: For complex medical or behavioral needs as outlined in ISP

All staff must complete:

HIPAA and confidentiality training

Abuse/neglect prevention and reporting

Seizure protocol (if applicable)

Cultural competence and person-centered care training

7. MEDICAID WAIVERS THAT COVER RESPITE CARE

IRIS – Self-directed respite using Fiscal Employer Agents (FEAs)

Family Care / Partnership – MCO-authorized respite included in the care plan

Children’s Long-Term Support (CLTS) – Respite for families of children with disabilities

Children’s Community Options Program (CCOP) – Non-waiver program that may also support respite

Children’s Mental Health Wraparound Programs (e.g., CCS) – For behavior-focused or emotional support respite

Note: All respite must be included in the participant’s plan and approved by their consultant or case manager.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Service Model Design
Timeline: 2–3 weeks

Phase: MCO/IRIS/Medicaid Enrollment & Staffing
Timeline: 1–2 months

Phase: Staff Training & Policy Manual Review
Timeline: 30–45 days

Phase: Launch of Respite Services
Timeline: Begins after plan approval and participant match

9. CONTACT INFORMATION

Wisconsin Department of Health Services – Long-Term Care
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

IRIS – DHS Managed Website
Website: https://www.dhs.wisconsin.gov/iris

ForwardHealth Portal
Website: https://www.forwardhealth.wi.gov

DHS Provider Licensing for CBRFs & AFHs
Website: https://www.dhs.wisconsin.gov/regulations/index.htm

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN RESPITE CARE PROVIDER
WCG supports new providers in launching flexible, family-centered respite care programs that meet DHS standards and integrate into waiver-based care planning.

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Scope of Work:

MCO, IRIS, and Medicaid enrollment support

Respite Care Services P&P Manual development

Facility licensing support (if needed)

Staff onboarding and training kits

Daily log, ISP tracker, and billing forms

Emergency and incident documentation tool

RESIDENTIAL CARE SERVICES PROVIDER IN WISCONSIN
OFFERING SUPPORTIVE, COMMUNITY-BASED HOUSING OPTIONS FOR INDIVIDUALS WHO NEED ASSISTANCE WITH DAILY LIVING WHILE PRESERVING AUTONOMY AND DIGNITY

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Residential Care Services in Wisconsin provide housing and daily support for individuals with disabilities, chronic health conditions, or functional limitations who are unable to live independently but do not require institutional care. These services promote long-term stability, community integration, and quality of life.

Wisconsin offers several licensed residential care models, which may be funded through Family Care, IRIS, or Children’s Long-Term Support (CLTS) waivers. Services must align with the participant’s Individual Service Plan (ISP) or Long-Term Care Functional Screen (LTCFS) and comply with licensing and Medicaid standards.

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Regulates residential facility licensure and monitors provider compliance.

Agency: Division of Quality Assurance (DQA)
Role: Issues licenses and conducts surveys for Adult Family Homes (AFHs), Community-Based Residential Facilities (CBRFs), and Residential Care Apartment Complexes (RCACs).

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Authorize funding and oversee care planning for waiver participants in residential settings.

2. TYPES OF RESIDENTIAL CARE SETTINGS

Adult Family Homes (AFH)

Serve 1–4 residents

Provide assistance with ADLs, meals, medication, and social activities

Require DHS licensure

Community-Based Residential Facilities (CBRF)

Serve 5+ residents

Offer personal care, supervision, and supportive services

Must meet staffing and facility requirements based on capacity and resident needs

Residential Care Apartment Complexes (RCAC)

Independent apartments with optional support services

Regulated under a separate certification process

Can serve elderly adults or people with disabilities

3. SERVICES PROVIDED IN RESIDENTIAL CARE

Residential settings offer 24/7 supervision and a blend of personal care and habilitation supports:

Assistance with bathing, dressing, and hygiene

Meal preparation and dietary accommodations

Medication assistance or administration

Health monitoring and emergency response

Socialization, recreation, and life skills training

Transportation coordination

Behavior support (if applicable)

All services must be delivered in a person-centered, home-like environment, and aligned with the resident’s individualized plan.

4. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Wisconsin Department of Financial Institutions (DFI)

Obtain Federal EIN and Type 2 NPI (if billing Medicaid)

Submit facility floor plans and program statements to DQA

Complete background checks, fire safety inspection, and sanitation review

Obtain facility licensure as AFH, CBRF, or RCAC

Enroll as an IRIS or Family Care provider (if serving waiver participants)

Create a Residential Care Services Policy & Procedure Manual

5. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN/NPI
Step 2: Choose residential model (AFH, CBRF, or RCAC) and apply to DQA
Step 3: Undergo DHS-required inspections and staff clearance
Step 4: Apply to serve IRIS or Family Care participants through local MCOs or ICAs
Step 5: Submit P&P Manual, program statement, and staffing plan
Step 6: Begin services upon licensure and participant placement

6. REQUIRED DOCUMENTATION

DHS license certificate and floor plans

NPI registration and Medicaid/Fiscal Employer Agent agreement

Residential Care P&P Manual including:

Admission, discharge, and transfer procedures

Medication handling and incident reporting

Fire safety, emergency preparedness, and infection control

Staff credentialing, supervision, and shift coverage

Daily care logs and activity schedules

Participant rights and grievance protocols

Billing documentation and service verification

7. STAFFING REQUIREMENTS

Role: Administrator / Facility Manager
Requirements: Experience in residential care, background check, compliance training

Role: Direct Care Staff / Resident Assistant
Requirements:

18+ years old with caregiver background check

First Aid and CPR certification

Personal care and habilitation training

Crisis response training (for behavioral support homes)

All staff must complete:

HIPAA and confidentiality training

Person-centered care and resident rights

Abuse, neglect, and exploitation prevention

Annual skills refreshers and supervision

8. WAIVER PROGRAMS THAT COVER RESIDENTIAL SERVICES

Family Care / Family Care Partnership – Residential costs and services funded through MCOs

IRIS (Include, Respect, I Self-Direct) – Participants choose residential supports through Fiscal Employer Agents (FEAs)

Children’s Long-Term Support (CLTS) Waiver – May cover child-specific group homes or out-of-home respite

Note: Room and board is often funded privately or via SSI/SSDI, while support services are paid through waiver programs.

9. TIMELINE TO LAUNCH

Phase: Business Registration & Facility Planning
Timeline: 1–2 months

Phase: DQA Licensing & Staff Credentialing
Timeline: 2–4 months

Phase: Medicaid/MCO Enrollment & Readiness Review
Timeline: 30–60 days

Phase: Opening and Participant Admission
Timeline: Begins once license is granted and resident funding is authorized

10. CONTACT INFORMATION

DHS Division of Quality Assurance – Residential Licensing
Website: https://www.dhs.wisconsin.gov/regulations/residential/index.htm

DHS Long-Term Care Programs
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

ForwardHealth Medicaid Portal
Website: https://www.forwardhealth.wi.gov

Wisconsin Department of Financial Institutions (DFI)
Website: https://www.wdfi.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN RESIDENTIAL CARE PROVIDER
WCG helps providers open licensed residential homes with comprehensive support for licensing, staffing, Medicaid enrollment, and daily care documentation.

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Scope of Work:

DHS licensing and IRIS/MCO enrollment

Residential Care P&P Manual development

Floor plan and program statement preparation

Staff credentialing logs and emergency plans

Resident care documentation, shift notes, and incident forms

Billing tools and compliance tracking templates

SUPPORTED EMPLOYMENT SERVICES PROVIDER IN WISCONSIN
EMPOWERING INDIVIDUALS WITH DISABILITIES TO OBTAIN AND MAINTAIN COMPETITIVE, INTEGRATED EMPLOYMENT IN THEIR COMMUNITIES

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Supported Employment Services in Wisconsin help individuals with disabilities find, secure, and retain meaningful employment in inclusive settings. Services are designed to promote independence, self-sufficiency, and full participation in the workforce, with personalized support ranging from job readiness to long-term job coaching.

These services are reimbursed under Wisconsin’s Medicaid Home and Community-Based Services (HCBS) Waivers, including IRIS (Include, Respect, I Self-Direct), Family Care, Family Care Partnership, and the Children’s Long-Term Support (CLTS) Waiver. Oversight is provided by the Wisconsin Department of Health Services (DHS), with authorization managed by IRIS Consultant Agencies (ICAs) and Managed Care Organizations (MCOs).

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Administers waiver programs and sets guidelines for service delivery.

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Authorize services, enroll providers, and oversee participant outcomes.

Agency: ForwardHealth
Role: Medicaid provider enrollment and payment processing (for State Plan-covered supports).

2. SUPPORTED EMPLOYMENT SERVICES OVERVIEW

Supported Employment includes a continuum of services tailored to assist individuals with disabilities in achieving employment goals in competitive, integrated environments.

Covered services may include:

Career Planning & Discovery – Identifying interests, skills, and job goals

Job Development & Placement – Resume building, applications, interviews

Job Coaching – On-site support to learn tasks, adapt to the work environment

Job Retention – Ongoing check-ins, employer communication, skill building

Self-Employment Support – Guidance on starting microbusinesses or freelance work

Workplace Soft Skills Training – Communication, time management, teamwork

Services must be individualized, outcome-oriented, and documented in the participant’s Individual Service Plan (ISP) or IRIS Support and Service Plan (SSP).

3. PROVIDER APPROVAL & QUALIFICATION REQUIREMENTS

Prerequisites:

Register business with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI (if applicable)

Enroll with IRIS Fiscal Employer Agents (FEAs) and/or MCO provider networks

Create a Supported Employment Services Policy & Procedure Manual

Ensure staff have experience in job development, disability support, or workforce coaching

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN/NPI
Step 2: Apply to serve IRIS or Family Care participants through relevant ICA or MCO
Step 3: Submit documentation of experience, staff resumes, and service policies
Step 4: If billing Medicaid directly, enroll via ForwardHealth
Step 5: Complete orientation or background checks as required
Step 6: Begin services upon plan approval and participant referral

5. REQUIRED DOCUMENTATION

Business registration and provider approval letters

Supported Employment P&P Manual including:

Intake assessments and discovery tools

Progress note templates and outcome tracking forms

Employer communication and accommodation logs

Health and safety policies for job sites

Confidentiality, HIPAA, and abuse prevention protocols

Participant rights and grievance processes

Billing records and service verification logs

6. STAFFING REQUIREMENTS

Role: Employment Specialist / Job Coach
Requirements:

High school diploma or higher (Bachelor’s preferred for vocational roles)

Experience in workforce development, disability services, or behavioral support

Background check compliant with Wisconsin’s Caregiver Law

Person-centered and culturally competent care training

All staff must complete:

HIPAA and documentation training

Employment planning and workplace safety training

Abuse/neglect prevention and de-escalation (if applicable)

Annual evaluation of service effectiveness and client outcomes

7. MEDICAID WAIVERS THAT COVER SUPPORTED EMPLOYMENT

IRIS (Self-Directed Waiver Program) – Services purchased through participant-directed budgets

Family Care / Family Care Partnership – MCO-authorized employment supports

Children’s Long-Term Support (CLTS) Waiver – For transition-age youth (typically 14+)

Children’s Community Options Program (CCOP) – Non-waiver employment readiness supports

Note: Services must be authorized and documented in the ISP/SSP. Participation in pre-vocational or volunteer services does not replace employment support under these programs.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Program Design
Timeline: 2–3 weeks

Phase: ICA / MCO Enrollment & Staff Onboarding
Timeline: 1–2 months

Phase: Documentation Setup & Referral Readiness
Timeline: 30–45 days

Phase: Service Launch
Timeline: Begins upon participant plan approval and assignment

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9. CONTACT INFORMATION

DHS Division of Long-Term Care
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

IRIS – DHS Managed Program Site
Website: https://www.dhs.wisconsin.gov/iris

ForwardHealth Medicaid Portal
Website: https://www.forwardhealth.wi.gov

Wisconsin Department of Financial Institutions (DFI)
Website: https://www.wdfi.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN SUPPORTED EMPLOYMENT PROVIDER
WCG supports agencies in launching vocational support programs that empower individuals with disabilities to succeed in the workforce.

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Scope of Work:

IRIS, MCO, and ForwardHealth enrollment support

Supported Employment Services P&P Manual development

Job readiness and coaching documentation templates

Outcome tracking and employer contact logs

Staff training in workforce integration and soft skills development

Billing and verification tools for time-limited and ongoing supports

PERSONAL CARE SERVICES PROVIDER IN WISCONSIN
DELIVERING IN-HOME ASSISTANCE WITH DAILY ACTIVITIES TO SUPPORT DIGNITY, INDEPENDENCE, AND SAFETY FOR INDIVIDUALS WITH FUNCTIONAL LIMITATIONS

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Personal Care Services (PCS) in Wisconsin offer hands-on assistance with activities of daily living (ADLs) to individuals who qualify for Wisconsin Medicaid (ForwardHealth). These services help participants remain in their homes or community settings rather than entering institutional care.

PCS are available under Wisconsin’s Medicaid State Plan and can also be incorporated into care plans under Family Care, IRIS (Include, Respect, I Self-Direct), and Children’s Long-Term Support (CLTS) waiver programs. Services are authorized based on a Personal Care Screening Tool (PCST) and must be supervised by a Registered Nurse (RN).

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Oversees Medicaid programs, including personal care policy, rate setting, and provider oversight.

Agency: ForwardHealth
Role: Manages provider enrollment, prior authorization (PA), and claims processing for personal care under Medicaid.

Agency: IRIS Consultant Agencies (ICA) / Managed Care Organizations (MCOs)
Role: Authorize and coordinate PCS under IRIS and Family Care.

2. PERSONAL CARE SERVICES OVERVIEW

Personal Care Services are medically necessary, non-skilled services provided to individuals who require assistance with daily living tasks due to a medical condition or disability.

Covered services may include:

Bathing and grooming

Dressing and undressing

Toileting and incontinence care

Mobility and transfers

Eating and feeding assistance

Skin care and basic hygiene

Assistance with medications (reminders, not administration)

Light housekeeping directly related to care needs

Services must be ordered by a physician or nurse practitioner and based on findings from the PCST. The RN supervisor develops and oversees the Plan of Care (POC).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI

Apply for Medicaid provider certification through ForwardHealth

Employ or contract a licensed RN to perform initial assessments and supervision

Develop a Personal Care Services Policy & Procedure Manual in compliance with DHS 105 and DHS 107

Maintain appropriate liability insurance

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN/NPI
Step 2: Apply to ForwardHealth as a Medicaid-certified personal care provider
Step 3: Submit documentation for RN supervision and business operations
Step 4: Complete orientation and sign Medicaid provider agreement
Step 5: Begin services following PCST completion and prior authorization (PA) approval

5. REQUIRED DOCUMENTATION

Business registration and ForwardHealth provider ID

PCS Policy & Procedure Manual including:

Service delivery protocols and RN supervision requirements

PCST completion and care plan documentation

Daily care logs and visit verification tools

Medication reminder procedures

Participant rights and grievance protocols

Infection control and abuse prevention policies

Timesheets, billing records, and shift documentation templates

6. STAFFING REQUIREMENTS

Role: Personal Care Worker (PCW)
Requirements:

18+ years of age

Completed DHS-approved PCW training (minimum 16 hours)

Background check via Wisconsin Caregiver Background Check Law

CPR and First Aid certification

Role: Registered Nurse (RN) Supervisor
Requirements:

Wisconsin RN licensure

Completes assessments, develops care plans, and provides ongoing staff supervision and training

All staff must complete:

HIPAA and documentation training

Abuse/neglect prevention training

Infection control and universal precautions

Annual competency checks and skills validation

7. MEDICAID PROGRAMS THAT COVER PERSONAL CARE

Wisconsin Medicaid State Plan (ForwardHealth) – Standard PCS coverage for eligible adults and children

Family Care / Family Care Partnership – PCS included in MCO-authorized service plans

IRIS (Self-Directed Waiver Program) – Participants hire their own PCWs through Fiscal Employer Agents (FEAs)

Children’s Long-Term Support (CLTS) Waiver – May authorize PCS for children with disabilities

All services require physician orders and either a PCST or long-term care functional screen (LTCFS).

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Manual Development
Timeline: 2–4 weeks

Phase: ForwardHealth Enrollment & Staffing
Timeline: 1–2 months

Phase: RN Supervisor & Staff Training Setup
Timeline: 30–45 days

Phase: Service Delivery Launch
Timeline: Begins upon PCST completion and PA approval

9. CONTACT INFORMATION

Wisconsin Department of Health Services – ForwardHealth
Website: https://www.forwardhealth.wi.gov

ForwardHealth Provider Services
Phone: 800-947-9627

Wisconsin Department of Financial Institutions (DFI)
Website: https://www.wdfi.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN PERSONAL CARE SERVICES PROVIDER
WCG helps new providers navigate ForwardHealth enrollment, train staff, and implement nurse-supervised, Medicaid-compliant personal care programs across Wisconsin.

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Scope of Work:

ForwardHealth Medicaid provider enrollment

Personal Care Services P&P Manual development

RN supervisory templates and PCST documentation tools

Daily care logs, shift notes, and billing forms

HIPAA, abuse prevention, and infection control training kits

Compliance and audit preparation support

ADAPTIVE EQUIPMENT SERVICES PROVIDER IN WISCONSIN
SUPPORTING FUNCTIONAL INDEPENDENCE THROUGH PERSONALIZED MEDICAL AND ASSISTIVE DEVICES FOR CHILDREN AND ADULTS WITH DISABILITIES

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Adaptive Equipment Services in Wisconsin involve the assessment, selection, delivery, and maintenance of assistive devices that help individuals with disabilities or chronic conditions function more independently at home or in the community. These devices can range from simple aids to complex mobility or communication systems.

Funding for adaptive equipment may come from Medicaid State Plan benefits, Home and Community-Based Services (HCBS) Waiver programs such as IRIS, Family Care, Children’s Long-Term Support (CLTS), and Children’s Community Options Program (CCOP). Oversight is provided by the Wisconsin Department of Health Services (DHS) and managed locally through Managed Care Organizations (MCOs) and IRIS Consultant Agencies (ICAs).

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Establishes Medicaid and waiver policy for durable medical equipment (DME) and adaptive devices.

Agency: ForwardHealth
Role: Handles provider enrollment, claims submission, and prior authorization for Medicaid-covered items.

Agency: IRIS Consultant Agencies (ICAs) / Managed Care Organizations (MCOs)
Role: Review and approve adaptive equipment requests through the participant’s Support and Service Plan (SSP) or Individual Service Plan (ISP).

2. ADAPTIVE EQUIPMENT SERVICES OVERVIEW

Adaptive Equipment providers supply and service a wide range of devices tailored to each individual’s functional needs.

Covered items and services may include:

Wheelchairs (manual or powered)

Hospital beds, lifts, and transfer devices

Orthotics and prosthetics

Augmentative and Alternative Communication (AAC) devices

Modified utensils or hygiene tools

Environmental controls (e.g., switches, voice-activated systems)

Visual, hearing, or sensory aids

Adaptive strollers or positioning equipment

Custom-fitted helmets, braces, and supports

All devices must be medically necessary, supported by a clinical justification, and included in the participant’s care plan.

3. PROVIDER APPROVAL & QUALIFICATION REQUIREMENTS

Prerequisites:

Register business with the Wisconsin Department of Financial Institutions (DFI)

Obtain Federal EIN and Type 2 NPI

Enroll as a Durable Medical Equipment (DME) provider with ForwardHealth (if billing Medicaid directly)

Enroll with IRIS FEAs and/or MCO networks if serving waiver clients

Employ or contract with licensed therapists (OT, PT, SLP) or assistive technology professionals to complete evaluations

Create a Policy & Procedure Manual for Adaptive Equipment Services

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN/NPI
Step 2: Apply for DME provider enrollment with ForwardHealth (if billing Medicaid)
Step 3: Apply to MCOs or ICAs for waiver-based service authorization
Step 4: Submit documentation including product offerings, evaluation protocols, and safety policies
Step 5: Provide clinical justifications and pricing for equipment upon referral
Step 6: Deliver, fit, and train individuals in device use per plan approval

5. REQUIRED DOCUMENTATION

Business registration and Medicaid provider number (if applicable)

Adaptive Equipment Services P&P Manual including:

Assessment, delivery, and fitting protocols

Device maintenance and follow-up support procedures

Equipment return and replacement policy

HIPAA, safety, and infection control practices

Manufacturer warranty tracking and repair logs

Clinical justification templates and service verification

Billing and inventory tracking forms

6. STAFFING REQUIREMENTS

Role: Adaptive Equipment Specialist / Technician
Requirements:

Experience with DME or assistive devices

Product knowledge and hands-on fitting expertise

Clean background check and product-specific training

Role: Licensed Evaluators (OT, PT, SLP, ATP)
Requirements:

Wisconsin licensure

Required for evaluation, fitting, or training for high-tech or custom equipment

All staff must complete:

HIPAA and confidentiality training

Safety and infection control procedures

Manufacturer-specific equipment training

Documentation and compliance tracking protocols

7. MEDICAID WAIVERS THAT COVER ADAPTIVE EQUIPMENT

IRIS – Participants self-direct purchases through FEAs based on approved budgets

Family Care / Family Care Partnership – MCO-funded equipment aligned with care goals

Children’s Long-Term Support (CLTS) – For youth with developmental disabilities or physical impairments

Children’s Community Options Program (CCOP) – May supplement adaptive equipment not covered by other sources

ForwardHealth Medicaid State Plan – Covers DME with prior authorization for eligible items

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Manual Development
Timeline: 2–4 weeks

Phase: Medicaid/MCO/IRIS Enrollment & Product Catalog Setup
Timeline: 1–2 months

Phase: Licensing, Staffing & Vendor Agreements
Timeline: 30–45 days

Phase: Start of Services
Timeline: Begins upon authorization of first device or evaluation request

9. CONTACT INFORMATION

ForwardHealth – DME Provider Enrollment
Website: https://www.forwardhealth.wi.gov

DHS Division of Medicaid Services – Long-Term Care Programs
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

IRIS Program Overview
Website: https://www.dhs.wisconsin.gov/iris

Wisconsin Department of Financial Institutions (DFI)
Website: https://www.wdfi.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN ADAPTIVE EQUIPMENT PROVIDER
WCG assists vendors, therapists, and DME agencies in launching compliant adaptive equipment services that align with Medicaid, waiver, and private funding streams.

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Scope of Work:

ForwardHealth and waiver enrollment support

Adaptive Equipment P&P Manual creation

Clinical justification, evaluation, and delivery templates

Product inventory and safety documentation systems

Waiver billing and equipment tracking tools

Staff training on HIPAA, safety, and DME protocols

SKILLED NURSING SERVICES PROVIDER IN WISCONSIN
DELIVERING LICENSED NURSING SUPPORT TO INDIVIDUALS WITH COMPLEX MEDICAL NEEDS TO PROMOTE HEALTH, STABILITY, AND COMMUNITY LIVING

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Skilled Nursing Services in Wisconsin offer intermittent or continuous medical care provided by Registered Nurses (RNs) or Licensed Practical Nurses (LPNs) to individuals with chronic health conditions, disabilities, or post-acute needs. These services support health monitoring, treatment administration, and clinical interventions that allow individuals to remain safely at home or in community settings.

Skilled nursing is covered under Wisconsin Medicaid’s State Plan, and may also be authorized through HCBS Waivers, including IRIS, Family Care, and the Children’s Long-Term Support (CLTS) Waiver. All services must be medically necessary, ordered by a physician, and documented in a formal Plan of Care (POC).

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Oversees Medicaid and waiver nursing policy, licensing, and service standards.

Agency: ForwardHealth
Role: Manages Medicaid provider enrollment, prior authorization (PA), and reimbursement.

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Authorize nursing hours based on participant needs and care plans.

Agency: Wisconsin Department of Safety and Professional Services (DSPS)
Role: Licenses RNs and LPNs practicing in the state.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing involves clinical services provided under medical supervision, typically at the individual’s residence or in licensed residential care facilities.

Covered services may include:

Medication administration (oral, IM, IV)

Wound care and dressing changes

Tube feedings and catheter management

Tracheostomy care and ventilator support

Vital signs and health monitoring

Diabetes management and insulin injections

Chronic disease oversight and patient teaching

Care coordination with physicians and therapists

Training for caregivers on complex care tasks

All services must be provided under a physician-ordered Plan of Care, reviewed and updated regularly by a supervising nurse.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your agency with the Wisconsin Department of Financial Institutions (DFI)

Obtain Federal EIN and Type 2 NPI

Employ or contract licensed RNs and/or LPNs

Apply for ForwardHealth provider enrollment under nursing services or home health

Enroll with MCOs and IRIS Fiscal Employer Agents (FEAs) for waiver-based services

Create a Skilled Nursing Services Policy & Procedure Manual per DHS and CMS guidelines

Maintain liability, malpractice, and workers’ compensation insurance

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN/NPI
Step 2: Apply to ForwardHealth as a Skilled Nursing or Home Health provider
Step 3: Submit required documentation (licenses, P&P Manual, RN credentials)
Step 4: If serving waivers, apply to IRIS and MCO networks
Step 5: Complete any required training or orientation
Step 6: Begin services upon care plan approval and prior authorization (if required)

5. REQUIRED DOCUMENTATION

Business registration and ForwardHealth provider number

Nursing Services P&P Manual including:

Physician orders and POC documentation process

Medication administration and safety protocols

Infection control and universal precautions

HIPAA and confidentiality safeguards

Emergency response and escalation protocols

Charting templates and shift notes

RN supervision logs (for LPNs and aides)

Staff credentialing and continuing education tracking

Grievance process and patient rights forms

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements:

Wisconsin RN license through DSPS

Responsible for assessments, care plans, and staff supervision

Must complete HIPAA, safety, and clinical documentation training

Role: Licensed Practical Nurse (LPN)
Requirements:

Wisconsin LPN license

Works under RN supervision

Performs delegated skilled tasks (e.g., injections, wound care)

All clinical staff must complete:

Universal precautions and infection control

Emergency procedures and medication safety

Annual skills validation and charting audits

Abuse and neglect prevention training

7. MEDICAID PROGRAMS THAT COVER SKILLED NURSING

ForwardHealth Medicaid State Plan – For children and adults with medically necessary nursing needs

IRIS Waiver – Participants self-direct nurse services with approval through FEAs

Family Care / Family Care Partnership – MCO-funded skilled nursing based on assessed need

Children’s Long-Term Support (CLTS) Waiver – Authorizes nursing for medically complex children

Katie Beckett Program – For medically fragile children not otherwise Medicaid-eligible

Note: All services must be tied to a Plan of Care, supported by documentation of medical need, and reviewed at regular intervals.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Manual Development
Timeline: 2–4 weeks

Phase: Staff Recruitment & Compliance Setup
Timeline: 30–60 days

Phase: Medicaid/MCO/IRIS Enrollment
Timeline: 2–3 months

Phase: Launch of Services
Timeline: Begins after service authorization and staff credentialing

9. CONTACT INFORMATION

ForwardHealth Medicaid Portal
Website: https://www.forwardhealth.wi.gov

DHS Long-Term Care Programs
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

Wisconsin Department of Safety and Professional Services (DSPS)
Website: https://dsps.wi.gov

IRIS Program Site
Website: https://www.dhs.wisconsin.gov/iris

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN SKILLED NURSING PROVIDER
WCG supports home health and private duty nursing agencies with the tools and documentation needed to launch high-quality, compliant skilled nursing services across Wisconsin.

​

Scope of Work:

ForwardHealth and waiver program enrollment

Skilled Nursing P&P Manual development

Plan of Care and charting templates

Staff credentialing packets and supervision logs

Medication safety, emergency, and infection control systems

Billing documentation and shift tracking tools

HABILITATION SERVICES PROVIDER IN WISCONSIN
SUPPORTING SKILL DEVELOPMENT, INDEPENDENCE, AND COMMUNITY INTEGRATION FOR INDIVIDUALS WITH DISABILITIES

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Habilitation Services in Wisconsin are designed to help individuals with intellectual, developmental, and other disabilities acquire, maintain, and improve the skills needed for daily living and inclusion in the community. These supports focus on personal development, adaptive behavior, and social participation in home and community settings.

Habilitation is a key component of Wisconsin’s Home and Community-Based Services (HCBS) Waiver programs such as IRIS, Family Care, and the Children’s Long-Term Support (CLTS) Waiver. Services must align with person-centered plans, meet functional support needs, and be delivered by qualified providers under Medicaid program guidelines.

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Oversees waiver services including habilitation policies, provider qualifications, and service standards.

Agency: ForwardHealth
Role: Manages Medicaid provider enrollment, billing procedures, and waiver reimbursement.

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Authorize habilitative services and monitor outcomes based on individualized service plans (ISPs).

Agency: Wisconsin Department of Safety and Professional Services (DSPS)
Role: Oversees professional licensing for certain staff categories, such as therapists or counselors, when applicable.

2. HABILITATION SERVICES OVERVIEW

Habilitation services are individualized interventions that build or enhance skills for independent living, communication, socialization, mobility, and community access.

Common habilitation supports include:

Daily living skills training (e.g., cooking, hygiene, money management)

Community integration and recreation participation

Communication and social skills development

Behavior support planning and implementation

Adaptive skills and mobility support

Employment readiness or volunteer skill-building

Self-advocacy and choice-making

Support with navigating public systems (transportation, civic participation)

All services must be tied to measurable outcomes and documented in an ISP or Plan of Support.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your agency with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI

Apply for provider status with ForwardHealth and applicable waiver programs

Develop a Habilitation Services Policy & Procedure Manual

Employ or contract qualified habilitation specialists or support staff

Maintain liability insurance, background checks, and staff training logs

Licensure is not always required unless services are delivered by professionals such as behavioral therapists or licensed counselors.

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and obtain EIN and NPI
Step 2: Apply to ForwardHealth as a habilitation support provider (typically under waiver program services)
Step 3: Develop and submit your Policy & Procedure Manual
Step 4: Apply to be a provider with IRIS Fiscal Employer Agents and MCOs for waiver participation
Step 5: Complete background checks and staff training
Step 6: Start providing services upon ISP approval and, if applicable, service authorization

5. REQUIRED DOCUMENTATION

ForwardHealth Provider Enrollment documents

Habilitation Services Policy & Procedure Manual, covering:

Individualized Service Plan process

Skill development and documentation protocols

Staff training and supervision procedures

Client rights, HIPAA, and consent forms

Incident reporting and safety protocols

Progress tracking forms and outcome measures

Emergency response and community access guidelines

Staff qualification records and background checks

Service agreements with IRIS/MCOs

6. STAFFING REQUIREMENTS

Role: Habilitation Specialist / Direct Support Professional
Requirements:

High school diploma or GED minimum (some programs may require higher education or specialized certifications)

Completion of training in habilitation support, person-centered planning, and disability rights

CPR/First Aid certification

Background check clearance

Supervised experience or orientation by agency leadership

All staff must receive:

Annual training in behavior support, communication strategies, and community inclusion

Abuse/neglect prevention, infection control, and HIPAA compliance

Ongoing evaluation and documentation skills training

7. MEDICAID PROGRAMS THAT COVER HABILITATION SERVICES

IRIS Waiver: Participant-directed habilitation supports under a customized budget and care plan

Family Care / Partnership: Habilitation and prevocational services funded through MCOs

Children’s Long-Term Support (CLTS) Waiver: Habilitative services for eligible children with developmental or physical disabilities

CCOP (Children’s Community Options Program): Supplemental supports that may include habilitation components

Note: All habilitative services must be part of an authorized ISP or Plan of Care, with measurable goals and progress documentation.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Manual Development
Timeline: 2–4 weeks

Phase: Staff Recruitment & Documentation Setup
Timeline: 30–45 days

Phase: Medicaid/Waiver Enrollment & Contracts
Timeline: 1–3 months

Phase: Begin Services Upon Plan Approval
Timeline: Services may start once participants are approved through IRIS or MCOs

9. CONTACT INFORMATION

ForwardHealth Medicaid Portal
Website: https://www.forwardhealth.wi.gov

DHS Waiver Services
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

IRIS Program
Website: https://www.dhs.wisconsin.gov/iris

MCO Network Contact Directory
Website: https://www.dhs.wisconsin.gov/familycare/mcos.htm

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN HABILITATION SERVICES PROVIDER

WCG helps entrepreneurs and agencies establish high-quality habilitation services with the operational, regulatory, and training support needed to launch and grow.

​

Scope of Work:

ForwardHealth and waiver provider enrollment

Habilitation Services P&P Manual development

Service documentation templates and outcome tools

Staff onboarding packets and training resources

Behavior support and skill-building curriculum guidance

Progress tracking and audit readiness support

ADULT HEALTH CARE SERVICES PROVIDER IN WISCONSIN
PROMOTING WELLNESS, FUNCTIONAL INDEPENDENCE, AND COMMUNITY INTEGRATION FOR ADULTS WITH CHRONIC CONDITIONS OR DISABILITIES

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Adult Health Care Services in Wisconsin focus on enhancing the physical, emotional, and cognitive well-being of adults with disabilities, chronic illnesses, or aging-related conditions. These services support individuals in managing their health, improving functional abilities, and participating in meaningful community activities.

Covered under Wisconsin’s Medicaid Home and Community-Based Services (HCBS) Waivers — including IRIS, Family Care, and the Community Options Program — Adult Health Care Services must be tailored to each individual’s assessed needs and detailed in a person-centered plan.

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Sets policy, eligibility criteria, and standards for adult health services under waiver programs.

Agency: ForwardHealth
Role: Processes Medicaid provider applications, service authorizations, and reimbursements.

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Approve adult health care services in individualized service plans (ISPs) and monitor outcomes.

2. ADULT HEALTH CARE SERVICES OVERVIEW

Adult Health Care Services are structured activities and health-related interventions that help participants improve or maintain functional abilities and reduce reliance on higher levels of care.

Covered services may include:

Health education and self-management training

Nutritional guidance and meal planning

Physical activity or mobility maintenance

Medication and chronic disease self-monitoring

Cognitive stimulation activities

Basic personal care (in certain structured settings)

Mental wellness support and coping strategies

Community resource navigation and referrals

Services are typically provided in an adult day center, structured group setting, or the individual’s home, depending on the waiver program and participant’s needs.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI

Apply for enrollment with ForwardHealth

Apply to serve participants under IRIS, Family Care, or Partnership

Hire qualified staff with background checks and required training

Develop an Adult Health Care Services Policy & Procedure Manual

Secure appropriate insurance coverage and staffing structure

Licensure may be required if delivering services in an Adult Day Health Center or in combination with personal care or skilled nursing supports.

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN/NPI
Step 2: Apply to ForwardHealth as a community-based services provider
Step 3: Submit P&P Manual, staffing plan, and relevant documentation
Step 4: Apply to IRIS Fiscal Employer Agents and/or MCO networks
Step 5: Complete required provider orientation or training modules
Step 6: Begin services upon authorization through participant ISP

5. REQUIRED DOCUMENTATION

ForwardHealth enrollment documentation

Adult Health Care Services Policy & Procedure Manual covering:

Program goals, structure, and staffing

Daily activity plans and engagement tracking

Participant assessments and ISP alignment

Health and safety protocols

Medication administration (if applicable)

HIPAA and confidentiality standards

Incident response and emergency procedures

Progress notes and charting templates

Staff credentialing logs and training verification

6. STAFFING REQUIREMENTS

Role: Adult Health Care Program Staff / Facilitators
Requirements:

Experience in health, human services, or community care

Completion of CPR/First Aid, infection control, and confidentiality training

Background check clearance

Ongoing professional development in aging, disability, or behavioral support

Role: Program Nurse or Health Consultant (if needed)
Requirements:

Wisconsin RN or LPN license

Available to oversee health-related programming and documentation

Optional for non-medical models, required if performing health assessments or clinical tasks

7. MEDICAID PROGRAMS THAT COVER ADULT HEALTH CARE SERVICES

IRIS Waiver: Participant-directed health promotion and adult day services

Family Care / Partnership: MCO-funded services delivered in structured or home-based settings

Community Options Program (COP): Locally administered support for individuals who qualify

Program of All-Inclusive Care for the Elderly (PACE): In select regions for seniors needing coordinated services

Note: All services must be aligned with the participant’s assessed needs and included in an approved service or support plan.

8. TIMELINE TO LAUNCH

Phase: Business & P&P Manual Development
Timeline: 3–4 weeks

Phase: Staff Hiring & Compliance Readiness
Timeline: 30–60 days

Phase: Waiver Enrollment (IRIS / MCO)
Timeline: 2–3 months

Phase: Program Launch
Timeline: After approval of participant ISPs and authorization

9. CONTACT INFORMATION

ForwardHealth Medicaid Portal
Website: https://www.forwardhealth.wi.gov

DHS HCBS Provider Resources
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

IRIS Program Information
Website: https://www.dhs.wisconsin.gov/iris

MCO Provider Networks
Website: https://www.dhs.wisconsin.gov/familycare/mcos.htm

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN ADULT HEALTH CARE SERVICES

WCG helps agencies launch Adult Health Care programs that improve quality of life for adults with disabilities or chronic health needs.

​

Scope of Work:

ForwardHealth and waiver program enrollment

Adult Health Services P&P Manual development

Program structure, service planning, and compliance templates

Staff onboarding tools and background check systems

Health tracking logs, activity plans, and charting formats

Billing, documentation, and audit support

ASSISTIVE TECHNOLOGY SERVICES PROVIDER IN WISCONSIN
ENABLING INDEPENDENCE AND ACCESS THROUGH TECHNOLOGY SOLUTIONS TAILORED TO INDIVIDUAL NEEDS

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Assistive Technology (AT) Services in Wisconsin provide individuals with disabilities access to tools and devices that promote greater independence, safety, communication, mobility, and participation in home and community life. These services include both the provision of assistive devices and the evaluation, training, and customization needed to ensure effective use.

Covered under Wisconsin Medicaid Waivers such as IRIS, Family Care, and the Children’s Long-Term Support (CLTS) Waiver, assistive technology must be authorized through a participant’s Individualized Service Plan (ISP) or Plan of Care and demonstrate a clear functional need.

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Establishes policy for AT under Medicaid waiver programs and monitors service compliance.

Agency: ForwardHealth
Role: Manages Medicaid enrollment, service authorizations, and payment for eligible AT services and devices.

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Authorize funding for AT based on assessments, service plans, and justification of medical or functional need.

Agency: Wisconsin Assistive Technology Program (WisTech)
Role: Provides guidance, demonstrations, and loan programs for assistive technology across the state.

2. ASSISTIVE TECHNOLOGY SERVICES OVERVIEW

Assistive Technology includes both devices and services that help individuals perform functions that might otherwise be difficult or impossible due to a disability.

Covered devices and services may include:

Communication devices (e.g., speech-generating tablets)

Environmental control systems (e.g., smart home access tools)

Adaptive switches and controls for mobility equipment

Specialized seating, positioning, or ergonomic supports

Augmentative and alternative communication (AAC) systems

Cognitive aids and memory supports

Vision/hearing-related technologies (e.g., screen readers, alert systems)

Assessments, customization, installation, and training on AT use

Devices must be individualized, cost-effective, and tied to improved independence or safety goals outlined in the care plan.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI

Apply for ForwardHealth enrollment under appropriate AT or DME (Durable Medical Equipment) categories

Develop a service-specific Assistive Technology Policy & Procedure Manual

Partner or subcontract with licensed professionals for evaluations (e.g., Occupational Therapists, Speech Pathologists, ATP-certified specialists)

Obtain any applicable DME licenses or durable goods distribution authorizations (as needed)

Maintain liability insurance, client education protocols, and return/exchange procedures

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN/NPI
Step 2: Enroll with ForwardHealth under AT/DME provider type
Step 3: Submit P&P Manual, staff qualifications, and documentation templates
Step 4: Enroll with IRIS FEAs and MCO networks as a waiver service provider
Step 5: Coordinate with professionals (e.g., OTs, SLPs) for AT evaluations if required
Step 6: Begin service provision upon authorization of AT need in care plan and device justification

5. REQUIRED DOCUMENTATION

Business registration and ForwardHealth provider ID

AT Services Policy & Procedure Manual including:

Device evaluation and recommendation process

Participant training protocols

Repair and maintenance policy

Return/exchange and warranty tracking

HIPAA and confidentiality compliance

Device delivery, setup, and training logs

Outcome monitoring and service effectiveness forms

Client rights and complaint resolution policies

Documentation templates for:

Justification of need

AT delivery and training checklists

Evaluation summaries and follow-up assessments

6. STAFFING REQUIREMENTS

Role: Assistive Technology Specialist / Technician
Requirements:

Experience with AT installation, customization, or device programming

Onboarding training in Medicaid waiver policies, documentation, and confidentiality

Background check clearance and CPR/First Aid (if working directly in homes)

Role: Licensed Evaluator (e.g., OT, PT, SLP, or ATP Certified)
Requirements:

Wisconsin license in respective profession

Must conduct assessments and make formal recommendations

Required for certain high-cost or complex device justifications under IRIS, MCOs, or CLTS

All staff must be trained in:

Equipment safety and troubleshooting

Participant-centered instruction

HIPAA, documentation, and reporting

Abuse and neglect prevention

7. MEDICAID PROGRAMS THAT COVER ASSISTIVE TECHNOLOGY

IRIS Waiver: Participant-directed AT with evaluator recommendation and Fiscal Employer Agent approval

Family Care / Partnership: MCO-authorized AT based on care team recommendation

Children’s Long-Term Support (CLTS) Waiver: Covers a wide range of AT and supports for eligible children

Katie Beckett Program (via CLTS): May allow for AT access for children with complex needs not otherwise Medicaid-eligible

Note: AT purchases must be cost-effective, necessary for achieving care plan goals, and supported by proper justification. Ongoing training and support may be included.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Manual Development
Timeline: 2–3 weeks

Phase: Licensing/Enrollment and Partnerships (OTs/ATPs)
Timeline: 30–45 days

Phase: ForwardHealth and Waiver Program Enrollment
Timeline: 2–3 months

Phase: Begin Services
Timeline: Upon service authorization and fulfillment of any evaluation or justification requirements

9. CONTACT INFORMATION

ForwardHealth Provider Enrollment
Website: https://www.forwardhealth.wi.gov

Wisconsin DHS – Assistive Technology Overview
Website: https://www.dhs.wisconsin.gov/children/assistive-technology.htm

WisTech (Wisconsin Assistive Technology Program)
Website: https://www.dhs.wisconsin.gov/disabilities/wistech.htm

IRIS Program Overview
Website: https://www.dhs.wisconsin.gov/iris

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN ASSISTIVE TECHNOLOGY PROVIDER

WCG helps device vendors, AT consultants, and community agencies offer life-changing assistive technology solutions across Wisconsin’s waiver programs.

​

Scope of Work:

ForwardHealth enrollment under AT and/or DME

AT Policy & Procedure Manual development

Evaluation and recommendation form templates

Vendor-client agreement and warranty documentation

Staff credentialing and training protocols

Setup, delivery, and instruction workflows

Compliance and audit readiness support

BEHAVIORAL HEALTH SERVICES PROVIDER IN WISCONSIN
SUPPORTING MENTAL HEALTH, EMOTIONAL WELLNESS, AND BEHAVIORAL STABILITY FOR INDIVIDUALS IN HOME AND COMMUNITY SETTINGS

​

Behavioral Health Services in Wisconsin provide essential mental health and behavioral supports to individuals with emotional disorders, psychiatric diagnoses, developmental disabilities, or behavioral challenges. These services are designed to stabilize functioning, support recovery, and reduce reliance on institutional care by delivering person-centered treatment and skill-building in home, community, or outpatient settings.

Covered under Wisconsin’s Medicaid State Plan and Home and Community-Based Services (HCBS) Waivers such as IRIS, Family Care, and the Children’s Long-Term Support (CLTS) Waiver, behavioral health interventions must be evidence-based, clinically appropriate, and aligned with each individual’s treatment or service plan.

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Regulates behavioral health provider qualifications, licensing, and Medicaid reimbursement under state and federal requirements.

Agency: ForwardHealth
Role: Processes Medicaid provider enrollment, authorizations, and billing for behavioral health services.

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Approve waiver-based behavioral health services and monitor implementation based on participant needs and service plans.

Agency: Wisconsin Department of Safety and Professional Services (DSPS)
Role: Licenses clinical professionals such as therapists, psychologists, and counselors.

2. BEHAVIORAL HEALTH SERVICES OVERVIEW

Behavioral health services aim to treat mental, emotional, and behavioral disorders, while improving coping strategies, social integration, and quality of life.

Covered services may include:

Individual, group, or family psychotherapy

Behavioral therapy and applied behavior analysis (ABA)

Crisis intervention and de-escalation support

Psychiatric assessments and medication management

Case management and treatment planning

Skill-building for emotion regulation, self-advocacy, and daily functioning

In-home or community-based behavioral supports

Peer support and recovery coaching (for some adult populations)

Services must be tailored to each participant’s behavioral health diagnosis, functional challenges, and identified treatment goals.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI

Employ or contract licensed behavioral health professionals (e.g., LCSW, LPC, LMFT, Psychologist, BCBA)

Enroll with ForwardHealth as a mental health clinic or therapy provider

Apply to participate in IRIS and/or MCO provider networks

Create a Behavioral Health Services Policy & Procedure Manual

Maintain professional liability insurance and ensure all staff meet credentialing and supervision standards

Licensure through DSPS is mandatory for all clinical professionals providing mental health or behavioral treatment.

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN/NPI
Step 2: Apply to ForwardHealth as a mental health or behavioral treatment provider
Step 3: Submit documentation, including licenses, staff rosters, and your P&P Manual
Step 4: Apply for waiver service authorization with IRIS FEAs and/or MCOs
Step 5: Complete any required training (e.g., HIPAA, cultural competency)
Step 6: Begin services after treatment plan approval and prior authorization (if required)

5. REQUIRED DOCUMENTATION

ForwardHealth enrollment application

Behavioral Health Services P&P Manual covering:

Intake and diagnostic assessment processes

Treatment planning and review protocols

Crisis intervention and safety planning procedures

HIPAA compliance and client confidentiality

Documentation standards for session notes and progress reports

Clinical supervision policies and scope of practice by role

Incident reporting, de-escalation, and follow-up

Discharge planning and continuity of care

Staff credentialing records and background checks

Participant service agreements and rights forms

6. STAFFING REQUIREMENTS

Role: Licensed Therapist or Counselor (LCSW, LPC, LMFT, etc.)
Requirements:

Active Wisconsin licensure through DSPS

Training in trauma-informed care, documentation, and safety planning

Responsible for assessments, therapy, and treatment plan development

Role: Behavioral Support Specialist / Technician
Requirements:

Bachelor's degree in psychology, social work, or related field preferred

Must work under clinical supervision

Provides direct in-home or community-based behavioral supports

Role: Board Certified Behavior Analyst (BCBA) – for ABA
Requirements:

National BCBA certification and Wisconsin license

Required for developing and supervising ABA therapy plans

All staff must complete:

HIPAA and confidentiality training

Emergency response and crisis management

Cultural competency and disability sensitivity training

Abuse and neglect prevention

7. MEDICAID PROGRAMS THAT COVER BEHAVIORAL HEALTH SERVICES

ForwardHealth State Plan Medicaid: Mental health clinic, outpatient counseling, medication management

IRIS Waiver: Participant-directed behavioral supports with prior approval

Family Care / Partnership: MCO-authorized mental health and behavioral treatment services

Children’s Long-Term Support (CLTS) Waiver: Behavioral supports, ABA, and counseling for children with developmental and mental health needs

Children Come First (CCF): Wraparound services for youth with high behavioral health needs

Note: Services must be medically necessary, supported by diagnosis, and included in a treatment plan with documented progress.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Licensing Setup
Timeline: 3–4 weeks

Phase: Provider Enrollment & Policy Development
Timeline: 45–60 days

Phase: Waiver and Medicaid Network Approvals
Timeline: 2–3 months

Phase: Service Delivery
Timeline: Begins after service plan or treatment plan is authorized and staff are credentialed

9. CONTACT INFORMATION

ForwardHealth Provider Portal
Website: https://www.forwardhealth.wi.gov

DHS Behavioral Health Services
Website: https://www.dhs.wisconsin.gov/mh/index.htm

DSPS License Lookup and Applications
Website: https://dsps.wi.gov

IRIS Program
Website: https://www.dhs.wisconsin.gov/iris

MCO Directory – Family Care Providers
Website: https://www.dhs.wisconsin.gov/familycare/mcos.htm

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN BEHAVIORAL HEALTH PROVIDER

WCG assists licensed professionals and agencies in launching compliant, high-quality behavioral health services under Wisconsin Medicaid and waiver programs.

​

Scope of Work:

ForwardHealth and waiver program enrollment

Behavioral Health P&P Manual creation

Treatment plan, progress note, and supervision log templates

Staff credentialing, licensing, and clinical documentation setup

Safety, privacy, and HIPAA compliance tools

Audit readiness and performance monitoring support

HOME MODIFICATION SERVICES PROVIDER IN WISCONSIN
CREATING SAFE, ACCESSIBLE, AND FUNCTIONAL LIVING SPACES FOR INDIVIDUALS WITH DISABILITIES AND MOBILITY CHALLENGES

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Home Modification Services in Wisconsin are designed to support individuals with disabilities, chronic conditions, or age-related mobility limitations by making their homes safer, more accessible, and better suited to their needs. These physical adaptations enable individuals to remain in their homes, maintain independence, and reduce the risk of institutionalization.

Home modifications are funded through Wisconsin Medicaid Waivers, including IRIS, Family Care, Partnership, and the Children’s Long-Term Support (CLTS) Waiver. All modifications must be tied to functional needs identified in the participant’s Individualized Service Plan (ISP) or Plan of Care and authorized by the waiver program.

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Establishes waiver rules and standards for home modifications under Medicaid.

Agency: ForwardHealth
Role: Administers Medicaid provider enrollment, billing, and reimbursement for waiver-authorized services.

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Assess functional need, approve modifications through participant service plans, and oversee quality.

Agency: Wisconsin Department of Safety and Professional Services (DSPS)
Role: Regulates licensed trades such as plumbers, electricians, and contractors performing structural work.

2. HOME MODIFICATION SERVICES OVERVIEW

Home modifications are physical changes to a person’s residence that enable safe and functional access to essential areas of the home.

Covered modifications may include:

Wheelchair ramps and widened doorways

Roll-in showers, grab bars, and bathroom safety features

Stair lifts, vertical platform lifts, and handrails

Lever-style handles and remote door openers

Lowered countertops and accessible cabinetry

Non-slip flooring and lighting enhancements

Specialized HVAC adjustments (if medically necessary)

Minor plumbing or electrical changes to support accessibility

All projects must be directly related to the participant’s disability, promote functional independence, and meet cost-effectiveness standards. Luxury upgrades, general home repairs, or work unrelated to disability needs are not covered.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI (if applicable)

Apply for provider status with ForwardHealth and waiver programs

Hire or contract licensed builders, plumbers, or electricians as required

Develop a Home Modification Services Policy & Procedure Manual

Maintain liability insurance and permits for residential construction

Ensure ADA compliance and alignment with waiver cost and scope guidelines

Providers may be contractors, occupational therapists, or vendors working in partnership with waiver agencies.

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN/NPI
Step 2: Apply to ForwardHealth and/or relevant waiver programs
Step 3: Submit documentation (business credentials, P&P Manual, trade licenses)
Step 4: Register with IRIS FEAs and MCO networks for waiver service delivery
Step 5: Complete any necessary provider orientation or site-specific training
Step 6: Begin services once a home modification is authorized by care team

5. REQUIRED DOCUMENTATION

ForwardHealth and waiver provider approval documentation

Home Modification Services Policy & Procedure Manual including:

Scope of work review and home assessment protocols

Cost estimate and invoice documentation standards

Participant and contractor agreement templates

Licensing and building code compliance checklists

Warranty, repair, and maintenance policies

Pre- and post-modification inspection documentation

Safety standards and ADA compliance review

Staff background checks and subcontractor verification

Templates for contractor bids, approvals, and before/after photos

6. STAFFING REQUIREMENTS

Role: Home Modification Contractor / Vendor
Requirements:

Proper trade licenses (e.g., general contractor, plumber, electrician)

Liability insurance and bonding (if applicable)

Experience with ADA-compliant remodeling and Medicaid waiver documentation

Background check and subcontractor screening

Role: Occupational Therapist (when needed for evaluation)
Requirements:

Wisconsin OT license

Writes functional home modification recommendations tied to participant needs

Collaborates with builders and waiver team

All staff must be familiar with:

Waiver funding limitations

Safety protocols during residential work

Documentation and billing processes

Disability rights and accessibility principles

7. MEDICAID PROGRAMS THAT COVER HOME MODIFICATIONS

IRIS Waiver: Participant-directed home modifications with budget and FEA approval

Family Care / Partnership: MCO-authorized adaptations based on functional assessment

Children’s Long-Term Support (CLTS) Waiver: Covers accessibility-related changes for children

Community Options Program (COP): May offer limited funds for accessibility retrofitting

Note: Home modification requests must be supported by documented need, cost estimates, and review by the care team. Projects must be the most cost-effective option that meets the participant’s goals.

8. TIMELINE TO LAUNCH

Phase: Business Registration & P&P Manual Development
Timeline: 2–3 weeks

Phase: Licensing and Contractor Credentialing
Timeline: 30–45 days

Phase: Enrollment with Waiver Programs (IRIS, MCOs)
Timeline: 1–3 months

Phase: Service Delivery
Timeline: Begins after service authorization, site assessment, and bid approval

9. CONTACT INFORMATION

ForwardHealth Provider Portal
Website: https://www.forwardhealth.wi.gov

Wisconsin DHS – Waiver Services Overview
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

IRIS Home Modifications Info
Website: https://www.dhs.wisconsin.gov/iris

Wisconsin DSPS – Contractor Licensing
Website: https://dsps.wi.gov

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN HOME MODIFICATION PROVIDER

WCG assists remodeling firms, contractors, and OT-led businesses in launching compliant, Medicaid-approved home modification services for Wisconsin’s waiver populations.

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Scope of Work:

Waiver enrollment and provider setup

Home Modifications Policy & Procedure Manual

Cost estimate, invoice, and bid templates

Functional needs assessment and OT referral tools

Compliance with ADA and safety regulations

Documentation workflows and warranty guidance

COMMUNITY INTEGRATION SERVICES PROVIDER IN WISCONSIN
EMPOWERING INDIVIDUALS TO PARTICIPATE FULLY IN COMMUNITY LIFE THROUGH PERSON-CENTERED SUPPORTS AND ENGAGEMENT

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Community Integration Services in Wisconsin help individuals with disabilities, mental health conditions, or aging-related challenges build meaningful connections, gain independence, and engage in everyday life activities. These services are essential for fostering inclusion, reducing isolation, and promoting the rights of individuals to live, work, and participate in the community on their own terms.

Covered under Wisconsin’s Medicaid Home and Community-Based Services (HCBS) Waivers—including IRIS, Family Care, and the Children’s Long-Term Support (CLTS) Waiver—community integration services are tailored to each individual’s preferences and outlined in their Individualized Service Plan (ISP).

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Establishes Medicaid policy, service guidelines, and oversight for community-based services.

Agency: ForwardHealth
Role: Manages Medicaid provider enrollment, claims processing, and waiver reimbursement.

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Approve service plans, monitor outcomes, and authorize community integration supports.

Agency: Aging and Disability Resource Centers (ADRCs)
Role: Provide referrals and community connections to ensure access to local resources and social opportunities.

2. COMMUNITY INTEGRATION SERVICES OVERVIEW

Community Integration Services promote involvement in civic, social, recreational, volunteer, or employment-related activities based on the individual’s goals, values, and interests.

Covered supports may include:

Participation in recreation, arts, spiritual, or cultural events

Volunteer work and job-readiness activities

Support attending community classes or clubs

Social skills development and peer interaction opportunities

Transportation assistance to community sites

One-on-one coaching for navigating social settings

Developing independent use of public resources (e.g., libraries, gyms, transit)

Supporting choice, autonomy, and advocacy in public life

Services must be individualized, build toward increased independence, and align with broader community inclusion goals outlined in the care plan.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI

Apply for ForwardHealth and waiver program enrollment

Hire qualified direct support staff trained in community-based service delivery

Develop a Community Integration Services Policy & Procedure Manual

Maintain liability insurance, transportation safety protocols (if applicable), and documentation systems

Conduct criminal background checks for all staff

Licensure is not typically required unless services include personal care or clinical interventions.

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN/NPI
Step 2: Apply to ForwardHealth and enroll with IRIS/MCO waiver programs
Step 3: Submit documentation including P&P Manual and staff training protocols
Step 4: Complete provider training or orientation through applicable programs
Step 5: Begin services once the participant’s ISP or support plan is approved

5. REQUIRED DOCUMENTATION

Provider enrollment confirmation

Community Integration Services Policy & Procedure Manual, including:

Person-centered planning and activity tracking

Social-emotional development strategies

Transportation coordination and supervision policies

Participant rights, choice, and dignity protocols

Safety procedures for outings and events

Progress documentation and participation logs

Community partner engagement and feedback tools

Cultural competency and inclusion policies

Staff onboarding materials and background check records

Templates for activity planning, daily notes, and service reporting

6. STAFFING REQUIREMENTS

Role: Community Support Specialist / Integration Facilitator
Requirements:

High school diploma or GED (associate’s or bachelor’s in human services preferred)

Experience supporting individuals with disabilities in community settings

CPR/First Aid certification

Background check and abuse prevention training

Transportation safety and client supervision protocols (if providing transportation)

All staff must complete:

Training in disability rights, person-centered practices, and HIPAA

Annual continuing education in inclusion, safety, and effective communication

Supervision and documentation procedures

7. MEDICAID PROGRAMS THAT COVER COMMUNITY INTEGRATION SERVICES

IRIS Waiver: Participant-directed supports for individualized community activities

Family Care / Partnership: MCO-authorized services aligned with long-term care goals

Children’s Long-Term Support (CLTS) Waiver: Community inclusion activities for children with developmental disabilities

Children Come First (CCF): Wraparound program with a focus on community-based support

Program for All-Inclusive Care for the Elderly (PACE): Limited availability for seniors seeking community engagement

Note: All services must be based on a functional need identified in the ISP, with clear documentation of outcomes, preferences, and risk mitigation strategies.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Manual Development
Timeline: 2–3 weeks

Phase: Staff Hiring & Training
Timeline: 30–45 days

Phase: Waiver Enrollment (IRIS, MCOs, CLTS)
Timeline: 1–3 months

Phase: Launch of Services
Timeline: Begins upon service plan approval and participant referral

9. CONTACT INFORMATION

ForwardHealth Provider Enrollment
Website: https://www.forwardhealth.wi.gov

DHS Long-Term Care and Waiver Program Resources
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

IRIS Program Overview
Website: https://www.dhs.wisconsin.gov/iris

Family Care MCO Directory
Website: https://www.dhs.wisconsin.gov/familycare/mcos.htm

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN COMMUNITY INTEGRATION PROVIDER

WCG supports community-focused agencies and direct support providers with tools and templates to launch high-quality community integration services that promote inclusion, independence, and lasting impact.

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Scope of Work:

ForwardHealth and waiver enrollment support

Community Integration P&P Manual development

Activity planning forms and documentation tools

Staff onboarding, training logs, and safety procedures

Transportation and supervision templates

Compliance, charting, and outcome tracking support

HOMEMAKER SERVICES PROVIDER IN WISCONSIN
SUPPORTING DAILY LIVING AND SAFE HOME ENVIRONMENTS FOR INDIVIDUALS WITH DISABILITIES, CHRONIC CONDITIONS, OR AGE-RELATED NEEDS

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Homemaker Services in Wisconsin provide essential assistance with routine household tasks that individuals may be unable to perform independently due to physical, cognitive, or developmental limitations. These services are intended to support clean, safe, and functional living environments while enabling individuals to continue living in their homes and participating in their communities.

Homemaker services are covered under Wisconsin’s Medicaid Home and Community-Based Services (HCBS) Waivers, including IRIS, Family Care, and the Children’s Long-Term Support (CLTS) Waiver. Services must be authorized within an Individualized Service Plan (ISP) or Plan of Care and delivered in accordance with person-centered principles.

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Defines policy, eligibility, and standards for homemaker services under HCBS waivers.

Agency: ForwardHealth
Role: Handles Medicaid provider enrollment, prior authorizations, and claims processing.

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Approve homemaker services based on functional assessments and participant goals.

2. HOMEMAKER SERVICES OVERVIEW

Homemaker Services focus on non-medical support that maintains the individual’s living environment in a safe and sanitary condition. These tasks do not include hands-on personal care but may be delivered in tandem with other services.

Covered services may include:

Dusting, vacuuming, and general cleaning

Dishwashing and kitchen sanitation

Laundry and linen changes

Meal preparation and grocery list assistance

Trash removal and basic home organization

Non-medical oversight and routine check-ins

Services must directly benefit the waiver participant and may be provided on a scheduled or intermittent basis, depending on individual needs.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI (if applicable)

Apply for provider status with ForwardHealth and relevant waiver programs

Hire trained homemakers or direct support staff

Create a Homemaker Services Policy & Procedure Manual

Maintain liability insurance and perform background checks on all staff

Follow DHS guidelines for waiver service documentation and supervision

Licensing is generally not required for homemaker-only agencies, unless other services (e.g., personal care or skilled services) are also being provided.

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and obtain EIN/NPI
Step 2: Apply to ForwardHealth as a waiver service provider
Step 3: Submit P&P Manual, staff qualifications, and documentation templates
Step 4: Enroll with IRIS Fiscal Employer Agents and/or MCOs
Step 5: Complete any waiver-specific orientation or training
Step 6: Begin service delivery upon approval of participant’s plan

5. REQUIRED DOCUMENTATION

ForwardHealth and waiver enrollment documentation

Homemaker Services Policy & Procedure Manual including:

Household task guidance and scope of work

Participant rights, consent, and service agreement forms

Daily log and shift note templates

Incident reporting and safety procedures

Staff training and supervision protocols

Confidentiality, HIPAA, and abuse prevention policies

Guidelines for maintaining clean and safe home environments

Staff credentialing files and background check logs

6. STAFFING REQUIREMENTS

Role: Homemaker / Direct Support Staff
Requirements:

High school diploma or GED preferred

Experience in domestic tasks and working with vulnerable populations

CPR/First Aid certification recommended

Criminal background check required

Training in safety, abuse prevention, confidentiality, and documentation

All staff must receive:

Orientation on waiver services and participant-centered support

Annual review of policies related to infection control, emergency response, and rights advocacy

Supervision and quality assurance monitoring

7. MEDICAID PROGRAMS THAT COVER HOMEMAKER SERVICES

IRIS Waiver: Participant-directed homemaker supports within approved budget

Family Care / Partnership: MCO-authorized services based on functional assessments

Children’s Long-Term Support (CLTS) Waiver: Includes light housekeeping support to maintain safe home settings for children with disabilities

Note: Homemaker tasks must be necessary due to the participant’s functional limitations and clearly documented in the ISP. General housekeeping for other household members is not covered.

8. TIMELINE TO LAUNCH

Phase: Business Registration & P&P Manual Development
Timeline: 2–3 weeks

Phase: Staff Hiring & Background Checks
Timeline: 30–45 days

Phase: Enrollment with ForwardHealth and Waiver Programs
Timeline: 1–3 months

Phase: Begin Services
Timeline: After participant plan approval and service authorization

9. CONTACT INFORMATION

ForwardHealth Provider Portal
Website: https://www.forwardhealth.wi.gov

DHS Long-Term Care Programs
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

IRIS Program Portal
Website: https://www.dhs.wisconsin.gov/iris

MCO Network Directory
Website: https://www.dhs.wisconsin.gov/familycare/mcos.htm

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN HOMEMAKER SERVICES PROVIDER

WCG helps agencies and entrepreneurs launch reliable, compliant homemaker services that empower participants to remain in their homes with dignity and cleanliness.

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Scope of Work:

ForwardHealth and waiver program enrollment

Homemaker Services P&P Manual creation

Service logs, cleaning task checklists, and participant consent forms

Staff onboarding documents and compliance tracking

Confidentiality and abuse prevention tools

Documentation review and audit support

CASE MANAGEMENT SERVICES PROVIDER IN WISCONSIN
COORDINATING PERSON-CENTERED SUPPORTS TO PROMOTE HEALTH, INDEPENDENCE, AND SERVICE ACCESS FOR INDIVIDUALS ACROSS WAIVER PROGRAMS

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Case Management Services in Wisconsin help individuals with disabilities, mental health conditions, chronic illnesses, or age-related needs access, coordinate, and monitor the services and supports outlined in their care plans. These services ensure continuity, reduce gaps in care, and advocate for the individual’s goals within Wisconsin’s long-term care system.

Case Management is covered under Wisconsin Medicaid’s Home and Community-Based Services (HCBS) Waivers—including IRIS (in limited circumstances), Family Care, Partnership, and the Children’s Long-Term Support (CLTS) Waiver. Case managers play a crucial role in promoting self-determination, health outcomes, and service quality.

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Establishes qualifications, scope, and monitoring standards for waiver-funded case management services.

Agency: ForwardHealth
Role: Processes Medicaid provider enrollment and reimbursement for case management services (especially under CLTS or Legacy waivers).

Agency: Managed Care Organizations (MCOs) / IRIS Consultant Agencies
Role: Deliver or oversee case management through assigned care teams (Family Care and IRIS Consultant Agencies manage internal coordination functions).

Agency: County Human Services Agencies
Role: Often contract or directly employ case managers for CLTS and legacy waiver programs.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management involves the development, implementation, coordination, and ongoing monitoring of individualized care plans to meet a participant’s needs and goals.

Core functions include:

Conducting initial and ongoing assessments

Creating or updating Individualized Service Plans (ISPs)

Coordinating formal services and informal supports

Referring individuals to community resources

Monitoring service delivery and addressing concerns

Supporting self-direction, advocacy, and goal attainment

Crisis planning and risk management

Documentation, reporting, and compliance tracking

All services must be individualized, reflect the person’s preferences, and be reviewed regularly.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI

Enroll with ForwardHealth and/or apply to county or MCO contracts (depending on the program)

Employ or contract qualified case managers

Develop a Case Management Services Policy & Procedure Manual

Carry liability insurance and establish documentation protocols

Perform background checks and ensure HIPAA compliance

Case managers must meet minimum education and experience requirements set by the program (usually a Bachelor’s in human services or a related field).

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN/NPI
Step 2: Apply to ForwardHealth and/or county/MCO networks
Step 3: Submit your Case Management P&P Manual and resumes of qualified staff
Step 4: Complete any required state or program-specific training
Step 5: Enter into provider agreements or service contracts (especially for CLTS or county-based waivers)
Step 6: Begin service delivery upon participant plan approval

5. REQUIRED DOCUMENTATION

ForwardHealth enrollment and/or provider contracts

Case Management Services Policy & Procedure Manual including:

Assessment and reassessment protocols

ISP development and approval procedures

Coordination and referral tracking

Service delivery monitoring tools

Participant rights and grievance procedures

HIPAA, confidentiality, and record retention policies

Crisis response and safety planning

Staff credentialing, supervision, and caseload guidelines

Templates for service notes, ISP revisions, and monitoring checklists

6. STAFFING REQUIREMENTS

Role: Case Manager / Support and Service Coordinator (SSC)
Requirements:

Bachelor’s degree in social work, psychology, nursing, or a related human services field

1–2 years of experience in long-term care or service coordination preferred

Familiarity with Medicaid waivers and person-centered planning

Background check clearance

HIPAA, abuse prevention, and documentation training

All case managers must complete:

Program-specific onboarding (e.g., CLTS Waiver Standards, Family Care protocols)

Cultural competency and disability awareness training

Annual updates in state compliance and service documentation

7. MEDICAID PROGRAMS THAT COVER CASE MANAGEMENT SERVICES

Children’s Long-Term Support (CLTS) Waiver: Case management delivered through counties or contracted providers

Legacy Waivers / Community Integration Programs (CIP/COP): County-administered case management for adults

Family Care / Partnership: MCOs deliver case management internally via interdisciplinary care teams

IRIS Waiver: Case management is replaced with IRIS Consultant Agency (ICA) support, though external case managers may be involved in specific transitions or supplemental supports

Katie Beckett Program: Case coordination provided by state-employed staff or contractors

Note: Case management reimbursement and models vary widely across programs. Providers must align with each program’s structure and billing standards.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Manual Development
Timeline: 2–3 weeks

Phase: Staffing & Credentialing
Timeline: 30–45 days

Phase: Provider Enrollment / Contracting
Timeline: 1–3 months (may vary by program and county)

Phase: Begin Services
Timeline: After ISP approval and provider authorization

9. CONTACT INFORMATION

ForwardHealth Provider Portal
Website: https://www.forwardhealth.wi.gov

DHS Waiver Services & Children’s Programs
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

Children’s Long-Term Support Waiver
Website: https://www.dhs.wisconsin.gov/clts

IRIS Consultant Agency Directory
Website: https://www.dhs.wisconsin.gov/iris/ica.htm

MCO Provider Directory – Family Care
Website: https://www.dhs.wisconsin.gov/familycare/mcos.htm

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN CASE MANAGEMENT PROVIDER

WCG supports solo case managers and human service agencies in launching and operating compliant, participant-centered case management services across Medicaid waiver programs.

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Scope of Work:

ForwardHealth and county/MCO enrollment

Case Management P&P Manual development

Service planning, documentation, and monitoring templates

Staff training logs and credential verification systems

HIPAA, safety, and risk mitigation protocols

Program-specific compliance checklists (CLTS, Family Care, etc.)

TRANSPORTATION SERVICES PROVIDER IN WISCONSIN
ENSURING SAFE, RELIABLE, AND ACCESSIBLE TRANSPORT FOR INDIVIDUALS TO ACCESS ESSENTIAL MEDICAL, THERAPEUTIC, AND COMMUNITY SERVICES

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Transportation Services in Wisconsin play a vital role in supporting individuals with disabilities, chronic health conditions, or mobility limitations by helping them travel to medical appointments, therapy sessions, employment sites, day programs, and community activities. These services are essential to maintaining independence, health, and community integration.

Transportation is covered under Wisconsin’s Medicaid programs, including the Non-Emergency Medical Transportation (NEMT) benefit and various Home and Community-Based Services (HCBS) Waivers such as IRIS, Family Care, Partnership, and the Children’s Long-Term Support (CLTS) Waiver. All transportation services must be authorized in the participant’s Individualized Service Plan (ISP).

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Oversees Medicaid transportation policy and waiver guidelines.

Agency: ForwardHealth
Role: Administers provider enrollment and oversees waiver-based transportation reimbursement.

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Approve and authorize transportation services in alignment with participant care plans.

Agency: Medical Transportation Management, Inc. (MTM)
Role: Administers the statewide Non-Emergency Medical Transportation (NEMT) benefit for ForwardHealth Medicaid.

2. TRANSPORTATION SERVICES OVERVIEW

Transportation Services include both scheduled and demand-responsive transport to help participants attend medical appointments, therapy, employment, or community-based services.

Covered transportation services may include:

Medical transportation to clinics, hospitals, or therapy providers

Community access transportation for employment, day programs, or social inclusion

Door-to-door or curb-to-curb transport based on the participant’s mobility needs

Wheelchair-accessible vehicle (WAV) transport

Mileage reimbursement for participant-directed drivers (under IRIS)

Transportation coordination for individuals with complex needs

Note: Transportation must not duplicate NEMT services covered by MTM unless it is clearly documented as a waiver-based or community integration need.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI

Apply for ForwardHealth provider enrollment and/or become a waiver program provider

Maintain commercial vehicle insurance and driver background checks

Hire qualified drivers trained in passenger safety and disability sensitivity

Create a Transportation Services Policy & Procedure Manual

Register vehicles, obtain local permits, and ensure ADA compliance for wheelchair vehicles

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN/NPI
Step 2: Apply to ForwardHealth (if serving Medicaid State Plan or CLTS Waiver)
Step 3: Apply for MCO or IRIS provider network enrollment
Step 4: Submit policy manual, insurance documents, and driver/vehicle info
Step 5: Complete any waiver program training (e.g., IRIS Fiscal Employer Agent training)
Step 6: Begin providing services upon ISP approval and authorization

5. REQUIRED DOCUMENTATION

ForwardHealth enrollment documents (if applicable)

Transportation Services Policy & Procedure Manual including:

Passenger safety protocols and emergency procedures

Vehicle inspection and maintenance logs

Driver qualification and background screening procedures

Service request intake and scheduling process

Participant rights and grievance reporting

HIPAA and confidentiality procedures

Mileage logs and trip verification forms

Accessibility standards and wheelchair securement policy

Staff training logs and insurance verification

Driver files including licenses, medical cards, and CPR/First Aid (if required)

6. STAFFING REQUIREMENTS

Role: Driver / Transportation Provider
Requirements:

Valid Wisconsin driver’s license with clean driving record

Criminal background check and caregiver screening

CPR/First Aid certification (recommended)

Disability awareness and passenger assistance training

Training in wheelchair securement and vehicle safety (for WAV drivers)

All drivers must receive:

Training in HIPAA, emergency procedures, abuse prevention

Annual vehicle inspection and documentation audits

Ongoing safety refreshers and incident reporting training

7. MEDICAID PROGRAMS THAT COVER TRANSPORTATION SERVICES

IRIS Waiver: Includes participant-directed or agency-based transportation to employment, day programs, or therapy (not duplicative of MTM)

Family Care / Partnership: MCO-authorized transport for medical, therapy, or community-based supports

Children’s Long-Term Support (CLTS) Waiver: Transportation for children with disabilities to access essential services

ForwardHealth Non-Emergency Medical Transportation (NEMT): Administered by MTM for medical appointments only

Note: Waiver-based transportation must be tied to a functional need and included in the ISP. Documentation must clearly differentiate from NEMT services.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Manual Development
Timeline: 2–3 weeks

Phase: Driver Hiring & Vehicle Setup
Timeline: 30–45 days

Phase: Medicaid/MCO/IRIS Enrollment
Timeline: 1–3 months

Phase: Service Launch
Timeline: Begins after provider approval and plan authorization

9. CONTACT INFORMATION

ForwardHealth Medicaid Portal
Website: https://www.forwardhealth.wi.gov

MTM Wisconsin NEMT Program
Website: https://www.mtm-inc.net/wisconsin/

DHS HCBS Waivers
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

IRIS Program Overview
Website: https://www.dhs.wisconsin.gov/iris

MCO Directory – Family Care Providers
Website: https://www.dhs.wisconsin.gov/familycare/mcos.htm

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN TRANSPORTATION PROVIDER

WCG helps agencies and solo providers launch Medicaid-compliant transportation services with the tools, policies, and systems required to support vulnerable populations safely and reliably.

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Scope of Work:

ForwardHealth and waiver enrollment guidance

Transportation Services P&P Manual creation

Trip logs, mileage forms, and incident report templates

Driver background check systems and onboarding checklists

ADA compliance support and wheelchair securement procedures

Billing guidance and audit-prep documentation

HOME HEALTH SERVICES PROVIDER IN WISCONSIN
DELIVERING MEDICALLY NECESSARY CARE TO INDIVIDUALS IN THEIR HOMES TO SUPPORT HEALTH, RECOVERY, AND INDEPENDENT LIVING

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Home Health Services in Wisconsin provide skilled, intermittent care to individuals with medical needs who require services delivered in their homes. These services support recovery after hospitalization, management of chronic health conditions, and avoidance of institutional placement by offering nursing and therapeutic care in a familiar environment.

Home Health is covered under Wisconsin Medicaid’s State Plan, and may also be authorized through Home and Community-Based Services (HCBS) Waivers such as IRIS, Family Care, and the Children’s Long-Term Support (CLTS) Waiver. Services must be ordered by a physician and tied to a medically necessary Plan of Care (POC).

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Establishes state regulations and oversees Medicaid policy for home health agencies.

Agency: ForwardHealth
Role: Manages Medicaid provider enrollment, prior authorization, and reimbursement.

Agency: Wisconsin Department of Safety and Professional Services (DSPS)
Role: Licenses Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and therapists.

Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Oversees federal home health conditions of participation for agencies seeking Medicare certification.

2. HOME HEALTH SERVICES OVERVIEW

Home Health Services are provided by a licensed agency and must be medically necessary, intermittent, and ordered by a physician. Services are delivered in the client’s home and are focused on clinical and rehabilitative care.

Covered services include:

Skilled nursing (wound care, injections, medication management)

Physical therapy, occupational therapy, and speech-language pathology

Medical social work services

Home health aide services (under nurse or therapist supervision)

Patient and caregiver education

Chronic disease management and monitoring

Coordination with physicians and specialists

Each service must be documented within a physician-certified Plan of Care and updated regularly.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your agency with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI

Employ or contract licensed RNs, LPNs, and therapists

Apply for ForwardHealth enrollment as a Home Health Agency

Develop a Home Health Services Policy & Procedure Manual in compliance with DHS and CMS guidelines

Maintain required insurances: general liability, malpractice, and workers’ compensation

Secure Medicare certification (optional but often pursued for dual funding)

Home health agencies must also comply with infection control, emergency preparedness, and quality improvement regulations.

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN/NPI
Step 2: Apply to ForwardHealth as a Home Health provider
Step 3: Submit agency credentials, licenses, staff rosters, and P&P Manual
Step 4: (Optional) Apply for Medicare certification if seeking dual reimbursement
Step 5: Enroll with MCOs and IRIS FEAs if serving waiver participants
Step 6: Begin services after Plan of Care approval and prior authorization (if required)

5. REQUIRED DOCUMENTATION

ForwardHealth enrollment documents

Home Health Policy & Procedure Manual covering:

Physician orders and Plan of Care development

Nursing and therapy documentation standards

Medication administration, infection control, and safety protocols

Supervision and scheduling of aides and therapists

Emergency response and on-call procedures

HIPAA compliance and participant rights

Clinical charting templates and visit notes

Quality assurance and incident tracking policies

Staff files including licenses, background checks, and continuing education logs

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements:

Licensed in Wisconsin through DSPS

Develops care plans, supervises LPNs and aides, performs direct clinical care

Must complete infection control, HIPAA, and documentation training

Role: Licensed Practical Nurse (LPN)
Requirements:

Wisconsin LPN license

Works under RN supervision to deliver delegated care (e.g., wound care, vitals)

Role: Therapist (PT, OT, SLP)
Requirements:

Wisconsin licensure in respective discipline

Provides therapy based on physician referral and Plan of Care

Role: Home Health Aide**
Requirements:

Completion of state-approved training (minimum 75 hours)

Provides personal care and support under RN or therapist supervision

7. MEDICAID PROGRAMS THAT COVER HOME HEALTH SERVICES

ForwardHealth Medicaid State Plan: Covers physician-ordered home health services for individuals with qualifying medical needs

IRIS Waiver: Allows participant-directed home health services if included in budget and authorized by the FEA

Family Care / Partnership: MCO-authorized home health services based on participant’s clinical assessment

Children’s Long-Term Support (CLTS) Waiver: Home health nursing and therapy services for children with complex medical needs

Katie Beckett Program: Allows medically fragile children who don’t otherwise qualify for Medicaid to receive in-home services

Note: All services must be documented within a Plan of Care, reviewed regularly, and provided by qualified, licensed staff.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Development
Timeline: 2–4 weeks

Phase: Licensing, Staffing & Compliance Setup
Timeline: 45–60 days

Phase: Medicaid/MCO/IRIS Enrollment & Medicare (if applicable)
Timeline: 2–4 months

Phase: Start of Services
Timeline: Begins after care plan approval and staff onboarding

9. CONTACT INFORMATION

ForwardHealth Medicaid Portal
Website: https://www.forwardhealth.wi.gov

Wisconsin DHS – Home Health Agency Resources
Website: https://www.dhs.wisconsin.gov/regulations/home-health-agencies.htm

DSPS License Lookup
Website: https://dsps.wi.gov

Medicare Certification – CMS
Website: https://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center

IRIS Waiver Program
Website: https://www.dhs.wisconsin.gov/iris

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN HOME HEALTH PROVIDER

WCG helps home health agencies set up high-quality, compliant operations across Wisconsin’s Medicaid and waiver programs, supporting both clinical excellence and regulatory readiness.

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Scope of Work:

ForwardHealth, Medicare, and waiver enrollment

Home Health P&P Manual development

Care plan templates and charting systems

Staff onboarding tools and supervision trackers

Infection control, emergency response, and HIPAA compliance tools

Billing guidance, prior authorization checklists, and audit readiness

MEAL & NUTRITION SERVICES PROVIDER IN WISCONSIN
PROMOTING HEALTH, INDEPENDENCE, AND WELL-BEING THROUGH NUTRITIOUS MEAL DELIVERY AND DIETARY SUPPORT FOR INDIVIDUALS WITH FUNCTIONAL OR MEDICAL NEEDS

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Meal & Nutrition Services in Wisconsin support individuals who are unable to prepare meals for themselves due to age, disability, chronic illness, or functional limitations. These services ensure that eligible participants receive balanced, safe, and culturally appropriate meals—either through direct delivery or meal preparation assistance—while also receiving nutritional guidance to support long-term health and community living.

Covered under Wisconsin’s Home and Community-Based Services (HCBS) Waivers—such as IRIS, Family Care, Partnership, and the Children’s Long-Term Support (CLTS) Waiver—Meal & Nutrition Services are tailored to each participant’s dietary needs and outlined in their Individualized Service Plan (ISP).

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)
Role: Oversees Medicaid waiver policy, including nutrition service standards and provider qualifications.

Agency: ForwardHealth
Role: Manages Medicaid enrollment, reimbursement, and service definitions related to food and nutrition supports.

Agency: IRIS Consultant Agencies / Managed Care Organizations (MCOs)
Role: Approve and monitor nutrition-related services under participant care plans.

Agency: Wisconsin Department of Agriculture, Trade and Consumer Protection (DATCP)
Role: Regulates food safety and commercial kitchen operations for providers delivering or preparing meals.

2. MEAL & NUTRITION SERVICES OVERVIEW

Meal & Nutrition Services aim to address the nutritional needs of individuals who are unable to shop for, prepare, or access adequate food independently.

Covered services may include:

Home-delivered meals (hot, frozen, or shelf-stable)

On-site meal preparation and nutrition assistance

Grocery shopping and meal planning support

Special diet meal prep (e.g., diabetic, low-sodium, pureed)

Culturally appropriate or allergy-specific meal options

Nutritional education and menu planning

Coordination with dietitians or healthcare providers

Services must be medically necessary or functionally required and aligned with goals in the care plan.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Wisconsin Department of Financial Institutions (DFI)

Obtain a Federal EIN and Type 2 NPI (if applicable)

Apply to ForwardHealth and/or become an IRIS or MCO-approved provider

If preparing meals, comply with DATCP food safety and kitchen licensing requirements

Hire staff with food safety training and obtain ServeSafe or equivalent certification

Develop a Meal & Nutrition Services Policy & Procedure Manual

Maintain liability insurance, delivery protocols, and client safety guidelines

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and obtain EIN/NPI
Step 2: Apply for ForwardHealth and/or waiver enrollment with IRIS/MCOs
Step 3: Submit documentation including menu samples, safety protocols, and staff credentials
Step 4: Secure kitchen license or partner with a licensed food preparation facility
Step 5: Complete provider orientation (as required by waiver program)
Step 6: Begin service delivery upon ISP approval and authorization

5. REQUIRED DOCUMENTATION

ForwardHealth enrollment or waiver approval documentation

Meal & Nutrition Services Policy & Procedure Manual including:

Meal preparation and delivery protocols

Menu planning and nutritional adequacy guidelines

Food safety, temperature control, and packaging standards

Emergency delivery plans and client contact logs

Cultural dietary accommodations and allergy risk management

Documentation of delivery dates, meal counts, and participant satisfaction

Staff food handling certifications and training records

Client rights, consent forms, and grievance processes

6. STAFFING REQUIREMENTS

Role: Meal Delivery Driver / Food Prep Staff
Requirements:

Background check and caregiver screening

Training in food safety, packaging, and confidentiality

ServeSafe certification or equivalent (if preparing meals)

CPR/First Aid (recommended for staff entering client homes)

Role: Nutrition Coordinator or Consultant (optional but beneficial)
Requirements:

Registered Dietitian (RD) license in Wisconsin

Provides oversight for menu planning and special dietary needs

Ensures meals meet Medicaid nutritional standards and ISP goals

All staff must complete:

HIPAA training

Abuse prevention and emergency procedures

Client interaction and customer service training

7. MEDICAID PROGRAMS THAT COVER MEAL & NUTRITION SERVICES

IRIS Waiver: Participant-directed nutrition support and meal delivery services

Family Care / Partnership: MCO-authorized meal prep, delivery, and dietary planning

Children’s Long-Term Support (CLTS) Waiver: Home-prepared or delivered meals for medically complex children

Community Options Program (COP): In some counties, nutrition services may be authorized as part of supportive care

Note: All meal services must be tied to functional limitations and documented in the ISP. General food costs without medical or functional justification are not reimbursable.

8. TIMELINE TO LAUNCH

Phase: Business Registration & P&P Manual Development
Timeline: 2–3 weeks

Phase: Licensing, Menu Development & Staff Training
Timeline: 30–45 days

Phase: Medicaid and Waiver Enrollment
Timeline: 1–3 months

Phase: Start of Services
Timeline: Begins upon care plan approval and food safety compliance

9. CONTACT INFORMATION

ForwardHealth Medicaid Portal
Website: https://www.forwardhealth.wi.gov

DHS Long-Term Care Services
Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

IRIS Program Website
Website: https://www.dhs.wisconsin.gov/iris

DATCP Food Licensing Information
Website: https://datcp.wi.gov

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WISCONSIN MEAL & NUTRITION SERVICES PROVIDER

WCG supports food vendors, meal delivery companies, and nutrition-focused providers in building sustainable and Medicaid-compliant operations that nourish and empower clients across Wisconsin.

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Scope of Work:

ForwardHealth and waiver program enrollment

Meal & Nutrition P&P Manual development

Menu templates, diet accommodation tools, and delivery logs

Food safety compliance and licensing support

Staff training documents and client intake forms

Billing and documentation workflows aligned with ISP requirements