Wisconsin home health agency license: DHS 133, the 10-patient provisional year and Medicare

Skilled care or personal care: which side you are on

Wis. Stat. § 50.49 defines a home health agency by three features. It primarily provides skilled nursing and other therapeutic services. Its services are governed by policies set by a professional group that includes at least one physician and at least one registered nurse, and a physician or RN supervises them. It keeps clinical records on all patients.⁠¹ The license requirement covers anyone who operates a home health agency serving patients in Wisconsin. It also covers anyone who advertises that they do.⁠²

DQA’s application page states the boundary bluntly. If you only help with activities of daily living, do housekeeping or take clients to medical appointments, do not complete a home health application.⁠³ DQA does not license them as home health agencies. If they want to bill Wisconsin Medicaid for personal care, they get personal care agency certification under Wis. Admin. Code § DHS 105.17 instead.⁠⁸ See non-medical home care licensing for how other states treat that model.

DQA publication P-01212 explains how surveyors judge “skilled.” Its key points:

• Care does not become skilled simply because a nurse or therapist provides it. Any service a non-professional can do safely without a nurse’s or therapist’s supervision is not skilled care.⁠⁵
• Examples it gives of skilled care: wound care for open, infected or complex wounds; IV medications or infusions; new tube feedings or new ostomy care; urinary catheterization; and tracheostomy suctioning. Teaching patients or caregivers to manage a disease or treatment, and assessing patients who could deteriorate, also qualify.⁠⁵
• A medical social worker alone cannot establish skilled services, even though DHS 133 lists medical social services as a therapeutic service. Physical, occupational and speech therapists can.⁠⁵
• “Homebound” is a Medicare payment condition. It is not a Wisconsin licensure requirement.⁠⁵

This matters for more than the application. Your provisional-license patients only count if they need skilled nursing or therapy.⁠²

The statute exempts several providers from licensing, even if their services resemble home health care. They are care management organizations as defined in Wis. Stat. § 46.2805(1), the programs and demonstration programs listed in § 46.2805(1)(a) and (b), and entities that contract with a care management organization to provide care management services under § 46.284(4)(d), for those contracted services. A hospital providing hospital-associated services under § 50.36(5m) is also exempt.⁠¹ Running an unlicensed agency is unlawful. The fine is up to $100 for a first offense and up to $200 for each later one, and each day after the first conviction counts as a separate offense.⁠¹

Three ways through DQA, and which one fits

DQA offers three tracks. All three start with the same application packet and end with an unannounced on-site survey.⁠³

Scroll the table sideways to see every column.

The accrediting-organization track requires an acceptance letter from the organization before you apply to DQA. DQA notes that the organizations may charge additional fees.⁠³ Wis. Stat. § 50.49(6)(am) allows DQA to accept CMS-approved accreditation instead of doing its own inspection. If you use that route, you must give DQA a copy of every periodic review report the accreditor writes.⁠¹

The state-only track is the one DQA points to if you do not plan to bill Medicare or Medicaid yet. It is also the track for an agency based in another state that wants to serve Wisconsin residents, because that agency’s Medicare certification is handled by its home state.⁠³ DQA advises applicants who want both licensure and Medicare certification to use one of the two simultaneous tracks rather than doing them one after the other.⁠³

The Medicare freeze and what it means for Wisconsin applicants

CMS imposed a nationwide six-month moratorium on Medicare enrollment of new home health agencies and new branches effective May 13, 2026. Only agencies whose enrollment application reached their Medicare Administrative Contractor before that date are excused. CMS can extend the moratorium in six-month increments.⁠¹⁰⁠¹² CMS told state survey agencies that during the moratorium, accreditation by a CMS-approved accrediting organization will not serve as the basis for Medicare certification.⁠¹¹ No extension notice appeared in the Federal Register as of October 12, 2026, so the initial term runs to November 13, 2026 unless CMS extends it.⁠¹⁰⁠¹²

Wisconsin law makes the freeze bite harder. DQA states that Medicare certification and a state license are both required for Medicaid certification. An agency cannot hold Medicaid home health certification without Medicare.⁠³ A new agency licensed during the freeze can therefore serve only private-pay, commercial insurance and other non-Medicare payers. The freeze does not block the state license itself, which comes from DQA, not CMS.⁠¹⁠³

Even without the freeze, Medicare and Medicaid pay nothing during the provisional period, because the agency is not yet certified. DQA says so directly on its application page.⁠³ Plan your cash for that period. The 90-day budget in your application is the state’s first check on it.⁠²

Who can run the agency

DHS 133.05 requires a governing body. It must adopt governing policies, adopt a statement of the services you will provide, oversee management, appoint an administrator, and provide a qualified substitute administrator for when the administrator is absent.⁠²

The administrator must be one of these:

• a licensed physician;
• a registered nurse; or
• a person with training and experience in health care administration and at least one year of supervisory or administrative experience in home health or related health programs.⁠²

The administrator must know DHS 133, administer all of the agency’s home health services, and cooperate with DQA investigations.⁠² You submit credentials showing that both the administrator and the substitute meet these requirements. The F-62674 application also names a nurse supervisor. It asks for a resume and, if applicable, a copy of the professional license for all three people, and asks whether the administrator runs any other health care provider.⁠³⁠⁴

The fit-and-qualified review

DQA first decides whether you are “fit and qualified.” The rule lists what it may consider:⁠²

• license denials, suspensions, injunctions or revocations of any health care agency or facility you were involved with, in any state;
• federal or state civil money penalties, provider-agreement terminations, payment suspensions or temporary management;
• convictions for patient or elder abuse or neglect, assaultive behavior, health care crimes or unlicensed practice, controlled substances, or sexual offenses;
• prior bankruptcies or closures of a health care operation;
• unsatisfied judgments, or debts at least 90 days past due.

The application form asks about any affiliation in the past five years with hospices, home health agencies, assisted living or other health care facilities. It also asks for parent-company, subsidiary and chain information, and for details of any management company.⁠⁴ Wisconsin also must deny or revoke a license if the Department of Revenue certifies delinquent state taxes, or if the Department of Workforce Development certifies unpaid unemployment insurance contributions.⁠¹

Building the application packet

The packet is the same on all three tracks, with one extra item on the accrediting-organization track: the acceptance letter. Send DQA:⁠³

1. Letter of intent

   A detailed description of the proposed agency.

2. Form F-62674

   The Wisconsin Home Health Agency License Application. It asks you to list the counties served by the parent office and by each branch, and whether each service (nursing, aide, PT, OT, speech-language pathology, medical social services) is provided directly, by contract or both. It also requires a list of every contractor, your official work week in hours, and every officer, director, member, partner and holder of 10% or more of the stock.⁠⁴

3. Administrator and substitute credentials

   Showing they meet DHS 133.06.

4. $300 application fee

   Paid by check to the Division of Quality Assurance. The fee is nonrefundable.⁠²⁠³

5. Background checks

   Completed online through the DHS Background Check Program, at $15 per individual (as published on 2026-10-12).⁠³

6. Organizational chart

   Including any other entities the proposed agency owns.

7. 90-day operating budget

   Built on the Model Balance Sheet, F-62674A. DHS 133.03(3)(e) requires proof that you can operate for at least 90 days.⁠²

8. Financial references

   Showing you can keep operating through the provisional period, such as a bank reference letter, bank statements, stock ownership or other income. The form says to include at least one bank and no relatives.⁠³⁠⁴

9. IRS EIN letter and organizational documents

   Articles of incorporation for a corporation, articles of organization and operating agreement for an LLC, or the partnership agreement for an LLP.⁠³

10. Policies and procedures with checklist F-62536

    Number every page and record the page numbers in the comments column of the checklist. The policies must also show compliance with ch. DHS 13 on caregiver misconduct reporting, using Chapter 6 of the Wisconsin Caregiver Program Manual, P-00038.⁠³

On the accrediting-organization track you also send the organization a copy of your F-62674, plus the F-62536 checklist and policies.⁠³ DQA accepts fee checks by mail. You can email or mail the other materials to the Licensing, Certification and CLIA Section, 201 E. Washington Ave., Room E300, Madison, WI 53703.⁠³

What your policies must cover

DQA’s registered nurse reviewer reads your policies against DHS 133. The rule requires, among other things, the following.

Services. You must provide, directly or by arrangement, at least part-time or intermittent nursing and home health aide services. Physical therapy, speech therapy, occupational therapy and medical social services are optional.⁠² Every contracted health care service needs a written contract, and contractors must meet the same qualifications as staff.⁠²

Nursing. Skilled nursing is provided by or under the supervision of an RN. The RN makes the initial evaluation visit, starts and revises the plan of care, and coordinates all services to the patient. Contracted RNs may only work in non-supervisory nursing assignments.⁠²

Plans of care. You develop an initial plan within 72 hours of accepting a patient. The physician, advanced practice nurse prescriber or physician assistant must sign the full plan within 20 working days of admission. It must be reviewed at least every 60 days.⁠²

Aides and supervision.

• A home health aide must be listed on the state registry.⁠²
• Aides must have completed training in nine subjects set out in DHS 133.17(4). If your agency provides the training, an RN must direct it.⁠²
• An RN assigns aides to patients and updates their written care instructions at least every 60 days.⁠²
• For patients receiving skilled nursing, an RN makes a supervisory visit at least every 2 weeks.⁠²
• For aide-only patients, an RN makes a supervisory visit at least every 60 days.⁠²

Personnel. You need written personnel policies, reviewed every year, covering recruitment, orientation, continuing training and staff evaluation.⁠² Every employee is oriented before beginning patient care.⁠² Within the 90 days before their first direct patient contact, a physician, physician assistant or RN must certify in writing that each new employee has been screened for tuberculosis and clinically apparent communicable disease.⁠² You must follow the caregiver background check rules in Wis. Stat. § 50.065 and ch. DHS 12, and the misconduct reporting rules in ch. DHS 13. You also need an infection control training program based on CDC recommendations.⁠²

Patients and records.

• If you discharge a patient for nonpayment, or because you can no longer meet a non-emergency change in their needs, you must give written notice at least 10 working days ahead.⁠²
• Discharge summaries are due within 30 calendar days.⁠²
• Medical records must be kept at least 5 years after discharge.⁠²
• Staff and consumers must evaluate the agency’s total program at least once a year, including a review of a sample of patient records.⁠²

DQA publishes the worksheets its surveyors use, and recommends them for self-review before the survey: Rights of HHA Patients (F-62601), the Contract Review Worksheet (F-62657) and the Program Evaluation Review Worksheet (F-62658).⁠³

From provisional license to regular license

1. DQA reviews the packet

   On the state tracks, DQA does the fit-and-qualified review first, then an RN reviews your policies. On the state-agency track DQA says it has up to 90 days to review the materials, including a detailed review of your policies.⁠³ The rule likewise gives DQA 90 days after a complete application to approve, deny or issue a provisional license.⁠² On the accrediting-organization track, a clean fit-and-qualified review produces a DQA letter. That letter prompts the accreditor to do a provisional licensure survey, and the provisional license follows.⁠³

2. Operate under the provisional license

   The provisional license runs 90 days. DQA can renew it on your written request, up to one year from the original issue date. The statute caps provisional licenses at one year.⁠¹⁠² You may serve clients during this time.⁠³

3. Build the patient census

   You must actively serve at least 10 Wisconsin patients who need skilled nursing or other therapeutic services. At least 7 of the 10 must be actively receiving skilled nursing when you request the survey.⁠²

4. Request the survey

   Send a letter with 10 patient care plans to DQA, or to your accrediting organization. This triggers an unannounced on-site survey against DHS 133. On the simultaneous tracks, the survey also covers the Medicare Conditions of Participation in 42 CFR Part 484.⁠³⁠¹³ At least 3 patients must be receiving skilled nursing on the survey day.⁠²

5. Correct deficiencies

   You have 10 working days after receiving a statement of deficiency to submit a plan of correction, or less if DQA decides a violation may harm patients.⁠²

6. Regular license

   After the survey and any corrections, DQA issues the regular license.⁠³ On the simultaneous tracks, during the provisional period you also file the CMS-855 Medicare enrollment application with National Government Services (Wisconsin’s Medicare contractor). You send DQA the signed CMS-1561 Health Insurance Benefits Agreement and the Office for Civil Rights assurance-of-compliance confirmation. DQA can then recommend certification, but CMS makes the final decision and issues the Medicare number.⁠³ As of October 12, 2026, the moratorium described above stops that last step for new agencies.⁠¹⁰⁠¹¹

The one-year cap is fixed in statute. If you cannot reach 10 skilled patients within a year of your provisional license, Wis. Stat. § 50.49(10) does not allow a longer provisional license.⁠¹

Fees after you open

The rule charges no separate fee for the first regular license of an agency that never had a provisional license.⁠² After the initial regular license, the next charge is the annual continuing fee. It is 0.25% of patient fee revenue, with a minimum of $500 and a maximum of $2,500 (as published on 2026-10-12).⁠² Patient fee revenue means gross patient revenue minus three things: contractual adjustments from Medicaid, Medicare, other federal payers and third-party payers; bad debts from private-pay clients; and charitable contributions.⁠²

You pay the fee with the annual report, due every 12 months on DQA’s schedule. If the report is late, DQA issues a warning. If a complete report has not arrived within 60 days after the due date, DQA may revoke the license.⁠¹⁠²

Keeping the license

The regular license has no expiration date. It stays valid until it is suspended, revoked or surrendered.⁠² It belongs only to the agency named on it and cannot be transferred or assigned.⁠¹

• Changes needing written notice within 10 days: any change in the services you provide, and any appointment or change of administrator.⁠²
• Changes needing contact with DQA: name, address, accreditation status, change of ownership (CHOW) and changes to ownership information.⁠³
• Changes needing a new application within 10 working days: transfer of 50% or more of the stock or assets, a change of 50% or more in partnership interests, or giving up management of the agency.⁠²

DQA may inspect and investigate at any time, review a sample of private-pay records, and pick patients to visit with their approval.⁠¹⁠² If DQA takes enforcement action and then returns for an on-site inspection of your correction, it may charge a $200 inspection fee.⁠¹ Refusing an inspection is grounds for denial or revocation.⁠² Penalties for violations include:⁠²

• suspension of new admissions;
• conditions on the license;
• revocation.

You can appeal a denial, revocation, an imposed plan of correction or a penalty. To do so, file a written hearing request with the Division of Hearings and Appeals within 10 days of receiving notice.⁠² You can also apply to DQA for a waiver or variance from any DHS 133 provision. DQA may grant one if it finds patient health, safety and welfare will not be harmed.⁠²

Two reporting duties apply from day one. Any fire in a licensed Wisconsin facility must be reported to DHS within 72 hours on form F-62500.⁠⁷ Medicaid-covered home health visits have required electronic visit verification since January 1, 2023.⁠⁶

Recent rule changes

Clearinghouse Rule CR 25-055 took effect March 1, 2026.⁠⁹ For home health agencies it repealed DHS 133.05(2), renumbered the governance rule into a five-item list, and amended the annual program evaluation rule in DHS 133.07(1).⁠² The statute’s requirement that a professional group including a physician and an RN set service policies is unchanged.⁠¹ Use DHS 133 as amended effective March 1, 2026, when drafting policies. The F-62674 application form (08/2023 edition) still cites the substitute administrator requirement as DHS 133.05(1)(e), the number it had before the 2026 renumbering. The same requirement is now DHS 133.05(5).⁠²⁠⁴

If you are planning a residential setting rather than in-home services, Wisconsin licenses those separately. See the adult family home license for 3-4 bed homes and the community-based residential facility license for 5 or more residents. Other states’ home health rules are compared under home health licensing.

Sources

1. 1
   Wisconsin State Legislature, Wis. Stat. § 50.49, Licensing and regulation of home health agencies Checked 12 Oct 2026 · Back to text ↑
2. 2
   Wisconsin State Legislature, Wis. Admin. Code ch. DHS 133, Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
3. 3
   Wisconsin Department of Health Services, Home Health Agencies: Application for State Licensure and Federal Certification Checked 12 Oct 2026 · Back to text ↑
4. 4
   Wisconsin Department of Health Services, Wisconsin Home Health Agency License Application, F-62674 (08/2023) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Wisconsin Department of Health Services, Defining "Skilled Care" for Wisconsin Home Health Agency (HHA) Licensure, P-01212 Checked 12 Oct 2026 · Back to text ↑
6. 6
   Wisconsin Department of Health Services, Home Health Agency: Rules and Regulations Checked 12 Oct 2026 · Back to text ↑
7. 7
   Wisconsin Department of Health Services, Home Health Agency: Home Checked 12 Oct 2026 · Back to text ↑
8. 8
   Wisconsin Department of Health Services, Personal Care Agencies: Application Checked 12 Oct 2026 · Back to text ↑
9. 9
   Wisconsin State Legislature, Clearinghouse Rule CR 25-055 Checked 12 Oct 2026 · Back to text ↑
10. 10
    Federal Register (CMS), Announcement of Nationwide Temporary Moratoria on Enrollment of New Home Health Agencies and Hospices Checked 12 Oct 2026 · Back to text ↑
11. 11
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA/Hospice: Moratoria on Enrollment of New HHAs and Hospices Checked 12 Oct 2026 · Back to text ↑
12. 12
    Centers for Medicare & Medicaid Services, Provider Enrollment Moratoria Checked 12 Oct 2026 · Back to text ↑
13. 13
    eCFR (National Archives), 42 CFR Part 484, Home Health Services Checked 12 Oct 2026 · Back to text ↑

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