1. Program Definition and Services

Respite Care Services in Wisconsin provide short-term, intermittent relief to primary family caregivers of individuals with chronic conditions or disabilities. Services are delivered in the client's home or community across two approaches:

• Hourly & Intermittent Respite: Brief supervision, companion care, and ADL assistance to cover daily caregiver obligations
• Overnight & Multi-Day Respite: Continuous, multi-day support managing medication reminders, behavioral redirection, and physical safety monitoring

2. Regulations

• Wisconsin Administrative Code DHS 105: Dictates Medicaid waiver provider certification and standards
• Wisconsin Caregiver Law: Defines health, safety, and background validation parameters for all direct-care personnel

3. Licensing or Certification

Entities do not require an independent medical facility license for home-based lines of business. However, they must obtain formal Waiver Provider Approval via the CLTS Provider Registry or regional MCO/IRIS networks. Residential-based overnight respite requires specialized facility licensure ( AFH or CBRF).

4. Responsible State Agencies

• Wisconsin Department of Health Services (DHS): Directs state Medicaid waiver policies and facility licensing
• MCOs & IRIS Consultant Agencies (ICAs): Manage local contracting, perform clinical assessments, and issue individual service authorizations
• ForwardHealth: Serves as the state Medicaid fiscal clearinghouse, controlling provider credential verification and billing processing

5. Application Process

Applicants complete corporate registration through the Department of Financial Institutions (DFI) and apply to the targeted waiver network (MCO, IRIS, or CLTS registry). Upon clearing programmatic credential checks, the provider links their profile to the ForwardHealth portal to activate electronic billing.

6. Required Documentation

• DFI business registration certificate and an organizational Type 2 NPI mapped to a respite or home care taxonomy
• ForwardHealth and waiver-specific provider enrollment approval agreements
• Operational Policy Manual covering intake, medication reminder constraints, emergency response, and backup staffing
• Background Information Disclosure (BID) forms and cleared background checks from the Wisconsin Online Record Check System (WORCS) for all workers
• Valid CPR/First Aid certifications and proof of commercial general liability insurance

7. Timeline for Approval

Corporate formation, insurance tracking, and NPI configuration takes 2 to 4 weeks. Personnel recruitment, WORCS background screening, and local MCO/CLTS registry onboarding requires 4 to 8 weeks.

8. Pre-Application Process

Prospective providers must finalize their business foundation before submitting files for state authorization. This requires legally incorporating via the DFI, activating state tax accounts, and obtaining a Federal Employer Identification Number (EIN).

9. Pre-Application Training

While founders do not attend an extended state academy, all Direct Support Professionals (DSPs) must clear onboarding modules within 60 days of hire. Training covers HIPAA rules, emergency protocols, documentation logs, and mandatory abuse reporting under the Wisconsin Caregiver Law.

10. Additional Notes

• Any staff member with a disqualifying history inside the WORCS portal is immediately barred from client contact under the Wisconsin Caregiver Law
• Non-medical respite workers are strictly restricted to verbal medication reminders; active pouring or handling of medications is prohibited without nurse delegation
• Respite service volume is strictly governed by pre-set hourly or daily maximum allocations mapped inside the participant's electronic budget file

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

To get started, click the link to request portal access.