Provider Enrollment and Ongoing Responsibilities : Ongoing Responsibilities

Requirements for Home Health and Personal Care Agencies to Report Personnel Information to ForwardHealth

ForwardHealth has implemented requirements for home health and personal care agencies to report personnel information to ensure appropriate licensing and to prevent waste, fraud, and abuse.

Reporting Requirements for Providers Enrolling in Wisconsin Medicaid

ForwardHealth requires home health agencies and personal care agencies, including out-of-state and border status providers, enrolling in Wisconsin Medicaid to report specific information regarding the following personnel who are employed by, contracted by, or employed by an agency under contract with the home health and personal care agency:

• LPNs
• RNs
• SLPs
• OTs
• OT assistants
• PTs
• PT assistants
• Home health aides
• Personal care workers

Home health and personal care agencies are required to report information on the personnel listed above, even if the employee or contractor is also a separately enrolled Medicaid provider. Medicaid-enrolled home health and personal care agencies will have to report the following information to ForwardHealth:

• First name, middle initial, and last name
• DOB
• SSN
• Employment effective date
• Employment end date (when applicable)
• License information (not required for home health aides or personal care workers)

Note: Providing personnel SSNs is voluntary; however, any person employed by, contracted by, or employed by an agency under contract with a Wisconsin Medicaid home health and/or personal care agency who provides home health and/or personal care services to members is required to supply a valid SSN in order for Wisconsin Medicaid to conduct screenings via the following databases:

• The SSA's Death Master File
• OIG LEIE
• The EPLS

When applicable, Wisconsin Medicaid will also conduct license verification. ForwardHealth is prohibited by law from reimbursing for services provided by anyone who is included on the SSA Death Master File, the OIG LEIE, or the EPLS for services provided by an unlicensed practitioner.

Services provided by home health agency and personal care agency workers whose SSN are not on file with ForwardHealth or by workers who do not pass the screening process are not reimbursable.

Personnel Screening During New Enrollment

When completing the Medicaid enrollment process for the first time, home health and personal care agencies will be required to enter their workers' information for screening. After entering a worker's information, the provider will see a pass status on the Portal panel if the screening was successfully completed. In addition, the worker's name and status will be included on the enrollment report that the agency will be instructed to print after completing the enrollment process.

If there is any discrepancy or problem during the screening, the worker will not appear in the list, and the information will be automatically forwarded to ForwardHealth for manual review. If the worker does not pass the screening, a letter will be mailed to the agency indicating the name of the worker and information regarding why the worker did not pass the screening.

Updating Personnel Information via the Demographic Maintenance Tool

Once enrolled in Wisconsin Medicaid, home health and personal care agencies, including out-of-state and border status providers, are required to report and maintain personnel information using the demographic maintenance tool. Each agency is responsible for designating agency personnel to update and maintain personnel information.

Note: In order to protect the individual's personal information, the SSN and DOB will not display after the first time the information is entered into the demographic maintenance tool fields.

ForwardHealth requires home health agencies and personal care agencies to report personnel information for any of the following qualifying events:

• The person becomes an employee of the enrolled Medicaid provider.
• The contract agency begins its contract with the enrolled Medicaid provider.
• A person begins employment with the contract agency.
• A person begins their contract with the enrolled Medicaid provider.

If a worker passes the screening, their name will appear in the list of workers panel, and the agency will receive a message that the worker passed the screening.

If there is any discrepancy or problem during the screening, the worker's name will not appear in the list, and the information will be automatically forwarded to ForwardHealth for manual review. If the worker passes the manual screening, their name will appear in the list within 10 business days. If the worker does not pass the screening, a letter will be mailed to the agency indicating the name of the worker and information regarding why the worker did not pass the screening.

Home health agencies and personal care agencies may submit claims for services beginning on the date the personnel information was reported to ForwardHealth only for services provided by persons who passed the screening on or before the DOS.

If the person does not pass the screening, the home health or personal care agency may not submit claims for services provided by that person to Wisconsin Medicaid or BadgerCare Plus members.

An agency should report the employment end date immediately after an employee resigns or the agency or contract agency terminates the employee.