New Provider Enrollment System for Adult Long-term Care

The Wisconsin Department of Health Services (DHS) is creating a centralized provider enrollment system for adult long-term care (LTC) waiver service providers. This centralized technology system will allow providers to submit all information necessary to become a certified Medicaid provider through the ForwardHealth Portal.

This new provider enrollment system will:

• Comply with federal requirements.
• Standardize, streamline, and automate the Medicaid enrollment process for adult LTC waiver service providers.

Most adult LTC waiver service providers, including organizations/agencies, sole proprietors, and individuals, who are not self-directed service or participant-hired workers, will use the new provider enrollment system in the future. Individual self-directed service and participant-hired workers will continue to enroll using current processes.

DHS will notify providers of any deadlines in advance and will share more information about the timeline as it becomes available.

Impacted Programs

• Family Care
• Family Care Partnership
• Program of All-Inclusive Care for the Elderly (PACE)
• IRIS (Include, Respect, I Self-Direct)

Impacted Providers and Entities

• Organizations/agencies
• Sole proprietors
• Individuals who are not self-directed service or participant-hired workers
• Self-directed support workers*
• Participant-hired workers*
• Managed care organizations (MCOs)
• Fiscal employer agents (FEAs)
• IRIS consultant agencies
• Self-directed personal care agency

* Individual self-directed support and participant-hired workers will continue to work with the MCOs and FEAs to complete Medicaid enrollment. This page will be updated with more information about impacts to these groups when it is available.

Benefits

The new provider enrollment system will increase the efficiency of provider enrollment activities and information through:

• Automation and centralization.
  • Provider enrollment, credentialing, demographic maintenance, and revalidation processes will be automated and centralized, where possible.
  • Enrollment processes will be aligned with those for state plan service providers.
  • The provider enrollment system will guide providers through the enrollment process, reducing the risk of errors.
  • Providers will submit information once per location or service type while enrolling, and the provider enrollment system will automate data entry, where possible.
  • There will be a reduction in duplicative activities for providers enrolling with multiple MCOs, FEAs, and/or programs.
• Standardized provider vetting.
  • All providers will go through standard vetting activities applicable for their type, specialty, and service combination.
  • Vetting activities involve ensuring the provider has all the necessary qualifications, as required by the waivers, to provide that service.
  • DHS will perform screening processes, thus streamlining the contracting and onboarding process with MCOs and FEAs.
• Improved data management and reporting.
  • DHS will have access to provider demographic information, which is critical for timely and accurate program evaluation and reporting.
  • DHS will develop a directory of Medicaid-certified providers for the use of the public, MCOs, and FEAs.

Questions & Answers

DHS will publish Q&A on this page for providers and other interested parties throughout the project.

DHS welcomes additional questions and feedback. Providers may email LTCProviderEnrollment@wisconsin.gov.