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Wisconsin Medicaid PA/HHTA F-11044: Home Health Therapy

Wisconsin Medicaid requires this attachment with the PA/RF when home health physical therapy, occupational therapy or speech and language pathology needs prior authorization. The 08/2026 revision is two pages. It identifies the disciplines requested, whether the request is initial, a renewal or a restart after a break, and the home health therapy the member already received for the current diagnosis.

Who completes it

The home health therapist completes it with the ordering physician, naming each therapist and their credentials in Section I. Section III records the requesting provider and the name, email address and signature of the person who filled out the form.

Submitting and payment

How to submit it
Attach it to the PA/RF and submit it to ForwardHealth through the Portal, by fax or by mail; the form points to the ForwardHealth Online Handbook for PA submission instructions.

Good to know

  • Section I has separate checkboxes for physical therapy, occupational therapy and speech and language pathology, each with its own line for the therapist's name and credentials.
  • Element 5 distinguishes an initial request, a renewal for a continuous plan of care, and a subsequent request when care starts again after a break.
  • Element 6 lists prior home health PT, OT and SLP for the current diagnosis with dates, frequency and duration, and a brief description. Exclude therapy in other settings or for other diagnoses.
  • Related forms include F-11008, the PA/Therapy Attachment used for outpatient therapy, and F-11041, the private duty nursing PA acknowledgement. The form cites Wis. Admin. Code DHS 107.11(3).

Get the official form

Download the current version from the source each time; forms change without notice.

Prior Authorization/Home Health Therapy Attachment (PA/HHTA)

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Does the PA/HHTA need a physician signature?

The 08/2026 version has no separate physician signature line. Section III records the requesting provider's name and the name, email address, signature and date of the person who filled out the form. The home health therapist completes the attachment with input from the ordering physician.

What is a subsequent request on the PA/HHTA?

Element 5 offers three reasons for a request. An initial request starts home health therapy, a renewal continues an existing plan of care without a gap, and a subsequent request starts care again after a break. The prior-therapy table in Element 6 then shows what the member already received.

Is the PA/HHTA used for outpatient therapy?

No. The PA/HHTA covers home health physical, occupational and speech therapy. Outpatient therapy prior authorization uses the separate PA/Therapy Attachment, F-11008. Both are listed among the attachments that accompany a PA/RF cover form.