Wisconsin Personal Care Agency (PCA)
Application and Certification Processes
This application process is for any individual, tribe,
county department, or independent living center intending to provide only
personal care services as a free-standing agency, to individuals in their
place of residence. Personal care services includes assistance with
activities of daily living such as bathing, dressing, ambulating, or eating, or
accompanying a client to a medical appointment.
Please review the state rules
and regulations for PCAs before pursuing this
Do not complete a PCA application if
the intent is to provide skilled nursing and other therapeutic services to
clients in their personal residence. Review
DHS 133 (exit DHS) for home health agency
requirements if the intent is to provide skilled care, or if uncertain which
type of agency is desired.
In Wisconsin, PCAs have a two-stage application
Complete the steps to obtain a provisional certification from the
Division of Quality Assurance (DQA);
Complete the steps to obtain Medicaid certification from ForwardHealth.
Stage I: Obtain Provisional Certification
Consists of several steps (explained in greater detail below)
to obtain a provisional certification:
View the PCA online training modules prior to beginning the
application process. This step will help clarify regulatory information
to assist the applicant in being certain about proceeding.
The Application Review Process: Request and complete an
application; pay fees and submit the required documentation that
demonstrates the applicant's preparedness to operate the agency; and ability
to comply with Wisconsin PCA certification rules and regulations. This review
process consists of two separate reviews to obtain a provisional
Once a provisional certification is granted, agency operations can
begin. The newly established PCA may begin admitting and caring for patients, and preparing for an onsite
Step A – Training Modules
Potential new personal care providers are encouraged to review the
training prior to beginning the application process. The training modules are
designed for all potential new PCAs, and are an excellent
tool for self-assessment. Viewing the modules will assist in gauging your
resources and personal readiness for pursuing an application and ultimately
succeeding in operations.
Step B – Application Review Process
All parties desiring to open a new free-standing PCA are required to complete an application,
pay fees and submit supporting documentation in the form of policies and
procedures that will demonstrate compliance with WI Administrative Rules before a provisional certification is granted.
Begin by contacting the DQA PCA Specialist for an application at
(608)-266-2702. The Specialist will provide a list of documents and fees
that must be submitted to DQA for review.
- The first review determines whether an applicant is fit and
qualified [DHS 105.17(1)(e)
(exit DHS)]. This review includes an analysis of a variety of
factors including financial solvency (including bankruptcy), personnel
qualifications, criminal background clearance, and history of operating
other health-related agencies in Wisconsin or other states, and payment of
required fees. The following items, along with additional items
identified in the application and letter from the PCA Specialist must be
A complete application.
Demonstrate compliance with the
Entity Caregiver Background Check process.
Demonstrate compliance with WI Administrative Rule
DHS 105.17 (exit
DHS) which describes requirements for fit and qualified.
Submit requested non-refundable
application fees: $300 application/certification fee, plus $10 per
caregiver background check.
Via submission of agency policies and procedures, demonstrate
compliance with WI Administrative Rule DHS 13: Investigation &
Reporting of Caregiver Misconduct. Refer to Chapter 6 of the
Wisconsin Caregiver Program Manual (PDF, 197 KB).
- Following a determination that the applicant has met the fit and
qualified criteria, a second review will be completed by a registered
nurse (RN) who reviews the applicant’s policies and procedures to
determine whether they meet Administrative Rule requirements of
DHS 105.17 (exit
DHS). The RN will consult with the applicant during this review if
After both reviews have been completed, and a determination is made that the
applicant satisfies all requirements, the provider’s application
will be submitted to ForwardHealth along with a recommendation for
Step C - Agency Operations Begin
An agency may begin operations following issuance of the provisional
certification for a term of up to one year. Within 90 days before its
provisional certification expires, the provisionally certified agency shall submit a written request
to the DQA for an onsite survey. This onsite survey is used to evaluate
the level of care being provided to patients. The onsite survey consists of
a review of patient care, review of client records and documentation,
interviews with staff, and observation of cares being given in the home
setting. An onsite survey will only be conducted when the agency can
demonstrate they meet the following criteria:
Admitted and cared for at least five personal care clients, and
Retains two or more clients at the time the agency submits their
written request for an onsite survey.
Failure to meet these requirements by the expiration of the provisional
certification period may result in denial of Medicaid certification.
An agency may find the forms, located on the
Information for Providers web page, useful in conducting a
self-evaluation of compliance with WI Administrative Rule requirements.
These are the same compliance review tools used by surveyors during the onsite survey process.
When the applicant can demonstrate readiness for their onsite survey,
send a written request for survey to:
Department of Health Services
Division of Quality Assurance
Attn: PCA Certification Specialist
PO Box 2969
Madison, WI 53701-2969
Stage II: Obtain Medicaid Certification
To obtain Medicaid certification, an applicant must apply separately to the
within the Division of Health Care Access and Accountability (DHCAA), may
approve the application and issue a Medicaid certification number or deny
the application. ForwardHealth will contact the applicant regarding their
determination and issuing of a Medicaid certification number.
August 12, 2014