The Division of Quality Assurance (DQA) in the Department of Health Services (DHS) serves the frail elderly, persons with developmental disabilities, mental illness, physical disabilities, sensory disabilities, and persons with substance abuse problems.
Regulation of facilities primarily serving adults is the responsibility of DQA. DQA is responsible for administering Wis. Admin. ch. DHS 83 as required by Wis. Stat. ch. 50, which governs licensure of a community-based residential care facility (CBRF).
DQA does not refer residents for placement in assisted living facilities nor does the DQA provide funding to facilities to care for residents. Residents may be eligible to receive waiver funding through county Departments of Health or Human Services or Family Care Managed Care Organization. For more information regarding funding for residents in assisted living, please visit the following websites:
"Community-based residential facility" means a place where 5 or more adults who are not related to the operator or administrator and who do not require care above intermediate level nursing care reside and receive care, treatment or services that are above the level of room and board but that include no more than 3 hours of nursing care per week per resident. (See Wis. Stat. § 50.01(1g)).
In an effort to ensure the Bureau of Assisted Living (BAL) is utilizing resources effectively, the Bureau conducted a systems analysis of the initial application process for community-based residential facilities (CBRFs), 3-4 bed adult family homes (AFHs), residential care apartment complexes (RCACs), and adult day care center providers.
Subsequent to the analysis, BAL determined that revision of the application materials and processes for the above provider types was needed to increase the efficiency of the licensing/certification/registration process.
Effective July 17, 2017, assisted living applicants will utilize the revised application materials and processes for any initial license/certification/registration or change of ownership.
Review DQA Revised Licensing, Certification, and Registration Licensing Information, P-01854 (PDF) for additional information.
Established Provider: A provider who previously or currently operates the facility type for which an application for licensure or certification is being made.
New Provider: A provider who has never held a license or certification for the facility type for which an application for licensure or certification is currently being made.
Attestation Prior to Onsite: BAL will require every applicant to complete an applicant compliance statement prior to scheduling an onsite licensing survey.
Fit and Qualified Application: Applicants will submit a completed fit and qualified application with the application.
Inactive Application: Applications not completed within six months of submission will be closed out.
Incomplete Application: If the application does not include the required documents, the application packet will be returned to the applicant without further processing. BAL will include a checklist identifying the missing item(s). The applicant may choose to resubmit the application with the required documentation. After a second unsuccessful submission, no further applications will be accepted from this applicant for the specified location for a period of one year.
Two Revisions: An application is not considered complete until all required documentation that meets regulations have been submitted. If the required documents do not meet the licensing/certification regulations, BAL will only send two revision letters per application. After a second unsuccessful revision, no further applications will be accepted from this applicant for the specified location for a period of one year.
Prior to Applying for a License
Review Wis. Admin. Code ch. DHS 83.
View the "Opening and Operating a Community-Based Residential Facility", which is a 2-part webcast and is required viewing if you are a new CBRF provider:
- Print the Opening and Operating a Community-Based Residential Facility Speaker Slides prior to viewing the webcast:
Part 1 speaker slides (PDF)
Part 2 speaker slides (PDF)
- After viewing both Parts 1 and 2 of the webcast, print and sign the Verification of Completion – CBRF Webcast that is displayed on a slide at the end of Part 2. This Verification of Completion must be submitted with your application materials for licensure.
All CBRFs, regardless of size, shall have a plan submittal (1) prepared by a design professional, (2) submitted to DHS, and (3) reviewed prior to construction. Existing structures seeking CBRF licensure shall also have completed the plan review process prior to licensure. If an existing CBRF is being considered for purchase, it is important to note that there is no transfer of licensure. Additional information regarding plan review is available on the DHS Plan Review website.
An initial licensing process is used for first time licensee applicants. A complete application is necessary to begin the process. Wis. Admin. Code § DHS 83.05(2) identifies the required content of a complete application.
When the Department determines that the application is complete, an onsite licensing visit will be scheduled. The Department has 70 days to approve or deny a license.
This 70 days for processing begins after a complete license application packet is received and the department completes the onsite survey.
The following license application information must be submitted:
- Signed Established Provider Licensure Application, F-02109A (Word) or a New Provider Licensure Application, F-02109C (Word)
- Fit and Qualified Application, F-02111 (Word)
- Documents listed in section A of the Established Provider Licensure Application Checklist, F-02109B (Word) or New Provider Licensure Application Checklist, F-02109D (Word)
- License fee
Applications not completed within six months of submission will be closed out.
If the application does not include the required documents, the application packet will be returned to the applicant without further processing. BAL will include a checklist identifying what item(s) are missing. The applicant may choose to resubmit the application with the required documentation. After a second unsuccessful submission, no further applications will be accepted from this applicant for a period of one year from the date the application was received.
Once the application is deemed complete, the BAL central licensing unit will send an Applicant Compliance Statement, F-02109 (Word) to the applicant. When the applicant is ready for an onsite inspection, the applicant will return the completed compliance statement to central licensing and an assisted living surveyor will be assigned.
Caregiver Background Checks
Caregiver background checks must be completed at a minimum of every four years.
- The Caregiver Background Check Process website includes information on Wisconsin Administrative Codes Chapter DHS 12 Caregiver Background Checks; Chapter DHS 13 Reporting and Investigation of Caregiver Misconduct; copies of forms and answers to frequently asked questions.
The Department will complete caregiver background checks on the following persons prior to initial licensure and every four years thereafter:
1) Non-government entities
The owner of the entity, whether or not the person has regular, direct contact with clients.
If the owner is a corporation or other type of business that does not have a single owner, then the organization may designate one principal officer to legally represent the organization for the purposes of fulfilling the background check requirement. For new applicants, the individual who signs the application fulfills this requirement.
Principal officers, corporation or board members of the business organization, who have regular, direct contact with clients.
- Non-client residents (over age 10) of the entity who have regular, direct contact with clients.
2) Government and tribal entities
An individual, e.g. the entity administrator designated by the government agency or tribe who operates the entity, whether or not the person has regular, direct contact with clients.
Non-client residents (over age 10) of the entity who have regular, direct contact with clients.
New applicants for licensure must submit a Background Information Disclosure (BID) form and BID Appendix form for each individual as described above, following the Caregiver Background Check Process.
The entity must complete a caregiver background check on all caregivers. A caregiver is a person who is all of the following:
- Employed by or under contract with an entity;
- Has regular, direct contact with the entity's clients or the personal property of the clients; and is under the entity's control.
"Direct contact" is defined as face-to-face physical proximity to a client that affords the opportunity to commit abuse or neglect or misappropriation of a clients property.
A completed caregiver background check consists of:
A completed Background Information Disclosure (BID);
Response from the entity's inquiry to the Department of Justice; and
The letter from DHS containing information regarding any government findings of misconduct or credential limitations.
Copies of background checks for anyone covered under this rule must be available for review upon Department request.
A licensing fee of $389.00 + $50.25 per resident based on capacity of facility is charged every two years. The fee for the twelve-month probationary license is 1/2 this amount. The fee is submitted with the application and made payable to "DQA."
Initial application fees and/or license/certification continuation fees are NON-REFUNDABLE.
Exception: community-based residential facilities where the total monthly charges for each resident do not exceed the monthly state supplemental payment rate under s. 49.77(3s) are exempt from the licensing fee.
Return the application, other materials and checks to:
Division of Quality Assurance
Attn: Licensing Associates
P.O. Box 7940
Madison, WI 53707-7940
Address any questions to the Licensing Associates at DHSDQABALLicensing@dhs.wisconsin.gov or 608-266-8482.
Licensing Process Seminar
Essential Steps to the Assisted Living Licensing Process
The Bureau of Assisted Living (BAL), Southeastern Regional Office and licensing staff are pleased to announce a free informational seminar for potential CBRF and adult family home (AFH) providers in the Milwaukee area. Seminar participants will learn:
- How to navigate the DHS website (www.dhs.wisconsin.gov).
- Information about Wis. Stat. ch. 50, Wis. Admin. Code chs. DHS 83 and 88, and other regulations that impact assisted living facilities.
- An understanding of the complete community-based residential facility and adult family home initial application process.
If you plan on starting an AFH or CBRF, please plan on attending. There is no cost for the seminar.
The seminar will be offered on two dates:
- Tuesday, June 20, 2017 (1 p.m. – 4 p.m.) - Full
- Tuesday, August 22, 2017 (1 p.m. – 4 p.m.) - Full
Space is limited. Please register by calling 414-227-2005. Seminar location will be provided upon registration.
2017 Initial Licensing Webinar Schedule
The Bureau of Assisted Living (BAL) is pleased to announce informational webinars to provide information about what prospective providers must know when starting a CBRF or adult family home (AFH).
These interactive webinars will be conducted utilizing Adobe Connect Pro software. Adobe Connect software is a web conferencing product that allows users to conduct live meetings and presentations over the Internet. For information on required software you will need in order to attend an Adobe Connect Meeting and how to test your computer prior to attending the webinar, refer to the Adobe Connect Meeting Technical Information (PDF).
Webinar participants will learn:
- How to submit a licensure application.
- Considerations in choosing a building.
- Policies and procedures – why they are important and how to use them.
- Key elements of AFH/CBRF operations: program statement, individual service plans, medications and more.
Please use the following link to join the Adobe Connect Webinar: https://connect.wisconsin.gov/initiallicensingwebinar and print the BAL-CBRF licensing slides (PDF, 4 MB) prior to participating in the webinar.
|Webinar Date||Time||Provider Type|
|July 10, 2017||9:00 a.m. – 10:30 a.m.||CBRF|
|1:00 p.m. – 2:30 p.m.||AFH|
|October 9, 2017||9:00 a.m. – 10:30 a.m.||CBRF|
|1:00 p.m. – 2:30 p.m.||AFH|