Wisconsin Personal Care Agency (PCA) Application and Certification Process

The personal care agency (PCA) 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 application process. For questions regarding PCAs, or to obtain an application, you may email the Division of Quality Assurance (DQA).

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 Wis. Admin. Code ch. DHS 133  for home health agency requirements if the intent is to provide skilled care, or if uncertain which type of agency is desired.

Reporting Agency Changes

If your existing PCA is undergoing name, address, administrator, change of ownership (CHOW), or change of ownership information (CHOI) you must contact DQA. You may contact a licensing specialist directly at 608-266-2702 or email DQA.

Change of Ownership – If operation of the PCA is later transferred to another owner, ownership group, or to a lessee, the Health Insurance Benefits Agreement will be transferred.

  • You are required to notify the DQA at the time you are planning a change of ownership transfer as your license is non-transferable. DQA will provide instructions regarding the CHOW process.

Application Process

To become a Medicaid certified PCA there are two separate application processes. One for the PCA and the other for Medicaid. Each process is described in the appropriately labeled tabs below.

State Certification
Application Process

It is recommended that applicants view the PCA online training modules 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 gaging your resources and personal readiness for pursuing an application and ultimately succeeding in operations.

The issuance of a certificate to operate a PCA in the state of Wisconsin is not part of the Medicaid provider enrollment process and therefore will not automatically assure certification in the Medicaid program.

Provisional Certification

As a personal care agency applicant, you are required to complete an application, pay fees and submit supporting documentation in the form of policies and procedures that will demonstrate your compliance with Wis. Admin. Code § DHS 105.17 for PCAs before a certificate will be issued.

The following must be completed as part of the state certification process:

  1. Application and Fees: You must complete an application and submit the application fee. An application may be obtained from the personal care agency certification specialist who can be reached at 608-266-2702. The specialist will provide a list of what documents and fees are required for submission with the application.
  1. Entity Caregiver Background Check: Demonstrate compliance with the Entity Caregiver Background Check process. A caregiver background check (CBC) is required to be completed for all applicants/legal representatives prior to the approval of any new license, certification or registration of a DQA regulated entity. Also review information on the requirement for your Employee Background Checks found on the Caregiver Background Check Process web page.
  1. Fit and Qualified: Demonstrate compliance with Wis. Admin. Code § DHS 105.17(1)(e) requirements for fit & qualified. 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.
  1. Policies and Procedures: Demonstrate, via submission of agency policies and procedures and patient care documentation, your compliance with Wis. Admin. Code ch. DHS 13 Reporting and Investigation of Caregiver Misconduct and Wis. Admin. Code § DHS 105.17. Refer to Chapter 6 of the Wisconsin Caregiver Program Manual, P-00038 (PDF, 290 KB).

Once all of the requested application materials are received an application is considered complete. Wisconsin has a two-step application review process. The first part of the review determines whether an applicant is fit and qualified and includes an analysis of a variety of factors including financial solvency, personnel qualifications, criminal background clearance, payment of required fees, history of person care or related health care agencies.

Following a determination that the applicant has met the fit and qualified criteria, a second review will be completed by a registered nurse who reviews the applicant's policies and procedures to determine whether they meet Wis. Admin. Code § DHS 105.17 requirements. The RN will consult with the applicant during this review if needed.

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 provisional approval.

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:

  1. Admitted and cared for at least five personal care clients, and
  2. 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.

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

Survey Preparedness

Compliance Review Tools: You may find the on this webpage useful in conducting an agency self-evaluation of compliance with Wisconsin administrative rule requirements. These forms are used by surveyors during onsite state certification surveys.

Medicaid Certification
Process

To obtain Medicaid certification, an applicant must apply separately through the ForwardHealth portal. ForwardHealth, 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.

Refer to Medicaid Contacts for additional contact information.

Last Revised: November 29, 2016