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 application process.
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 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 approval process:
- 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 certification.
- 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 survey.
Step A Training Modules
Potential new personal care providers are encouraged to review the PCA online 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)]. 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 completed:
- A complete application.
- Demonstrate compliance with the Entity Caregiver Background Check process.
- Demonstrate compliance with WI Administrative Rule DHS 105.17 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. 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.
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 PCA - 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 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.