Personal Care Agencies: Rules and Regulations
New online licensure and certification system for health and residential care providers
The Wisconsin Department of Health Services (DHS) Division of Quality Assurance (DQA) launched the DHS DQA Provider Portal, a new online system for licensure/certification, background checks, plan reviews, and other provider applications for certain users. Visit our webpage for more information.
Are you a provider for a personal care agency (PCA)? We're here to help. This page includes rules and regulations for operating a PCA in Wisconsin.
Regulatory guidelines
Select a link to learn more:
- Caregiver Programs - Learn more about caregiver programs, including background checks, feeding assistance, medication aides, and more.
- Covered Personal Care Services (Wis. Admin. Code § DHS 107.112) - Learn more about covered personal care services.
- Medical Assistance (Wis. Admin. Code §§ DHS 101-109) - Learn definitions, eligibility, covered services, and more.
- Personal Care Providers (Wis. Admin. Code § DHS 105.17) - Learn about the definitions, requirements, qualifications, and more for PCAs.
- Personal Care Services (Wis. Stat.§ 49.45(42)) - Learn about the fees and conditions for reimbursement for these services.
- Provider Rights and Responsibilities (Wis. Admin. Code § DHS 106) - Learn more about providing services, submitting claims for reimbursement, voluntary and involuntary termination from the program, and more.
Electronic Visit Verification (EVV) requirement
In response to the federal 21st Century Cures Act, the Wisconsin Department of Health Services (DHS) requires EVV for:
- Medicaid-covered personal care services effective Sept. 1, 2020.
- Medicaid-covered home health services effective Jan. 1, 2023.
EVV is an electronic system that verifies authorized services were provided. Home care workers are required to submit information at the beginning and end of each visit using an EVV system.
Learn more about the EVV requirement.