Personal Care Agencies: Application and Certification Process
You may use this application process to become a Wisconsin personal care agency (PCA). Individuals, tribes, county departments, and independent living centers may apply. Personal care services include help with activities of daily living, such as:
- Accompanying patients to medical appointments.
PCAs provide these services to individuals at their place of residence.
First, review the state rules and regulations for PCAs before starting this application process. For questions regarding PCAs, or to get an application, email the Division of Quality Assurance (DQA) at firstname.lastname@example.org.
Do not complete a PCA application for skilled nursing and other therapeutic services. Review Wis. Admin. Code ch. DHS 133 for home health agency requirements for skilled care and other services.
Reporting PCA changes
You must contact DQA if your existing PCA is undergoing a:
- Name change.
- Address change.
- Administrator change.
- Change of ownership (CHOW). If the operation of the PCA is transferred, the Health Insurance Benefits Agreement will be transferred. You must notify DQA of the change of ownership since your license is non-transferable.
- Change of ownership information (CHOI).
- Email: email@example.com.
- Call 608-266-2702.
Please read about the processes below to become a Medicaid-certified PCA.
View the PCA online training modules before starting the application process. The training modules are designed for all new PCAs. They are an excellent tool for self-assessment. The modules will help you gauge your readiness for applying.
Note: Receiving a certificate to operate a PCA in the state of Wisconsin is not part of the Medicaid provider enrollment process. This process doesn’t assure certification in the Medicaid program.
As a PCA applicant, you are required to complete an application, pay fees, and submit supporting documentation. These steps show compliance with Wis. Admin. Code § DHS 105.17 before a certificate will be issued.
As part of the state certification process, you must complete:
- Application and fees—You must complete an application and submit the application fee. You can get the application from a PCA certification specialist at 608-266-2702 or firstname.lastname@example.org. The specialist will provide a list of what documents and fees are needed.
- Entity caregiver background check—A caregiver background check is required for all applicants/legal representatives for any new license, certification, or registration of a DQA-regulated entity. Review the background check requirements.
- Fit and qualified—Demonstrate compliance with Wis. Admin. Code § DHS 105.17(1)(e). This review evaluates factors including financial solvency (including bankruptcy), personnel qualifications, and criminal background clearance. It also includes history of operating other health-related agencies in Wisconsin or other states, and payment of required fees.
- Policies and procedures—Show your compliance with Wis. Admin. Code ch. DHS 13 (reporting and investigation of caregiver misconduct) and Wis. Admin. Code § DHS 105.17 (personal care providers). Refer to Chapter 6 of the Wisconsin Caregiver Program Manual, P-00038 (PDF).
An application is considered complete when all the requested materials are received. Wisconsin has a two-step review process. The first part of the review determines whether an applicant is fit and qualified as defined in Wis. Statute 50.49.
A registered nurse completes the second part. They review the applicant’s policies and procedures to decide if they meet Wis. Admin. Code § DHS 105.17 requirements. The registered nurse consults with the applicant during this review if needed.
After these reviews, the department will either approve or deny the application. Approval will be effective for one year from the date the complete application was submitted.
A PCA may begin operations once they are approved. The applicant shall submit a written request to the department for an on-site survey within nine months of the approval’s effective date. An on-site survey only will be conducted when the PCA can show they meet the following criteria:
- Admitted and cared for at least five clients.
- During the on-site survey, provide personal care services to at least two clients.
If the applicant does not submit a written request for an on-site survey within nine months of the date the application was approved, the application will no longer be valid.
When the applicant is ready for their on-site survey, send a written request for the survey to:
Madison, WI 53701-2969
The department shall either recommend or not recommend certification of the applicant to the department’s Division of Medicaid Services (DMS) within 90 days of the on-site survey.
Our Compliance Review Tools can help your agency conduct a self-evaluation of compliance. These forms are used by surveyors during on-site state certification surveys.
After certification is recommended, the PCA must apply for Medicaid certification through the ForwardHealth portal.
ForwardHealth, within the Division of Health Care Access and Accountability (DHCAA), will approve or deny the application. If approved, they will issue a Medicaid certification and certification number.
Refer to Medicaid Contacts for other contact information.