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1. Long-Term Care (LTC) Providers

All Long-Term Care providers must complete and submit the following documents:

2. 1-2 bed Adult Family Home Providers

All providers seeking a contract and/or certification of a 1-2 bed home must complete and submit the following documents:

Applicants may not reapply for certification in Wisconsin within two (2) years after the effective date under any of the following circumstances:

  • Previously denied certification or licensure for cause

  • A revoked certificate or license

  • Voluntarily surrendered license or certification for any type of residential provider while facing active denial

  • A de-certification or revocation action

If approved for contracting/certification a certification fee of $475 per facility will be required for all Corporate facilities to begin the certification process.  The annual re-certification will be $350 per facility for all Corporate facilities.

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