Providers

Join Our Network

Download an application below to get started.

Community Care offers member-centered care to seniors and adults with intellectual and physical disabilities in eastern Wisconsin. We’re the only Wisconsin organization to offer all three long-term care programs: Family Care, Partnership and the Program of All-Inclusive Care for the Elderly (PACE). We are always interested in adding providers to our network who share Community Care’s mission of delivering quality, cost-effective care to those we serve.

Interested in joining the Community Care provider network? Download an application below to get started. All applications are available in Adobe PDF and Microsoft Word formats.

Community Care highly recommends providers attend an Application Training Session. Dates and more information on trainings can be found in the Provider Education session, by clicking here. These trainings are required for any provider whose application has been denied and are looking to reapply. 

If you have questions or need confirmation as to which application you should complete, call 1-866-937-2783 and select option 2.

 

Application Documents

General Application: Word, PDF
Owner-Occupied Adult Family Home (OOAFH) Application: Word, PDF
Transportation Provider Application: Word, PDF
Health Care Group Application: Word, PDF

Checklist of Materials to Send With Your Application

All required items (on the application checklist) must be submitted with general application, transportation application or OOAFH application to be considered. If all required items are not submitted at time of application, applications will be denied and providers will need to reapply at a future date.

  • All licenses and/or certifications
  • Certificate of Insurance with Community Care, Inc. listed as the certificate holder (No Declaration Page or Insurance Application or Insurance Binder)
  • Attestation Form - ( Word or PDF format) to be completed by all providers
  • W-9 Form (to be completed by all providers)
  • Residential Data Collection (to be completed by all corporate residential providers and submitted with the General Application)
  • Residential Summary - (Word or PDF format) to be completed by all residential providers
  • Direct Deposit Form - ( Word or PDF format) with a cancelled or voided check
  • Program Statement required for all certified or licensed providers

Submit Your Completed Application To:

  Mail:  Community Care, Inc.
            ATTN: Provider Management
            1801 Dolphin Drive
            Waukesha, WI 53186

Email:  [email protected]

  Fax:  (262) 446-6707

Application restrictions: Community Care, Inc. is only accepting pre-application documents for these provider types. Consideration will only be given to providers who have services that match the needs of specific members.

For a currently licensed 3-4 Bed Adult Family Home or currently Certified 1-2 Bed Adult Family Home located in Kenosha, Milwaukee or Racine Counties, to be considered for contract, all of the following pre-application documents must be submitted:

Current needs in Milwaukee, Racine and Kenosha Counties include homes that are:

  • State approved 3-4 Bed AFHs (DQA) or Certified 1-2 Bed AFHs for non-ambulatory residents and/or
  • Capable of serving members with a background that includes any of these service specialties;
    • Drug and/or alcohol use
    • Correctional history
    • Sex offender history
    • Complex medical needs requiring RN oversight.

To be considered all of the following pre-application documents must be submitted:

  • Current Adult Family Home License (DQA issued) with HCBS compliance or 1-2 Bed Certificate
  • Program Statement demonstrating programming capable of serving members with backgrounds described above,
  • Summary of management and direct staff expertise, experience and credentials related to the specific services being offered,
  • Summary of experience writing and adhering to Behavioral Support Plans including the submission of a sample BSP/ISP that has been de-identified, 
  • A written Training Plan including detailed training for the specific target groups identified above,
  • Credentials and experience of any specialty staff including Registered Nurses  if applicable,
  • Contact information, including name, phone and email

    If, after review, your pre-application materials align with current member placement needs, you will receive an invitation to submit a full application.  If no need is identified, your pre-application materials will be kept for potential future need.  If the information is not complete, no consideration will be given. (updated 8-25-23)

    For a currently Certified 1-2 Bed Adult Family Home located in Dane County to be considered for contract, all of the following pre-application documents must be submitted:

  • Program Statement demonstrating programming capabilities
  • Summary of management and direct staff expertise, experience and credentials related to the specific services being offered/program capabilities,
  • Summary of experience writing and adhering to Behavioral Support Plans including the submission of a sample BSP/ISP that has been de-identified, 
  • A written Training Plan including detailed training for the services being offered
  • Credentials and experience of any specialty staff including Registered Nurses  if applicable,
  • Contact information, including name, phone and email

If, after review, your pre-application materials align with current member placement needs, you will receive an invitation to submit a full application. If no need is identified your pre-application materials will be kept for potential future need. If the information is not complete, no consideration will be given.

 

 

 

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