Providers

Join Our Network

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.

Adult Family Homes in Dane, Kenosha, Milwaukee or Racine Counties, please see below for important information regarding our pre-application process.

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.

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.

Download an application below to get started:

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

Application Forms

  • 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
  • Electronic Funds Transfer Form ( Word or PDF format) with a cancelled or voided check
  • DHS Enrollment Form (for providers who do not have a Medicaid number) 

 

If you are a licensed 3-4 bed Adult Family Home in Kenosha, Milwaukee or Racine counties or a certified 1-2 bed Adult Family Home in Dane, Kenosha, Milwaukee, or Racine counties, you must submit the following pre-application documents to be considered:

  • 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

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.

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 future needs. If the information is not complete, pre-application will not be considered.

Submit completed application or pre-application materials to:

[email protected]

By mail:

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

or  Fax: (262) 446-6707

 

 

 

 

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