Personal Needs Assessment (PNA) requirements for Personal Care Worker (PCW) authorizations
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Governs requirements for Personal Needs Assessments (PNA) and related documentation for Personal Care Worker (PCW) initial and renewal authorizations for i Care BadgerCare Plus and SSI members requesting PCW services.
Effective August 15, 2026, initial and renewal PCW service requests in Kenosha, Milwaukee, Ozaukee, Racine, Washington, and Waukesha counties must include a PNA completed by an approved assessor prior to submitting the Prior Authorization request.
Effective September 15, 2026, the PNA requirement will expand statewide for initial and renewal PCW service requests.
i Care will require Electronic Visit Verification (EVV) for all caregivers (live-in and non-live-in) effective July 15, 2026.
PNA requirement applies to new (initial) or renewal authorizations for PCW services when quantity is greater than 3 hours per day.
Personal Needs Assessment and Documentation Requirements
PNA and documentation criteria for PCW authorizations
Covered when ALL of the following criteria are met:
ALL of the following
- PNA required for any PCW service request of three (3) or more hours in a single day, regardless of days per week.
ALL of the following
- From Aug 15, 2026, initial and renewal PCW service requests in Kenosha, Milwaukee, Ozaukee, Racine, Washington, and Waukesha counties must include a PNA completed by an approved assessor prior to submitting the Prior Authorization request.
- This PNA requirement expands statewide on Sep 15, 2026 (applies to i Care members only).
ALL of the following
- If requested service level is three (3) or more hours per day, the PCW agency must refer the member to a Personal Needs Assessor (PNA).
Approved assessors
- For members residing WITHIN the specified counties, assessments must be completed by Independence First or Holistic Home Health Care.
- Members outside those counties may be assessed by i Care PNA Screeners or other contracted PNAs as applicable.
- The Personal Needs Assessor must contact the member and schedule an in-person visit within seven (7) calendar days of contact from the PCW agency.
ALL of the following
- PCW agency transfers the completed PCST to the Personal Needs Assessor and refers members when service level is ≥3 hours/day.
- After the PNA returns the completed PCST to the PCW agency, the PCW Registered Nurse develops the Plan of Care based on the PCST findings and sends the POC to the prescribing provider for signature.
- Once all required documentation is complete, the PCW agency submits the prior authorization request to i Care for review.
ALL of the following
- Requirements apply to all i Care BadgerCare Plus and SSI members requesting PCW services; this PNA requirement applies solely to i Care members (other plans may have different rules).
- Electronic Visit Verification (EVV) will be required for all caregivers (live-in and non-live-in) effective July 15, 2026.
Service Coding and Thresholds
| No specific CPT/HCPCS/ICD-10 codes specified in this document. |
Prior Authorization Workflow and Provider Responsibilities
Refer to PNA and follow PCST → POC → PA workflow for requests ≥3 hours/day
If the requested PCW service level is three (3) or more hours per day, the PCW agency must refer the member to a Personal Needs Assessor (PNA). The agency transfers the completed PCST to the PNA, who must schedule an in‑person visit within seven (7) calendar days; after the PNA returns the completed PCST, the PCW RN develops the Plan of Care and the agency submits the prior authorization to i Care once all required documentation is complete.
- PCW agency refers member to a Personal Needs Assessor for requests ≥3 hours/day.
- PCW agency transfers the completed PCST to the PNA.
- PNA schedules an in‑person visit within seven (7) calendar days and returns the completed PCST to the PCW agency.
- PCW RN develops the Plan of Care based on the PCST; POC sent to prescribing provider for signature; then agency submits prior authorization to i Care.
Include PNA completed by approved assessor before submitting prior authorization
For initial and renewal PCW service requests, a Personal Needs Assessment completed by an approved assessor must be included prior to submitting the prior authorization: effective August 15, 2026 for members in Kenosha, Milwaukee, Ozaukee, Racine, Washington, and Waukesha counties, and effective September 15, 2026 statewide.
- Aug 15, 2026: Requirement applies to initial and renewal requests in Kenosha, Milwaukee, Ozaukee, Racine, Washington, and Waukesha counties.
- Sep 15, 2026: Requirement expands statewide for initial and renewal PCW service requests.
Key Terms
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