Personal Care II Application Process

The links below should be used to get materials to complete an application for Personal Care II. In addition, a completed an approved application would also qualify the provider agency as a provider of Personal Care I, HASCI Attendant and Companion services.

Print out a copy of the application. This should be completed and sent to the address listed.

The objectives of the PC II/HASCI Attendant and HASCI Respite services are to restore, maintain, and promote the health status of Medicaid Home and Community- Based waiver participants through home support, medical monitoring, escort/transportation services, and assistance with activities of daily living.

Print a copy of the scopes of services. This does not need to be included with the application, but does give information of what is required of your agency in providing services for the CLTC/DDSN programs.

Competency evaluations are required for all personal care aides prior to the provision of services. You may use this form or create one of your own which incorporates the same elements contained in this form.