Certified Adult Family Homes

Welcome! We are proud to serve as a certifying agency for 1–2 Bed Adult Family Homes in Wisconsin. Our mission is to support dependable, person-centered residential care by guiding providers through the certification process and ongoing compliance. Below, you will find essential documents for current providers, including materials for both Sponsor Binders and Member Binders. For further guidance, we encourage you to review the official Wisconsin Medicaid Standards for Certified 1–2 Bed Adult Family Homes, which outline the qualifications, responsibilities, and expectations for providers and certifying agencies.

Member Binder Documents

AFH Member Binder Cover

AFH Member Binder Table of Contents

Annual Admission Rate Agreement -Member Rights Notice (Updated Annually or as needed by IDT Staff)

Member Information Sheet (Updated as needed)

Medical Appointment Form

Member Health Screening & Medication Authorization

Authorization to Secure Medical Treatment

Individual Service Plan

Medication Logs

Monthly Financial Ledger

Monthly Summary

Incident Reports

Rights and Responsibilities

Sponsor Binder Documents

AFH Reporting Guidelines

Immediate Reportable Incident Plan

Fire Drills-Smoke – CO2 Log

Client Rights Limitation or Denial Instruction Form

Member Rights Notice

Evacuation & Unplanned Absence Plan

DHS 82, Certified Adult Family Home, Resident Rights

AFH Background Check Policy

AFH Grievance Procedure

AFH Sponsor Binder Cover Insert

Medicaid Standards for Certified 1-2 Bed Adult Family Homes | Wisconsin Department of Health Services

AFH Training Log

Applicant-Household Member Health Assessment

Appeals and Grievance Policy

HCBS Adult Residential Provider Assessment

DataClarity User Guide

Fire Evacuation Plan

Fire Inspection Checklist

Internal Revenue Bulletin: 2014-4 | Internal Revenue Service

LCI Encryption User Guide

Program Statement

Provider Handbook

AFH Sponsor Binder Table of Contents

TT WPS Microsoft Excel Spreadsheet