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Minnesota Department of Human Services Community-Based Services Manual (CBSM)
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Provider-signature requirements for HCBS support plans

Page posted: 6/14/17

Page reviewed:

Page updated:

Legal authority

42 C.F.R. §441.725(b)(9)

Overview

As of Jan. 6, 2017, the lead agency must obtain a signature from each home and community-based service provider (i.e. waiver/AC) for all new and updated support plans. The provider’s signature indicates their acknowledgement of the services and supports in the plan and their agreement to deliver them as outlined.

Applicability

This requirement applies to all providers, case managers, care coordinators and certified assessors who deliver or arrange home and community-based services (HCBS).

This requirement applies to all HCBS support plan formats, including:

  • Coordinated Services and Supports Plan (CSSP), DHS-6791B (PDF)
  • Community Support Plan, DHS-4166 (PDF)
  • • Managed care organization (MCO) care plans for people on EW
  • • MnCHOICES Support Plan application.
  • Responsible lead
    agency staff

    The lead agency staff responsible for completing the support plan should send it to the provider for review and signature.

    Most of the time, the case manager/care coordinator will complete the person’s plan. The assessor may complete the plan when services are planned to begin before the case manager is assigned.

    Partial versus the
    entire support plan

    The person who receives services must receive a copy of the entire support plan.

    The person needs to make informed decisions about both of the following:

  • • Which providers receive a copy of the plan
  • • Whether to share the entire plan with each provider or only the sections that pertain to the services each provides.
  • The applicable lead agency staff should discuss the value of sharing information from the support plan with providers to help them deliver services in a person-centered manner. However, the person may make an informed decision to not share the plan or portions of the plan with any given provider.

    Partial plans

    If only sending sections of the support plan to a provider, use professional judgement when identifying what additional information to include. In addition to the sections that pertain to the services they provide, consider sending the following sections of the support plan to the provider:

  • • Basic demographic information
  • • Frequency related to the service provided
  • • Goals related to the service provided
  • • How the plan will be monitored
  • • Implications
  • • Support instructions.
  • If appropriate, the information sent to the provider should include sections for risk mitigation and emergency back-up information.

    Attach the provider-signature page to the partial plan.

    How to document provider signatures

    How the lead agency documents provider signatures depends on the support plan format it uses. Find guidance below.

    Counties and tribes

    If the county/tribe uses MnCHOICES for assessments, document provider signatures on the MnCHOICES Coordinated Services and Supports Plan Signature Sheet, DHS-6791D (PDF).

    If the county/tribe does not yet use MnCHOICES for all assessments, document provider signatures on the signature pages associated with the support plans it uses (e.g., DHS-4166).

    MCOs

    MCOs use their applicable support plan formats to document provider signatures.

    How to request provider signatures

    Send the support plan and applicable signature sheet to the provider via secure email, fax, mail, or deliver it in-person. The applicable lead agency staff should record the dates of all signature requests in the person’s record.

    Two attempts

    The lead agency should make a total of two attempts to get a provider’s signature.

    Make the first attempt within 30 calendar days of the date the plan was completed.

    If the provider does not sign and return the signature sheet, make an additional attempt within 60 calendar days of the date the plan was completed.

    Additional guidance

    Both the applicable lead agency staff and the provider should keep a copy of the provider’s signature for their records.

    The person only needs to sign the full support plan – not each individual provider-signature sheet.

    Frequently asked questions

    For answers to frequently asked questions, see the CBSM — FAQs about provider-signature requirements for HCBS support plans.

    Additional resources

    CBSM – Assessment applicability and timelines
    DHS – Transition plan for home and community-based settings

    Instructions to complete the MnCHOICES Community Support Plan with Coordinated Services and Supports form, DHS-6791C (PDF)

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    © 2017 Minnesota Department of Human Services Updated: 6/14/17 11:13 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 6/14/17 11:13 AM