Program Policies and Forms

Home and community-based service providers licensed under Chapter 245D are required to develop and implement policies and procedures in order to ensure the health and safety, exercise and protection of rights, and to ensure continuity in service provision and service coordination of persons served.

Policies are statements that describe the philosophy or mission of the organization about a particular subject and establish:

  • • a framework for how the organization will provide services; and
  • • the expectations an organization maintains for its employees
  • They are action statements that define individual responsibilities and expectations. Policy and procedures statements should be understandable by staff and provide effective measures to assist staff to perform their duties and meet their responsibilities.

    The 245D policy and procedure requirements are intended to ensure the safe and appropriate treatment of persons receiving services, and that staff are knowledgeable and well-equipped to perform their job duties.

    Sample policies and procedures and forms

    Providers may use the DHS sample documents as a template for their programs by filling in the blanks or modifying them to fit their programs’ format and style. The sample documents represent current licensing requirements and are updated as needed due to changes in rule or law. Providers are responsible for ensuring the documents they use conform to current licensing requirements.

  • Sample policies and forms for basic support services (PDF)
  • Sample policies and forms for intensive support services (PDF)
  • Self-monitoring checklist (PDF)
  • Electronic policies and procedures

    Providers may maintain policies and procedures in an electronic format if they can ensure policies and procedures are indexed with a table of contents or another method approved by the commissioner and that they are accessible to staff. Providers must meet requirements related to staff training and monitoring implementation by program staff. Policies and procedures must also be available to service recipients, legal representatives, and case managers as required under Chapter 245D.

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