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Apply for a 245D-HCBS License
For access to the 245D HCBS License application, you must complete the following:
Fill out form completely with all required information
*This will not be uploaded with the application, but is required to compile necessary information
• Drug and Alcohol Prohibition Policy
• Emergency Use of Manual Restraint (EUMR) Policy
• Grievance Policy
• Maltreatment of Minors Reporting and Internal Review Policy
• Service Suspension and Termination Policy
• Vulnerable Adults Maltreatment Reporting and Internal Review Policy
*It is highly encouraged that you use our sample policies for your program. They were developed by 245D HCBS Licensors and will ensure compliance with 245D Standards. Follow the highlighted instructions on the top of each document.
Fill out Page 2 of the Authorized Agent Notarized Signature Form and sign in front of a Notary Public
Include your policy information, or indicate why you are exempt from this requirement, with a signature on the bottom
Indicate the highest authority in your program, including all Controlling Individuals
All documents to be uploaded into the application and must be in a PDF or Microsoft Word format.
Within a couple of days after you submit your 245D application, your Sensitive Information Person will receive an email from the DHS NETStudy Administrator with instructions and temporary access to your NETStudy account to run background studies on all Controlling Individuals. These studies need to be run and to be cleared before your license can be issued. Be sure to monitor any Spam/Junk folders for the email correspondence.
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