Minnesota Minnesota

Community-Based Services Manual (CBSM)

Community-Based Services Manual (CBSM)


Documents for long-term services and supports (LTSS) assessment, eligibility and support planning

Page updated: 4/21/25

Page comprehensively reviewed: 4/21/25

This page provides information about required documents for some LTSS programs and services. Certified assessors, case managers and care coordinators use this page to understand when and how to use these documents with MnCHOICES.

Use the following links to move to a document category:

  • · Application documents.
  • · Assessment documents.
  • · Supporting documents.
  • · Financial determination of eligibility documents.
  • · Support planning documents.
  • · MMIS and billing documents.
  • · Appeals documents.
  • · Other documents.
  • Note: If a document is no longer used with MnCHOICES, the certified assessor can use it as a reference tool. Assessors, case managers and care coordinators must reference assessment and support planning guidance documents in the MnCHOICES help center.

    For information about documents in MnCHOICES, refer to CBSM – Documents produced within the MnCHOICES application.

    Acronyms on this page

    This page includes the following acronyms:

  • · Alternative Care (AC).
  • · Brain Injury (BI) Waiver.
  • · Brain Injury – Neurobehavioral (BI-NB).
  • · Community Alternative Care (CAC) Waiver.
  • · Community Access for Disability Inclusion (CADI) Waiver.
  • · Community First Services and Supports (CFSS).
  • · Developmental Disabilities (DD) Waiver.
  • · Elderly Waiver (EW).
  • · Essential Community Supports (ECS).
  • · Minnesota Senior Care Plus (MSC+).
  • · Minnesota Senior Health Options (MSHO).
  • · Special Needs BasicCare (SNBC).
  • Application documents

    Supplemental document name

    Used with legacy assessment processes?

    Used with legacy health risk assessment?

    Used for CFSS? (limited use ONLY for specific contracted agencies)

    Used with MnCHOICES?

    Attach in MnCHOICES?

    Application for Social Services, DHS-2140 (PDF) or lead-agency-developed form

    No

    No

    No

    Yes, continue to use this form or equivalent form to apply for Rule 185 case management

    No

    Back to top

    Assessment documents

    Supplemental document name

    Used with legacy assessment processes?

    Used with legacy health risk assessment?

    Used for CFSS? (limited use ONLY for specific contracted agencies)

    Used with MnCHOICES?

    Attach in MnCHOICES?

    Mini-Cog Instructions for Admission and Scoring, DHS-3428M (PDF)

    Yes, for AC, EW, BI, CAC and CADI, when applicable

    No

    No

    Yes, when applicable and in conjunction with assessment content

    When required, attach to the person record

    CFSS Assessment, DHS-6893A

    No

    No

    Yes

    No, may use as a guide when assessing and authorizing requests for 45-day temporary start of service or temporary increase over the phone

    No

    Instructions for CFSS Assessment, DHS-6893A

    No

    No

    Yes

    No, may use as a guide when assessing and authorizing requests for 45-day temporary start of service or temporary increase over the phone

    No

    Caregiver Questionnaire, DHS-6914 (PDF)

    Yes, when applicable

    Yes, when applicable

    No

    Yes, when applicable

    Yes, attach to the person record

    Medication list (lead agency-developed document)

    Yes, for AC, BI, CAC, CADI and EW, when applicable

    Yes, when applicable

    Yes, when applicable

    Yes, when available

    When required, attach to the person record

    Back to top

    Supporting documents

    Supplemental document name

    Used with legacy assessment processes?

    Used with legacy health risk assessment?

    Used for CFSS? (limited use ONLY for specific contracted agencies)

    Used with MnCHOICES?

    Attach in MnCHOICES?

    AC, BI, CADI, EW Case Mix Classification Worksheet, DHS-3428B (PDF)

    Yes, for AC, BI, CAC, CADI and EW

    No

    No

    No, components are built into MnCHOICES

    No

    MnCHOICES Primary Medical Provider's Documentation of Medical Monitoring and Treatment Needs, DHS-7096

    Yes, for CAC

    No

    No

    Yes, for CAC

    When applicable, attach to the person record

    BI Waiver Assessment and Eligibility Determination, DHS-3471 (PDF), Instructions/Worksheet, DHS-3471A (PDF)
    and
    BI Waiver Eligibility and Documentation Checklist, DHS-3471B (PDF)

    Yes, for BI

    No

    No

    No, components are built into MnCHOICES

    No

    Case Manager’s Guide to Determining ICF/DD Level of Care for ICF/DD and DD Waiver Services, DHS-4147A (PDF)
    and
    Instructions, DHS-4147B (PDF)

    Yes, for DD

    No

    No

    No, components are built into MnCHOICES

    No

    CFSS Home Care Rating/Units Reference Tool, DHS-6893H (PDF)

    No

    No

    Yes

    No, components are built into MnCHOICES

    No

    OBRA Level I Criteria Screening for Developmental Disabilities or Mental Illness, DHS-3426

    Yes, for AC, BI, CAC, CADI, DD and EW

    Yes, for nursing facility admit only

    No

    No, form exists within MnCHOICES

    No

    Physician letter of medical necessity (refer to CBSM – Instructions for completing physician letter of medical necessity for the BI-NB Waiver)

    Yes, for BI-NB

    No

    No

    Yes, for BI-NB

    When applicable, attach to person record

    Related Conditions Checklist, DHS-3848 (PDF)
    and
    Instructions, DHS-3848A (PDF)

    Yes, for DD, when applicable

    No

    No

    Yes, for DD, when applicable

    When applicable, attach to person record

    Back to top

    Financial determination of eligibility documents

    Supplemental document name

    Used with legacy assessment processes?

    Used with legacy health risk assessment?

    Used for CFSS? (limited use ONLY for specific contracted agencies)

    Used with MnCHOICES?

    Attach in MnCHOICES?

    LTC: Communication of LTSS Eligibility Form, DHS-5181

    Yes

    Yes, for nursing facility admit only

    No

    Yes

    No

    Request for Payment of Long-Term Care Services, DHS-3543 (PDF)

    Yes

    Yes, for nursing facility admit only

    No

    Yes

    No

    AC Program Eligibility Worksheet, DHS-2630 (PDF)
    or
    AC Program Eligibility Worksheet Type A, DHS-2630A (PDF)

    Yes, for AC

    No

    No

    Yes, for AC

    Yes

    AC Program Estate Recovery Information, DHS-5186 (PDF)

    Yes, for AC

    No

    No

    Yes, for AC

    No

    AC Program Client Disclosure Form, DHS-3548

    Yes, for AC

    No

    No

    Yes, for AC

    No

    Essential Community Supports (ECS) Financial Eligibility Worksheet, DHS-6683 (PDF)
    or
    ECS Program Eligibility Worksheet for a Married Individual When Only One Spouse Requests Services, DHS-6683A (PDF)

    Yes, for ECS

    No

    No

    Yes, for ECS

    Yes

    ECS Financial Disclosure Form, DHS-6826

    Yes, for ECS

    No

    No

    Yes, for ECS

    No

    About the MnCHOICES documents you are receiving, DHS-6791K (PDF)

    No

    No

    No

    Yes, as applicable for both assessment and support plan

    No

    Back to top

    Support planning documents

    For information about roles and the support planning process, refer to CBSM – Support planning for LTSS.

    Supplemental document name

    Used with legacy assessment processes?

    Used with legacy health risk assessment?

    Used for CFSS? (limited use ONLY for specific contracted agencies)

    Used with MnCHOICES?

    Who completes?

    Attach in MnCHOICES?

    Emergency Back-Up Plan (PDF) (resource that describes components)

    Yes

    No

    No

    No

    Not applicable

    No

    Individual Community Living Support (ICLS) Planning Form, DHS-3751

    Yes, for AC, EW

    No

    No

    Yes

    Case manager or care coordinator

    Yes, attach to person record

    Back to top

    MMIS and billing documents

    Lead agencies create the LTC and/or the DD screening document through MnCHOICES. Lead agencies can use LTC Screening Document, DHS-3427 (PDF) or DD Screening Document, DHS-3067 for reference. For changes not related to an assessment, lead agencies should use DHS-3427 or DHS-3067 for updates as needed. For more information, refer to Instructions for Completing and Entering the LTCC Screening Document and Service Agreement into MMIS, DHS-4625 (PDF) or the DD Screening Document Codebook.

    Supplemental document name

    Used with legacy assessment processes?

    Used with legacy health risk assessment?

    Used for CFSS? (limited use ONLY for specific contracted agencies)

    Used with MnCHOICES?

    Attach in MnCHOICES?

    DD Screening Document, DHS-3067

    Yes, for DD

    No

    No

    No, built into MnCHOICES

    Note: Users access this document for administrative changes made outside of MnCHOICES.

    No

    LTC Screening Document – AC, BI, CAC, CADI, ECS, EW, MHM, MSC+, MSHO, SNBC, DHS-3427 (PDF)

    Yes, for AC, BI, CAC, CADI, ECS and EW

    No

    No

    No, built into MnCHOICES

    Note: Users access this document for administrative changes made outside of MnCHOICES.

    No

    Service Agreement, DHS-3070 (PDF)

    Yes, for fee-for-service AC, BI, CAC, CADI, DD, ECS and EW

    No

    No

    No, built into MnCHOICES

    Note: Counties and tribal nations use this document for reference only.

    No

    Back to top

    Appeals documents

    Supplemental document name

    Used with legacy assessment processes?

    Used with legacy health risk assessment?

    Used for CFSS? (limited use ONLY for specific contracted agencies)

    Used with MnCHOICES?

    Attach in MnCHOICES?

    State Agency Appeals Summary, DHS-0035 (PDF)

    Yes, by counties and tribal nations for AC, BI, CAC, CADI, DD, ECS and EW

    No

    Yes

    Yes, by counties and tribal nations for AC, BI, CAC, CADI, DD, ECS and EW

    No

    Appeal Summary for Long-Term Services and Supports, DHS-6807 (PDF)

    Yes, by counties and tribal nations for AC, BI, CAC, CADI, DD, ECS and EW

    No

    Yes

    Yes, by counties and tribal nations for AC, BI, CAC, CADI, DD, ECS and EW

    No

    LTSS Notice of Action (Assessments and Reassessments), DHS-2828A

    Note: For information about when it is appropriate to use this form, refer to CBSM – Notice of action.

    Yes, by counties and tribal nations for AC, BI, CAC, CADI, DD, ECS and EW

    No

    Yes

    Yes, by counties and tribal nations for AC, BI, CAC, CADI, DD, ECS, EW

    Note: Users access this document for administrative changes made outside of MnCHOICES.

    Yes, when completed outside of MnCHOICES

    LTSS Notice of Action (Service Plan), DHS-2828B

    Note: For information about when it is appropriate to use this form, refer to CBSM – Notice of action.

    Yes, by counties and tribal nations for AC, BI, CAC, CADI, DD, ECS and EW

    No

    Yes

    Yes, by counties and tribal nations for AC, BI, CAC, CADI, DD, ECS and EW

    Yes

    Your Appeals Rights, DHS-1941 (PDF) or lead-agency-developed form

    Yes

    No

    Yes

    Yes

    No

    Back to top

    Other documents

    Supplemental document name

    Used with legacy assessment processes?

    Used with legacy health risk assessment?

    Used for CFSS? (limited use ONLY for specific contracted agencies)

    Used with MnCHOICES?

    Attach in MnCHOICES?

    MnCHOICES Assessment Summary Worksheet, DHS-6791A (PDF)

    Yes

    No

    No

    Yes

    No

    MnCHOICES Reassessment Communication Form, DHS-6791E
    and
    Instructions, DHS-6791F (PDF)

    Yes

    Yes

    No

    Yes

    No

    OBRA Level II evaluative report for people with developmental disabilities or related conditions, DHS-4248 (PDF)

    If applicable, nursing facility admit only

    If applicable, nursing facility admit only

    If applicable, lead agency staff complete for nursing facility admit only

    Yes, nursing facility admit only

    No

    Pre-Admission Screening and Resident Review (PASRR) Level II Mental Health Tool

    If applicable, nursing facility admit only

    If applicable, nursing facility admit only

    If applicable, lead agency staff complete for nursing facility admit only

    Yes, nursing facility admit only

    No

    Recommendation for State Plan Home Care Services, DHS-5841
    (for people using MSHO, MSC+, SNBC or Families and Children only)

    Yes

    Yes

    No

    Yes

    No

    Notice of Privacy Practices, DHS-3979 (PDF) or lead-agency-developed form

    Yes

    Yes

    Yes

    Yes

    No

    MnCHOICES Lead Agency Transfer and Communication Form, DHS-6037 (PDF)

    Yes

    Yes

    No

    Yes

    No

    Informed consent to share/release information (lead agency-developed document)

    Yes

    Yes

    Yes

    Yes

    No

    Notice of Privacy Practices and Notice of Rights and Responsibilities, DHS-4839E or lead-agency-developed document

    Yes

    Yes

    Yes

    Yes

    No

    Minnesota Abuse Reporting Center Brochure, DHS-6778E (PDF)

    Yes

    Yes, as applicable

    Yes, as applicable

    Yes, required for all assessments for DD Waiver

    As applicable for all other waivers/programs

    No

    I Know Me: Creating The Best Home For Me, DHS-6803A (PDF)

    No

    Yes, as applicable

    Yes, as applicable

    Yes, as applicable

    No

    What Does Person Centered Mean For Me, DHS-6803 (PDF)

    No

    Yes, as applicable

    Yes, as applicable

    Yes, as applicable

    No

    EW Conversion Rate Request, DHS-3956 (PDF) 

    Yes, for EW, as applicable

    No

    No

    Yes, for EW, as applicable

    Yes

    AC/EW PCA/CFSS Enhanced Rate Budget Exception Request, DHS-8243 (PDF)

    Yes, for AC/EW, as applicable

    No

    No

    Yes, for AC/EW, as applicable

    Yes

    Additional resources

    For information about documents in MnCHOICES, refer to CBSM – Documents produced within the MnCHOICES application.

    For service-specific required forms, refer to:

  • · CBSM – Caregiver living expenses.
  • · CBSM – Environmental accessibility adaptations (EAA) – home and vehicle modifications.
  • · CBSM – EAA additional square footage.
  • · CBSM – EW conversion rates.
  • · CBSM – Host county notification.
  • · CBSM – Individual community living supports (ICLS).
  • · CBSM – Monitoring technology usage.
  • · CBSM – Waiver/AC reimbursement for unforeseen circumstances.
  • · CDCS Policy Manual.
  • · CFSS Manual – PCA, CFSS and CSG enhanced rate/budget.
  • For program/service information, refer to:

  • · CBSM – AC.
  • · CBSM – BI Waiver.
  • · CBSM – CAC Waiver.
  • · CBSM – CADI Waiver.
  • · CBSM – DD Waiver.
  • · CBSM – ECS.
  • · CBSM – EW.
  • · CBSM – LTCC.
  • · CBSM – MnCHOICES.
  • · CFSS Policy Manual.
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