The purpose of the protocol is to:

The protocol is not a form for lead agencies to use. Rather, it is a framework for understanding how to incorporate a person-centered approach into the support-planning process.

The protocol applies to all people who use home and community-based services (HCBS) and are eligible to receive support planning.

Because different federal and state authorities govern the services in each HCBS program, the lead agency’s level of accountability for meeting the protocol’s standard varies.

For specific populations and levels of accountability, see Table 1: Covered populations and level of accountability on page 9 of the protocol (PDF).

Though many people contribute to the creation of a support plan that is person-centered, there are specific groups of professional support planners who are responsible to follow the protocol.

For more information, see Table 2: Responsible professionals on page 10 of the protocol (PDF).

Support planners must use this protocol any time support planning happens. At a minimum, support planners must follow the protocol when a person:

Part one of the protocol explains Minnesota's standards for person-centered practices during the support-planning process. It applies to everyone covered by the protocol.

These standards include four categories of essential elements:

Information about part one begins on page 15 of the protocol (PDF).

Part two of the protocol explains transition-planning requirements specific to people who move from one residence to another and do not intend to return. Part two does not replace part one.

The requirements in this section include two categories of essential elements:

The case manager/care coordinator or support planner must base all transition plans off the person's support plan that is person-centered.

Information about part two begins on page 21 of the protocol (PDF).

Temporary settings

Part two does not apply if a person has a short stay in one of the following:

However, part two does apply when the person does all of the following:

My Move Plan Summary

When a person moves from one residence to another, part two requires the case manager/care coordinator or support planner to work with the person to complete the My Move Plan Summary, DHS-3936 (PDF).

For more information about this requirement, see CBSM – My Move Plan Summary.

To monitor lead agency compliance with the requirements in the protocol, DHS uses two processes:

Lead agency reviews

For information about lead agency reviews, see HCBS Lead Agency Review – Review protocols and elements.

Care plan audits

Managed care organizations (MCOs) examine care plans for compliance with all assessment and care-planning requirements during the annual audit of people’s care plans. The audit-review requirements are similar to the lead agency review team’s protocols.

MCOs issue corrective action plans for care plans that do not meet the audit protocol for person-centered practices. MCOs report the findings from their annual audits to DHS.

For mental health services, DHS provides technical assistance in the implementation of the protocol.

Person-centeredness is an important part of recovery and resiliency for children, families and adults who receive mental health services. DHS encourages mental health targeted service providers to use person-centered philosophies in all aspects of their work. To do this, providers should use the protocol as a guide.

People who receive services and professionals can contact the DHS Behavioral Health Division for information about training resources by: