DSD eList announcement
Date: May 17, 2021
To: Lead agency staff
From: DHS Disability Services Division
Purpose: To announce updates to the Long-Term Services and Supports Request for Physician Certification of Level of Care form (DHS-7096)
Effective: Immediately
Contact: dsd.responsecenter@state.mn.us
Updated MnCHOICES hospital level-of-care form
DHS updated the form medical providers use to confirm the medical treatment and monitoring needs of a person. Lead agencies must immediately begin using the new version, Primary medical provider’s documentation of medical monitoring and treatment needs, DHS-7096 (PDF), for this process.
The updated form:
It also has updated instructions for the medical provider. The form asks them to clearly clarify the specific medical treatments, monitoring and interventions needed by the person to remain safely in the community.
Additional information
For information on this policy, review the hospital section of the CBSM — Level of care page.
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