Instructions to complete Moving Home Minnesota Service Authorization Plan (MHM SAP), DHS-6759P

Page posted: 7/1/25

The transition coordinator (TC) or demonstration case manager (DCM) uses this page as they complete Moving Home Minnesota Service Authorization Plan (MHM SAP), DHS-6759P.

When to use

MHM SAP, DHS-6759P is for people who:

· Access pre-transition services in an institutional setting. The TC is responsible to authorize these services.

· Access post-transition services in a community setting and are not on a home and community-based services (HCBS) waiver. The TC or DCM is responsible to authorize these services.

The TC or DCM follows the instructions on this page to authorize services.

When not to use

DHS-6759P is not used for people who meet one of the following criteria:

· Fee-for-service using Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD) or Elderly Waiver (EW).

· Age 65 or older and enrolled in Minnesota Senior Health Options (MSHO) or Minnesota Senior Care Plus (MSC+) and using EW.

The instructions on this page do not apply to people who meet the above criteria. Instead, refer to MHM Manual – Services.

Instructions

When a person is eligible to receive MHM pre-transition or post-transition services and is not on a waiver, follow this process:

1. The TC or DCM discusses MHM services with the person and documents their supports and desires in MHM Transition Planning Tool (TPT), DHS-6759J.

2. The TC or DCM completes MHM SAP, DHS-6759P for services that require a service agreement. Services that require a service authorization are listed on MHM Manual – Services. For current rates and limits, refer to the Long-Term Services and Supports (LTSS) Service Rate Limits, DHS-3945.

3. The TC or DCM submits DHS-6759J and DHS-6759P to DHS using one of the following methods:

· MHM Communication Form, DHS-6759H using the “Supporting Documents” reason for communication.
Note: The TC or DCM can only attach one document to each communication form submission.

· Secure email to movinghomemn.mfp@state.mn.us so DHS staff can enter it into MMIS. For instructions about sending secure emails, refer to CBSM – How to exchange private and protected information via email with DHS.

· Fax to 651-431-7745.

4. The TC or DCM keeps a copy of DHS-6759P in the person’s file.

5. DHS creates the person’s MHM service agreement.

6. The person’s provider(s):

· Plan and deliver services based on the person's needs, as documented in the person’s TPT.

· Cannot provide services or incur expenses until they receive a service authorization letter (SAL) in their MN–ITS SAL mailbox.

· Submit claims based on actual services delivered.