MHM documents and forms

Page updated: 8/1/22

This page provides a list of frequently used Moving Home Minnesota (MHM) forms referenced in this manual. Use DHS – eDocs searchable document library to search for and download forms, applications and other documents.

Documents

MHM Money Follows the Person Demonstration Participant Handbook, DHS-6580B (PDF)

MHM Brochure, DHS-6580A (PDF)

Forms for participants, lead agencies and transition coordinators

MHM Intake Form, DHS-5032:

· Completed for people who are interested in receiving MHM (can be completed by anyone)

· Starts the process for receiving MHM

MHM Informed Consent, DHS-6759I (PDF):

· Completed by people who are interested in receiving MHM

· Gives the service provider, lead agency and/or transition coordinator permission to gather personal information to determine program eligibility

MHM Communication Form, DHS-6759H:

· Completed by providers, transition coordinators and lead agencies

· Allows providers and case managers to communicate a person’s needs and changes to DHS

MHM Transition Planning Tool, DHS-6759J (PDF):

· Completed by people who currently receive MHM and their transition coordinators

· Helps the transition coordinator develop a person-centered transition plan for the person’s move to the community

MHM Housing Transitions Worksheet, DHS-6759G (PDF):

· Completed by transition coordinators

· Helps determine the best type of housing for people applying for MHM

Forms for provider enrollment

Home and Community-Based Services (HCBS) Programs Service Request, DHS-6638 (PDF):

· Completed by providers at enrollment

· Identifies which services providers will deliver provide and determines the verifications needed for enrollment

MHM – Transition Planning, Transition Coordination and Demonstration Case Management – Provider Assurance Statement, DHS-3879 (PDF):

· Completed by providers at enrollment

· Documents that providers assure they meet the qualifications necessary to provide MHM