skip to content
Primary navigation

Phase 2 Provider Attestation

Providers must complete an attestation if they provide or have a license to provide the following services to people who receive waiver funding:

  • Adult foster care or supported-living services provided in a licensed setting
  • Child foster care or child supported-living services provided in a licensed setting
  • Customized living
  • Adult day services — family and center-based
  • Day training and habilitation, prevocational services and structured day

Providers who already submitted an attestation form for a setting do not need to complete a new one for that setting. These settings were part of Phase 1 of the attestation process. Phase 2 will include a second wave of providers with new settings in 2017 who have not already submitted an attestation.

DHS identified 222 new settings with new claims or licenses, from the effects of isolating survey or a change in ownership during 2017. These are residential settings in which providers deliver services paid for by BI, CAC, CADI or DD waivers, and group or cluster people with disabilities.

DHS assigned an ID number to each new setting. Providers can view the Phase 2 List of Provider Settings (XLS) to locate your assigned ID number to complete an attestation using the Home and Community-Based Services (HCBS) Provider Attestation form, DHS-7176-ENG (PDF).

Providers must complete Phase 2 provider attestations by April 13, 2018.

Attestation resources by service

back to top