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... DHS-7176B-ENG (PDF) Sample DHS licensing forms 245D licensed services Sample Policies and Forms for Intensive Supports and Services (PDF) 245A licensed services Grievance Procedure Sample for Family Child Care: DHS-7740 (PDF) ...
Description: Links referenced in the guidebooks and the attestation form to help providers complete the HCBS settings rule attestation process.
Date:
February
19, 2019
... any policy and forms they use meet the 245D licensing requirements, including the samples provided. Read ... Intensive sample policies and procedures Applicable MN statute or rule Date of last ...
Date:
July
21, 2025
... respite.
Apply for license
Application Process
Complete the 245D pre-application worksheet. Prepare the policies and procedures identified in the pre-application worksheet by using these sample templates:
Drug and Alcohol Prohibition Policy Emergency use ...
Date:
April
09, 2026
... current licensing requirements.
Basic services sample policies
Basic sample policies and procedures Applicable MN statute and rule Date of last revision Admission Criteria Policy (DOCX) MN Statutes 245D.11, subd. 4 8/1/2022 Data Privacy ...
Date:
July
21, 2025
... and provided copies of the following policies and procedures affecting a person’s rights under section 245D.04 within 5 days of service initiation: ________ Grievance Policy ________ ... Division 245D HCBS SAMPLE FORM 07/01/2017Page 1 of 1
Date:
May
09, 2018
... Community of Practice • 245D - HCBS self-monitoring checklists • 245D - HCBS sample policies and procedures • 245D - HCBS sample forms • 245D - HCBS FAQs 21 Contacts • ...
... any policy and forms they use meet the 245D licensing requirements, including the samples provided. Read the applicable statute sections or rule parts to ensure you understand the requirements. Required policies and procedures Applicable MN statute or rule Date of last ...
... any policy and forms they use meet the 245D licensing requirements, including the samples provided. Read the applicable statute sections or rule parts to ensure you understand the requirements. Required policies and procedures Applicable MN statute or rule Required Policies and ...
... 3 Complete 245D License Application Application: Start a 245D- HCBS ... including services policies and procedures. Providers may use the DHS sample documents as ...
... Policies and Forms for Intensive Supports and Services 245D licensed providers may link to the sample ... MN statute or rule Date of last ...