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... Ownership
and Control Interest of an Entity (DHS-
5259) (PDF)
Fitness Test
•
Fitness tests may be conducted ... when you
submit the
Disclosure of Ownership (DHS-5259) (PDF)
.
•
Owners
are individuals with direct or indirect ...
Description: SFS Provider Screening PowerPoint
Date:
August
25, 2025
... County
Medicaid
Other
165988
144
86045259.73
597536.5259
518.3824116
2021
Clearwater County
Medicaid
All
43785
... 12
109.12
2022
Todd County
MNCare
All
5259
21
1920605.27
91457.39381
365.2035121
2022
...
Date:
July
18, 2025
... Ownership and Control Interest of an Entity (DHS-5259) Provider Entity Sale or Transfer Addendum (DHS-5550) ... Ownership and Control Interest of an Entity (DHS-5259) Provider Entity Sale or Transfer Addendum (DHS-5550) ...
Description: This page lists all Provider Eligibility and Compliance (PEC) enrollment forms that accept electronic signatures
Date:
July
31, 2026
... the Disclosure of Ownership and Control Interest (DHS-5259) .
Description: The following questions and answers provide further details about the Home and Community-Based Services (HCBS) revalidation process.
Date:
July
31, 2026
... Ownership and Control Interest of an Entity (DHS-5259) (PDF) during enrollment. If a QP is an ...
Description: The Minnesota Department of Human Services (DHS) is in the process of transitioning from personal care assistance (PCA) to Community First Services and Supports (CFSS). During this transition time, Steps for Success training covers information from both programs. To learn more about CFSS, visit Community First Services and Supports.
Date:
July
31, 2026
... of Required Documentation
Form-related issue (e.g. 5259)
Failure to Update Enrollment Changes (ie address,
ownership)
...
Date:
July
01, 2026
... 430594.51 21755 55859 1471 509679.51 358042.5259 149549.9841 -12642 14729 509679.51
14 Clay ...
Date:
July
31, 2026
... 06/01/2025 - 06/30/2025
4937
5079
5259
5021
5074
5456
5375
5242
5186
4942
4806
...
Description: Medicaid Section 1115 Demonstration Monitoring Report (Template Version 1.0)
Date:
June
11, 2026
... Ownership and Control Interest of an Entity (DHS-5259)
.
Requirement for Individual EIDBI providers
Effective Aug. 5, ...
Date:
May
05, 2026
... Ownership and Control Interest of an Entity (DHS-5259)
.
Requirement for Individual EIDBI providers
Effective Aug. 5, ...
Description: April 7, 2026 MHCP Provider News
Date:
April
21, 2026