Provider attestation FAQ

This best place for you to find all of the information about the HCBS rule and provider attestation is to visit our Transition plan for home and community-based settings webpage. There, you will find general information about the HCBS rule. 

If you click on the plus sign next to “Provider attestation,” you will find specific information about the attestation requirement. We have organized the information by provider type. You will see links to the attestation form, the guidebook designed specifically for that service and other forms and templates that might be helpful. In addition, under the “More information” section, you will find announcements, webinar information and important links.

Visit the Disability Services Division training archive for attestation webinar audio and handouts.

The attestation is only applicable to HCBS waiver (AC, BI, CAC, CADI, DD and EW) providers. If a provider does not provide services to people funded by a waiver, it does not need to complete the attestation process.

The first phase of assessment and compliance validation includes providers of services in the following settings:

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

The federal government also requires states to identify any setting that may have the effect of isolating individuals from the broader community. DHS is developing a process for a second phase of setting assessment that will identify additional settings that may have an effect of isolating. These settings, once identified, will need to complete a provider attestation.

You can find information about the provider attestation in the PRVLTR folder of your MN–ITS mailbox. You can also find this information on the Transition Plan for home and community-based settings webpage (under the Provider attestation toggle). DHS also sent information via mail to your setting address. If you are unable to find this information in your MN-ITS mailbox following the instructions above, please contact the MHCP Provider Resource Center at 651-431-2700 or 800-366-5411 (press 6 for MN-ITS related questions).

No, the attestation form link is not provider or setting-specific. All providers may use Home and Community Based-Services (HCBS) Provider Attestation (DHS-7176-ENG).

No. Only providers of the following services funded under the AC, BI, CAC, CADI, DD and EW waivers need to complete the provider attestation:

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

To submit an attestation, you must upload at least one supporting document. It is acceptable to upload a document(s) used to meet one of the area(s) under current licensing or registration requirements while updating other documents. 

Before Sept. 1, 2017, you can then log back into the submitted attestation form, adjust any “do not yet comply” areas and upload the new documents. Please know that DHS keeps your previously submitted documents in a file specific to your site, so you will not see them as attachments when you sign back in to the form.

Submit blank forms and policies. Do not provide person information or redacted person information. Supporting documents may show that a provider complies in multiple areas. It is not necessary to submit the same supporting evidence multiple times.

Yes, providers will need to complete an attestation and submit supporting documentation for each setting/site in which they provide the HCBS services that are included in the attestation process. You do not need to complete an attestation for sites where you do not provide HCBS services. If you provide services through multiple waivers at the same site, you only need to complete one attestation per setting/site.

• If you are not able to proceed to the next page, recheck your HFID number or look up your number using the MDH Provider Directory.
• Please make sure you are using the HFID number that is associated with the housing with services registration, not your comprehensive home care license.
• If you are still unable to enter a valid number, submit an inquiry on the DSD contact form. Include in your message "Sign-in number for attestation needed" along with your provider name, the setting address, city, state, ZIP code, phone number and the provider service type at the setting.

• If you provide corporate adult foster care to people on the BI, CAC, CADI or DD waivers, you must use your 245D-Community Residential Setting (245D-CRS) license number to sign in to the attestation form. You can find your 245D-CRS license number by using DHS Licensing Information Lookup webpage. Enter identifying demographic information (such as name or city). Under “license type,” select “Home and Community Based Services-Community Residential Setting” using the drop-down. Check the “Foster care services or supported living services” box and click “Search.”

• 
  

• If you provide family adult foster care to people on the BI, CAC, CADI, DD or EW waivers, you must use your Adult Foster Care (245A) license number. You can find your Adult Foster Care (245A) license number by using the DHS Licensing Information Lookup webpage. Enter identifying demographic information (such as name or city). Under “license type,” select “Adult Foster Care” using the drop-down menu and click “Search.”

• 
  

• If you are licensed to provide adult foster care under both 245A and 245D, your setting will be listed under one of these license numbers. If the license number for 245D did not work, enter the 245A license number.

After you submit the attestation, a “thank you” screen will appear to verify that you submitted your attestation successfully. The contact person listed in the attestation form will also receive a confirmation email that includes a PDF of the attestation submission.

Once you submit a completed attestation that complies with all areas of the attestation, you do not need to take any further action. You will only hear from DHS if we have questions or we need to assess your setting(s) further.

No, there is no limit. If you want attachments to save, you must use the “submit” button vs. the “save” button. DHS accepts multiple submissions. We will know it is your final submission when all of the questions are marked as compliant.

You may submit Word, Excel and PDF documents. Scanning documents is acceptable as well, but please be sure to indicate the page number in the designated spot for that standard.

No. When you attach your documents at the end of the form, you should then select the “Submit Attestation” button. Note: If you select “Save & Exit,” your attachments will not be saved.

A response was due from adult day service and customized living providers by April 30, 2017. The response is due from foster care, day training and habilitation (DT&H), prevocational and structured day providers by May 31, 2017. Providers may indicate “do not yet comply” in areas in which they need to make changes. Providers must be in compliance by Sept. 1, 2017.

Agencies with multiple sites will find instructions on how to copy an attestation form on page 33 of the Guidebook: Customized Living (DHS-7176E-ENG) (PDF). This will allow providers to duplicate the form and change the site ID number and other information specific to that site.

We are partnering with providers during the attestation process and consider this time as one of technical assistance. That said, we need providers to submit their initial responses to determine where our outreach is needed and to move toward compliance.

To comply with this requirement, providers must ensure a person’s physical environment meets his or her needs. For example, people may use common areas in the home, such as the kitchen, dining area, laundry and shared living areas to the extent they desire. 

Providers should not restrict people who require the use of a wheelchair or walker to only their bedroom and the dining hall because the doorways to the kitchen and activity room are too narrow.

People have the opportunity to develop close, private and personal relationships without having unnecessary barriers or obstacles imposed on them. HCBS federal rules require that people be able to have visitors at any time, without restriction, just like anyone would have in their own home or rental unit. Providers should also not be screening the person’s visitors. This does not mean that individuals may be inconsiderate of others’ rights or the need for quiet and safety in the residence. 

Providers may modify or restrict the person's right to have visitors at any time on an individual basis. See the Modifying/restricting HCBS standards section below for more information.

• For AFC settings licensed under 245A, the Individual Resident Placement Agreement and Residency Agreements must be reviewed and signed, along with the Recipient Rights, on admission and reviewed annually.
• For AFC settings licensed under 245D, the Residency Agreement and the Recipient Rights must be reviewed and signed on admission and annually thereafter.
• For CL licensed as home care under 144A and registered as housing with services (HWS) under 144D, each person must have a lease that is reviewed and signed, along with the Recipient Rights, on admission. The Recipient Rights must be provided before a client receives services.

There is no CMS guidance on type of lock. The person needs to have control over his or her privacy inside or outside of his or her bedroom. The provider must respect and protect the person’s need for privacy.

No, you cannot have a blanket policy that covers everyone in that setting. Every person in that setting must have an assessment that shows his or her need for a secure environment. This modification must be written in every person’s support plan. See the Modifying/restricting HCBS standards section below for more information. If a person is able to come and go safely, then he or she needs a code or another way to move freely about the building.

A provider’s policies must incorporate and honor HCBS rule quality standards and people’s rights. Rights include but are not limited to: 

• Access to food at anytime 
• Privacy 
• Access to visitors

A person's rights and choice may only be limited if his or her assessed need requires modification for health or safety reasons. Providers must document any modification to the HCBS rule expectations for choices or rights. Providers may not restrict entire programs or houses under the HCBS rule. Providers must describe and justify the details in each person’s support plan. Again, modifications to a person's choice and rights under HCBS rule must be specific to the person's individualized, assessed needs and not based on the needs of other people living in the same home or residence.

Check-ins about the person's interest in competitive, integrated employment should occur during service planning and support team meetings. 

According to 245D.07 and 245D.071, providers must participate in service planning and support team meetings for the person after the stated timelines established in the person’s coordinated service and support plan or as requested by the person or the person’s legal representative, the support team or the expanded support team. 

For a person receiving intensive support services (which includes DT&H), meetings must also occur within 30 days of a written request by the person, his or her legal representative or the case manager at a minimum of once per year.

You must provide flexible scheduling and activities during times that complement a person’s work schedule. The rule states that people who want to work must be supported in their choice. Many older adults choose to retire or not to seek employment.

Lead agencies must ensure informed choice using the Person-Centered, Informed Choice and Transition Protocol (PDF). Providers must provide the person options and opportunities to try new things on an ongoing basis. Polices should reflect that you are supporting people, as requested, and regularly checking in with them on the opportunity to explore employment.

Day services (adult day, DT&H, prevocational and structured day services) are not required to support a person to access the community 1:1. The provider, however, should talk to people about their likes, dislikes and interests and make sure they have opportunities to participate in activities that match their preferences. Providers should also share community activity information to raise awareness of and access to the broadest array of activities that may occur inside and outside of the setting. It is not acceptable for providers to offer only on-site activities.

Providers do not need to wait until all signed documents are returned by participants/legal representatives before checking “compliant” in the attestation. 

When a provider marks “compliant” in the attestation, we expect that the provider has notified people of the change(s) and is seeking signatures, if needed. DHS encourages providers to notify people as soon as possible of policy/practice changes. Providers do not need to wait for the next scheduled team meeting to notify people. 

DHS has modified sample licensing forms and developed new forms to assist providers with implementing HCBS requirements. You can find these documents on the HCBS transition website, under the provider attestation toolkits.

Submit the supporting documentation defined in the HCBS Provider Attestation Guidebook for Residential Settings: Foster Care and Supported Living (SLS) Services (DHS-7176G-ENG) (PDF), as well as the following: 

• Individual resident placement agreement (IRPA) 
• Adult foster care program plan