Homepage Free Minnesota Dhs Template
Article Map

The Minnesota Department of Human Services Licensing Division has developed a comprehensive set of policies and forms tailored for providers offering intensive supports and services under the 245D licensure. These crucial documents serve as a blueprint for ensuring adherence to the stringent regulatory requirements stipulated by Minnesota statutes and rules. With a requirement for providers to establish and maintain specific policies such as Drug and Alcohol Prohibition, Emergency Use of Manual Restraint, and Grievance Policies, among others, by January 1, 2014, the aim is to foster a standardized operational framework that guarantees the safety, rights, and well-being of service recipients. Additionally, the inclusion of forms for various operational needs, including incident reporting, medication administration, and program admission and discharge, underscores the state's commitment to meticulous oversight and quality assurance in care provision. Providers, by linking to and modifying these sample policies and forms for their use, take on the responsibility of compliance, ensuring that their practices not only meet the minimal legal requirements but also align with best practices in care provision and recipient protection. This initiative reflects a structured approach towards enhancing the quality of care and operational efficiency within the Minnesota human services sector.

Minnesota Dhs Example

Minnesota Department of Human Services

Licensing Division

Sample Policies and Forms for Intensive Supports and Services

245D licensed providers may link to the sample policies and forms below and modify them for use in their programs. Providers are responsible for ensuring 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

 

 

 

 

revision

 

 

 

 

 

 

 

 

 

 

Required Policies and Procedures

 

 

 

 

 

 

These policies are required at time of application for providers who do not hold a 245B license.

 

 

 

 

 

 

 

Drug and Alcohol Prohibition Policy

 

245A.04, subd. 1(c)

10/31/2013

 

 

 

 

 

 

Emergency Use Of Manual Restraint (EUMR) Policy

 

245D.06, subd. 1(a); 245D.06,

10/31/2013

 

 

 

subd. 5; & 245D.061, subd. 9

 

 

 

 

 

 

 

Grievance Policy

 

245D.10, subd. 2

10/31/2013

 

 

 

 

 

 

Maltreatment Of Minors Reporting and Internal Review Policy

 

245A.66 and 626.556

10/31/2013

 

 

 

 

 

 

Service Suspension And Termination Policy

 

245D.10, subd. 3

10/31/2013

 

 

 

 

 

 

Vulnerable Adults Maltreatment Reporting and Internal Review Policy

 

245A.65, subd. 1(a) and (b) &

10/31/2013

 

 

 

626.557, subd. 4a

 

 

 

 

 

 

Required Policies and Procedures

 

 

 

 

 

 

 

 

All policies must be developed by January 1, 2014.

 

 

 

 

 

 

 

Admission Criteria Policy

 

245D.11, subd. 4

10/31/2013

 

 

 

 

 

 

Data Privacy Policy

 

245D.11, subd. 3

10/31/2013

 

 

 

 

 

 

Emergency Response, Reporting and Review Policy

 

245D.11, subd. 2; 245D.02, subd.

10/31/2013

 

 

 

8; 245D.22, subd 4-7

 

 

 

 

 

 

 

Health Service Coordination and Care (Residential Programs) Policy

 

245D.11, subd. 2(2)

10/31/2013

 

 

 

 

 

 

Incident Response, Reporting and Review Policy

 

245D.11, subd. 2(7); 245D.02,

10/31/2013

 

 

 

subd. 11; 245.91, subd. 6;

 

 

 

 

609.341, subd. 3 and 14

 

 

 

 

 

 

 

Safe Medication Assistance and Administration Policy

 

245D.11, subd. 2(3)

10/31/2013

 

 

 

 

 

 

Safe Transportation Policy

 

245D.11, subd. 2(4)

10/31/2013

 

 

 

 

 

 

Universal Precautions and Sanitary Practices Policy

 

245D.11, subd. 2(1)

10/31/2013

 

 

 

 

 

Required Policies And Procedures for Community Residential Settings and Day Services Facilities

 

 

 

 

 

 

 

 

All policies must be developed by January 1, 2014. Samples will be available in July and August 2014.

 

 

 

 

 

 

 

Program Abuse Prevention Plan (PAPP)

 

245A.65, subd. 2 (a) & 245A.65,

10/31/2013

 

 

 

subd. 2 (a)

 

 

 

 

 

 

Documentation Requirements – Optional Program Forms

 

 

 

 

 

 

 

 

 

45 Day Meeting Summary

 

 

10/31/2013

 

 

 

 

 

 

Admission and Discharge Register form

 

 

10/31/2013

 

 

 

 

 

1

Revised 10/31/2013

Minnesota Department of Human Services

Licensing Division

Assessment Results for Intensive Support Services

 

10/31/2013

 

 

 

Emergency Report and Internal Review Form

 

10/31/2013

 

 

 

Fire Drill Log

 

10/31/2013

 

 

 

Funds and Property Authorization

 

10/31/2013

 

 

 

Health Needs Change Notice

 

10/31/2013

 

 

 

Health Needs Record

 

10/31/2013

 

 

 

Incident Report and Internal Review

 

10/31/2013

 

 

 

Individual Abuse Prevention Plan (IAPP) Form

245A.65, subd.2(b) & 626.6557,

10/31/2013

 

subd. 14

 

 

 

 

HCBS Incident Reporting Requirements - Who to Notify Form

 

10/31/2013

 

 

 

HCBS Service Recipient Rights Packet

 

10/31/2013

 

 

 

HCBS Service Recipient Rights Restrictions

 

10/31/2013

 

 

 

Intensive Support Services Assessment

 

10/31/2013

 

 

 

Medication Administration and Emergency Medical Authorization

 

10/31/2013

 

 

 

Medication Administration Review Record

 

10/31/2013

 

 

 

Medication and Treatment Administration Packet

 

10/31/2013

 

 

 

Medication Setup Record

 

10/31/2013

 

 

 

Person-Centered Planning and Service Delivery Requirements

 

10/31/2013

 

 

 

Progress Review Report for Intensive Support Services

 

10/31/2013

 

 

 

Psychotropic Medication Use and Monitoring Record

 

10/31/2013

 

 

 

Quality Management Evaluation and Program Improvement Plan

 

10/31/2013

 

 

 

Release of Information Authorization

 

10/31/2013

 

 

 

Satisfaction Evaluation

 

10/31/2013

 

 

 

Service Admission Checklist for Intensive Services

 

10/31/2013

 

 

 

Service Recipient Information Cover Sheet

 

10/31/2013

 

 

 

Service Recipient Record Checklist

 

10/31/2013

 

 

 

Service Suspension or Termination for Intensive Support Services Checklist

 

10/31/2013

 

 

 

Staff Orientation and Training Packet

 

10/31/2013

 

 

 

Support Team Meeting Summary

 

10/31/2013

 

 

 

Supports and Outcome Methods for Intensive Support Services

 

10/31/2013

 

 

 

2

Revised 10/31/2013

Form Characteristics

Fact Name Description
Applicability The forms and policies are intended for 245D licensed providers offering intensive supports and services in Minnesota.
Governing Law Several Minnesota statutes and rules govern the required policies and forms, including but not limited to 245A.04, 245A.65, 245D.06, 245D.10, and 626.556.
Modification and Use Providers may link to, modify, and use the sample policies and forms for their programs, ensuring they meet all 245D licensing requirements.
Required Policies for Application Specific policies are mandatory at the time of application for providers who do not hold a 245B license, covering areas such as drug and alcohol prohibition, emergency use of manual restraint, and grievance policies.
Documentation Update Requirement All policies must be developed by January 1, 2014, with samples available in July and August 2014, indicating a requirement for providers to establish or update their documentation according to the latest standards.

Steps to Writing Minnesota Dhs

Completing the Minnesota Department of Human Services (DHS) form is an essential step for providers offering intensive supports and services under the 245D license. These forms and policies not only help in aligning services with state requirements but also ensure that the care provided to individuals is of the highest standard, respectful, and compliant with regulations. The documentation process can seem daunting, yet breaking it down into steps makes it manageable and effective in maintaining regulatory compliance and supporting the well-being of service recipients.

  1. Review the list of Required Policies and Procedures to determine which policies are applicable to your program. Note the relevant MN statute or rule and the date of last revision for each policy.
  2. For each required policy, click the link (if provided) to access the sample policy or form. If no link is provided, you will need to develop the policy based on the statutory or rule requirements listed.
  3. Modify the sample policies and forms as necessary to fit the specific needs and circumstances of your program. Ensure that all modifications still meet the criteria set forth by the 245D licensing requirements.
  4. Develop the Admission Criteria Policy, Data Privacy Policy, and any other specific policies required by January 1, 2014, if you are a new provider or do not hold a 245B license. Use the statutory or rule references as a guide for the necessary content and compliance requirements.
  5. Fill out the Optional Program Forms such as the 45 Day Meeting Summary, Admission and Discharge Register form, and others that are relevant to your service provision. Ensure accurate and complete entries for all required fields.
  6. Carefully review each completed policy and form, checking for compliance with the 245D license requirements and the specifics of your program's operations and services.
  7. Implement these policies and forms in your program, making them accessible to staff members. Ensure all team members are trained on the correct use and purpose of each policy and form.
  8. Regularly review and update your policies and forms to reflect any changes in licensing requirements, program services, or best practices. Keep track of revision dates and document updates as needed to maintain compliance and support quality service provision.

Remember, the process of filling out these forms and updating policies is ongoing and reflective of your commitment to providing safe, responsive, and quality services. Regular updates and reviews are crucial for staying in compliance and ensuring that your services consistently meet the needs and standards expected by the Minnesota Department of Human Services.

Listed Questions and Answers

  1. What is the Minnesota DHS Form?

    The Minnesota Department of Human Services (DHS) Form pertains to various sample policies and forms designed for intensive supports and services under the 245D licensed providers. These documents facilitate providers in implementing standard practices that comply with state requirements.

  2. Who needs to use these forms and policies?

    These are intended for providers who offer intensive support and services and are either applying for or already hold a 245D license. Such documents must be adapted for use in their programs while ensuring compliance with 245D licensing requirements.

  3. Are there required policies for new applicants who do not have a 245B license?

    Yes, specific policies are mandatory at the time of application for providers without a 245B license. These include policies on drug and alcohol prohibition, emergency use of manual restraint, grievance procedures, maltreatment reporting, service suspension and termination, among others.

  4. What is the significance of the January 1, 2014 deadline mentioned?

    All policies required under the 245D licensure must be developed and implemented by providers by January 1, 2014. This deadline ensures that providers comply with state regulations from the outset of their operations.

  5. Can the sample policies and forms be modified?

    Yes, 245D licensed providers may link to these sample policies and forms and modify them for use in their specific programs. However, they must ensure any modifications still meet the 245D licensing requirements.

  6. How can providers ensure their policies and forms comply with 245D licensing requirements?

    To ensure compliance, providers should read the applicable Minnesota statute sections or rule parts. Understanding these requirements helps in developing or modifying policies and forms that meet state standards.

  7. What are some examples of the required policies and procedures listed?

    Examples include Drug and Alcohol Prohibition Policy, Emergency Use Of Manual Restraint Policy, Maltreatment Of Minors Reporting and Internal Review Policy, Data Privacy Policy, and Health Service Coordination and Care Policy.

  8. What are the documentation requirements and optional program forms mentioned?

    The document also outlines optional forms for program documentation, such as the 45 Day Meeting Summary and Admission and Discharge Register form, among others. These assist in the detailed record-keeping and tracking required for quality care and compliance.

  9. Where can the latest versions of these forms and policies be accessed?

    Providers must visit the Minnesota Department of Human Services Licensing Division's website for the most current versions of policies, forms, and further guidance on compliance with 245D licensing requirements.

Common mistakes

When filling out the Minnesota Department of Human Services (DHS) form, it's crucial to avoid common mistakes to ensure compliance and the proper handling of the form. The following are eight common mistakes made:

  1. Not fully understanding the form's purpose and requirements before starting to fill it out. Each section has specific requirements tailored to different services and policies that providers must comply with.

  2. Overlooking the importance of reading the applicable MN statute or rule sections mentioned in the form. This can lead to missing essential compliance points necessary for the proper implementation of the policies.

  3. Failing to customize the sample policies and forms to suit specific program needs. While providers are permitted to modify these samples, it's crucial that any adjustments still meet the 245D licensing requirements.

  4. Omitting the date of last revision when updating policies and procedures. This date is crucial for ensuring that all practices are up-to-date and in alignment with current regulations and standards.

  5. Ignoring the requirement to develop all listed policies by the specified deadline. Delaying the development of these policies can result in non-compliance and potential legal repercussions.

  6. Skimming over the details about required policies and procedures for community residential settings and day services facilities, especially when these details are applicable to the provider's operations.

  7. Neglecting to review and update optional program forms such as the 45 Day Meeting Summary or Admission and Discharge Register form, which are critical for the accurate documentation and tracking of service recipient information.

  8. Misunderstanding the scope and application of the Intensive Support Services Assessment and other assessment-related forms, leading to incomplete or inaccurate evaluations of service recipient needs.

Avoiding these mistakes requires a thorough review of the DHS form, a clear understanding of the 245D licensing requirements, and careful attention to detail when filling out and updating the form. Properly completed forms ensure compliance, enhance the quality of service provision, and uphold the welfare of service recipients.

Documents used along the form

When handling the complexities of service provision under the Minnesota Department of Human Services (DHS), particularly for those operating within the guidelines of a 245D license, a myriad of forms and documents beyond the basic DHS form becomes indispensable. These additional documents ensure compliance, enhance service quality, and safeguard the rights and wellbeing of both service recipients and providers.

  • Admission and Discharge Register: Facilitates tracking admissions, discharges, and transfers of service recipients, critical for capacity management and historical recordkeeping.
  • Incident Report and Internal Review: Essential for documenting any significant incidents or accidents involving service recipients, allowing for internal review and regulatory reporting.
  • Medication Administration Review Record: Used to log and monitor medication dispensation, ensuring compliance with prescriptions and safeguarding against errors.
  • Health Needs Record: Provides a detailed account of a service recipient's health history, current needs, and medication regimens, crucial for personalized care planning.
  • Individual Abuse Prevention Plan (IAPP) Form: Outlines strategies and measures to prevent abuse of a vulnerable individual, tailored to their specific risks and needs.
  • Fire Drill Log: Records the dates, outcomes, and any follow-up actions from fire drills, critical for emergency preparedness and safety compliance.
  • HCBS Service Recipient Rights Packet: Informs service recipients of their rights under Home and Community-Based Services (HCBS) settings, empowering them to advocate for their dignity and choices.
  • Quality Management Evaluation and Program Improvement Plan: A structural document for continuous quality improvement, documenting evaluations of services provided and implementing changes for enhancement.

In addition to the Minnesota DHS form and the documents listed, providers may encounter other forms specific to their programs' needs or recipients' individual requirements. Together, these forms and documents form a comprehensive framework to manage, monitor, and continuously improve service delivery for vulnerable populations, ensuring providers meet regulatory standards and foster environments of care, respect, and dignity.

Similar forms

The Minnesota Department of Human Services (DHS) Form, with its comprehensive structure and requirement for detailed policies and procedures, closely mirrors the functionality and purpose of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Policies documentation. Both sets of documents aim to protect sensitive information, with the DHS form focusing on individuals receiving intensive supports and services and the HIPAA documents concentrating on the protection of individual health information. They ensure services are provided in compliance with specific regulations, emphasizing the importance of confidentiality and proper handling of personal information.

Similar to the Minnesota DHS Form, the Individualized Education Program (IEP) documents used within the education sector also provide tailored plans and services for individuals, particularly catering to students with disabilities. While the DHS form stipulates policies for intensive support services, the IEP outlines educational goals, services, and accommodations for students, focusing on ensuring that educational institutions meet the unique needs of each student. Both documents necessitate regular reviews and adjustments to ensure the evolving needs of individuals are met.

The Incident Reporting and Internal Review Forms found within the Minnesota DHS Form share their objectives with OSHA's Workplace Injury and Illness Reporting Forms. These documents are pivotal in recording and analyzing incidents to prevent future occurrences. While the DHS form specifies procedures for incident reporting in care settings, OSHA's forms are used across various workplaces to ensure safety and health regulations are maintained, highlighting a shared commitment to safety and accountability across different sectors.

Similarities can also be drawn between the Minnesota DHS Form and the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs) and interpretive guidelines. Both sets of documents serve as foundational compliance frameworks for healthcare providers, detailing the standards and requirements necessary to offer services. The DHS form provides guidelines for 245D licensed providers, whereas CMS CoPs outline the minimum health and safety standards that hospitals and other healthcare institutions must meet to participate in Medicare and Medicaid programs.

The Person-Centered Planning documents within the DHS form resemble the core principles of the Patient-Centered Medical Home (PCMH) Recognition programs. Both prioritize the individual's active participation in their care and support planning, ensuring services are aligned with their preferences, needs, and values. This person-focused approach is integral to enhancing quality, accessibility, and satisfaction in service delivery, whether in community-based support settings or primary care.

Documentation for Guardianship or Power of Attorney shares a similar intent with the admission and service consent portions of the Minnesota DHS Form. Both types of documents establish the legal and ethical guidelines for representation and decision-making on behalf of individuals who may not be fully capable of making decisions for themselves, whether due to disability, illness, or underage status. This ensures actions and services provided are in the best interest of the individual, recognizing their rights and dignity.

Lastly, the Quality Management Evaluation and Program Improvement Plan within the Minnesota DHS Form echoes the Performance Improvement Project (PIP) protocols utilized by Managed Care Organizations (MCOs). Aimed at continuous quality improvement, both documents require the implementation of systematic efforts to improve services and outcomes. Through data collection and analysis, they promote organizational learning and the application of findings to enhance service quality, reflecting a shared emphasis on accountability and excellence in service provision.

Dos and Don'ts

When filling out the Minnesota DHS form, especially for 245D licensed providers, it is essential to pay close attention to detail and adhere to the proper guidelines to ensure compliance with state requirements. Here are several do's and don'ts that can help you navigate the process effectively:

  • Do read all the required policies and procedures thoroughly to ensure you fully understand the Minnesota Department of Human Services Licensing Division’s expectations and requirements.
  • Do verify that any policy or form you choose to modify for use in your program meets the 245D licensing requirements, referring to the appropriate MN statute or rule parts as necessary.
  • Do ensure that your adapted policies and forms are developed by the specified deadlines, recognizing the importance of timeliness in compliance.
  • Do keep up-to-date with any revisions to required policies and procedures, noting the date of last revision provided by the Minnesota Department of Human Services Licensing Division to guide your review.
  • Do contact the Minnesota Department of Human Services for guidance if you are unsure about how to correctly adapt a sample policy or form for your program.
  • Don't use the sample policies and forms without first modifying them to suit the specific needs and circumstances of your program, acknowledging that each program may have unique requirements.
  • Don't overlook the importance of consulting the applicable statute sections or rule parts when ensuring that your policies and forms meet all stated requirements, as failing to do so could lead to non-compliance issues.

Adhering to these guidelines when filling out the Minnesota DHS form will help ensure that your policies and procedures are in full compliance with the state’s requirements, fostering a safe and compliant environment for those you serve.

Misconceptions

When it comes to the intricacies of the Minnesota Department of Human Services (DHS) forms and policies, especially for those involved in 245D licensed services, it's easy to find oneself tangled in a web of confusion and misinterpretation. Here are six common misconceptions about the Minnesota DHS form that need to be cleared up.

  • Misconception 1: One Size Fits All - Many believe that the sample policies and forms provided by the Minnesota DHS can be adopted as is, without any customization. However, providers are actually expected to modify these documents to suit the specific needs of their programs, ensuring that they meet all the 245D licensing requirements.
  • Misconception 2: Set in Stone - Another common misunderstanding is that once a policy is created or a form is adopted, no further changes are necessary. On the contrary, providers are responsible for continually ensuring that their policies and forms not only comply with the 245D standards but are also updated as rules or program needs evolve.
  • Misconception 3: Only the Basics Required - Some might think the list given outlines all the paperwork necessary for compliance. However, these represent only a sample of required policies and procedures. Providers must develop comprehensive policies covering all aspects of operation as dictated by 245D and any other applicable statutes and rules.
  • Misconception 4: Immediate Implementation is Optional - It's easy to assume that these requirements can be gradually met after application or licensure. But these policies and procedures are required at the time of application for providers who do not already hold a 245B license, necessitating early and swift action.
  • Misconception 5: No Legal Review Needed - Given these are samples provided by the DHS, there's a misconception that they do not need a legal review if customized by the provider. It's crucial for providers to have their adapted policies and forms reviewed by a legal professional to ensure they meet all legal requirements and adequately protect the provider and the services' recipients.
  • Misconception 6: One-Time Compliance - Lastly, there's a belief that once compliance is achieved, no further attention is needed. In reality, compliance is an ongoing process that requires regular reviews, updates to policies and procedures, and adjustments in practices to ensure they stay current with any legislative changes or best practices.

Understanding these misconceptions and correcting them is vital for any provider operating under the 245D licensure to ensure not only legal compliance but also the provision of high-quality care and services. Insight into these common errors can pave the way for more effective, person-centered support for those in need.

Key takeaways

Filling out and using the Minnesota Department of Human Services (DHS) forms for providers of Intensive Supports and Services under the 245D license involves understanding key regulations and requirements. Here are several takeaways that can help ensure compliance and proper utilization:

  • Providers must ensure that the policies and forms they adopt, whether created independently or modified from DHS samples, comply with the specifics of the 245D licensing requirements. This includes understanding the referenced Minnesota statutes or rules associated with each form or policy.
  • There are mandatory policies and procedures required at the time of application for providers not holding a 245B license. These include, but are not limited to, Drug and Alcohol Prohibition, Emergency Use of Manual Restraint, and Maltreatment of Minors Reporting and Internal Review Policies. Comprehensive knowledge of each policy’s statute or rule is crucial for adherence and successful implementation.
  • All required policies and procedures must be developed by a set deadline, previously marked as January 1, 2014. Keeping abreast of such deadlines is vital for maintaining licensing and ensuring no disruptions in service due to non-compliance.
  • Documentation and record-keeping are integral components of the 245D license requirements. Forms for assessing support services, incident reporting, medication administration, and service recipient rights must be completed accurately and maintained as per DHS guidelines.
  • Providers are encouraged to utilize the DHS sample policies and forms as starting points but must carefully modify them to fit the nuances of their specific services and client needs. Proper adaptation and customization are essential to meet the comprehensive 245D licensing standards fully.

The responsibility lies with the provider to stay informed and updated on any changes to the law or DHS requirements. Diligence in form utilization, policy implementation, and ongoing education about regulatory updates is a continuous process that helps protect both service recipients and providers while ensuring high standards of care and service delivery.

Please rate Free Minnesota Dhs Template Form
4.72
Stellar
162 Votes