HCBS waiver providers enrolling with DHS must meet general and service-specific MHCP requirements. All enrolled providers enter into an MHCP Provider Agreement. HCBS waiver providers must complete additional documents to support verification of provider qualifications including service specific assurances and copies of licenses, certifications, registrations and permits.
Provider Enrollment at DHS is responsible for handling all of the enrollment paperwork for waiver service providers. You send the required information to Provider Enrollment using a fax machine. The fax number is (651) 431-7462. Information required includes:
- Use the Waiver and Alternative Care (AC) Programs Service Request Form (DHS-6638) to report the service(s) you plan to provide and report your qualifications to provide the service(s)
- Completed MHCP Provider Agreement (DHS-4138)
- Completed Application and Instructions for Home and Community Based Services Providers (DHS-4015)
- Addendums to the provider agreement and/or assurances may also be required depending on the service (s) provided
- Disclosure of Ownership and Control Interest
- Direct Deposit/Electronic Funds Transfer
After an agency or individual meets provider enrollment requirements, MHCP will send a Welcome Letter to confirm your enrollment.
