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Adult Foster Care - Provider Corner
Provider Forms Provider FormsAppeal/Grievance Procedure - Timelines for appealing negative licensing actions and grievance procedures for providers. Competency Rule - This review test must be completed by applicants at initial licensure. It also may be used as a training aid for AFC homes which employ staff. Disaster Plan - This form will be used in the case of an emergency involving a pandemic outbreak, natural disaster, or catastrophic event. Providers must update the licensor within 14 days of any changes to the contact information on the form. Fire Drill Log - To document provider's fire and storm drills. Floor and Escape Plan - To diagram provider's home. Home Safety Checklist - Licensor uses to inspect provider's home. Incident Report - Provider completes when an accident occurs. Individual AFC/FADS Background Studies Training - Link to the DHS website for providers to be trained on entering background study information on NETStudy. Off-Year Review - This form will be sent to the provider one year after a relicensing visit. The provider should review the form carefully and document completion of each of the items in order to verify annual compliance with MN Rules and Statutes regarding AFC licensure. Placement Record - To document resident placements. Program Abuse Prevention Plan - This plan is completed by the license holder by assessing the residents and physical environment of the licensed facility and surrounding grounds. The license holder should determine how the risk of harm will be reduced in each area of assessment. This form must be reviewed annually by the license holder and updated as the needs of the residents change. This plan should not contain resident names or identifying information. Provider Enrollment Application - All providers delivering services to enrollees of MN Health Care Programs (MHCP) must complete an Enrollment Application form and a Provider Agreement form. A provider number must be assigned in order for the provider to be able to submit a claim for payment for Adult Foster Care services provided to clients on the Elderly Waiver, CADI Waiver, TBI Waiver, or MR/RC Waiver. Training Log - Caregivers with 0-5 years of licensure/experience are required to complete 12 hours of training annually. Caregivers with 6+ years of licensure/experience are required to complete 6 hours annually. Vulnerable Adult Act Training - Annual training on the Vulnerable Adult Act is required by MN Statute 245A.65. Complete the on-line competency test and follow instructions to obtain a certificate of completion. All license holders and caregivers must receive a score of 80% or higher to be considered adequately trained on the Vulnerable Adults Act. Maintain annual certificates with the license holder and caregivers' training logs. NOTE: Forms are in Adobe Acrobat format. If necessary download the free Reader from Adobe's website. Placement PacketThe Placement Packet must be completed at admission for every Adult Foster Care resident in the home. The license holder is responsible for assuring that these forms are completed according to MN Rule 9555.6245.
Relicensing PacketRelicensing Checklist - Review in preparation for licensing visit. DHS Family Systems Application - Complete the application, sign, and return to licensing. To find out the municipality contact information required for page 5 of the application, please see the City Officials or Township Officers lists of government officials in Wright County. Privacy Rights Notice - Review for privacy rights information. Privacy Rights Signature Page - Sign and return to licensing. Instructions for NETStudy - Follow instructions for initiating background studies prior to licensing visit. Home Safety Checklist - Complete and maintain in the home until licensing visit. Training Log - Complete and return to licensing. Fire Drill Log - Complete and return to licensing. Placement Record - Complete and return to licensing. Staff and Training Log for 245B (DD Waiver) Licensed Sites - This form must be completed at relicensing time for all homes licensed to provide residential habilitation services (DD Waiver) under MN Statute 245B. Vulnerable Adult Act Training - Annual training on the Vulnerable Adult Act is required by MN Statute 245A.65. Complete the on-line competency test and follow instructions to obtain a certificate of completion. All license holders and caregivers must receive a score of 80% or higher to be considered adequately trained on the Vulnerable Adults Act. Maintain annual certificates with the license holder and caregivers' training logs. Licensing LawsMinnesota Department of Public Safety Minnesota Statute 245A - Human Services Licensing Act Minnesota Statute 245C - Human Services Background Studies Act Multidisciplinary Adult Protection Team Adult Foster Care Provider Meeting June 9, 2011 - This information was presented at the Adult Foster Care provider meeting held at Wright County Human Services on June 9, 2011. The information includes statistics, resources, substitute decision-making, diet/nutrition, GRH agreement/contract, Borderline Personality Disorder, individual resident record, money/valuables, placements, training, changes to AFC licensing, submitted questions. Adult Foster Care Provider Meeting February 3, 2011 - This information was presented at the Adult Foster Care provider meeting held at Wright County Human Services on February 3, 2011. The information includes Provider Updates, Statistics, Flooding, Hot Water, GRH Payments, Internal Reviews, Medication Assistance, OIG Exclusion Checklist, Cash Resource Assistance, Public Health Trainings, Training (VA & On-line), Upcoming Events, and Communication. Adult Foster Care Provider Meeting August 16, 2010 - This information was presented at the Adult Foster Care provider meeting held at Wright County Human Services on August 16, 2010. The information includes statistics, resident records, house rules, taxes, billing, placements and host county concurrence, contracts, training hours, VA training, law changes, on-line training, medication disposal, data privacy issues, incident reports, and communication. Adult Foster Care Provider Meeting October 20, 2010 - This information was presented at the Adult Foster Care provider meeting held at Wright County Human Services on October 20, 2010. The information includes statistics, provider updates, marketing/advertising, hunting, client passing, correction orders, training needs, CRS/RSS license, holidays, medications, upcoming events, and communication. Adult Foster Care Provider Meeting April 13, 2010 - This information was presented at the Adult Foster Care provider meeting held at Wright County Human Services on April 13, 2010. The information includes statistics, NETStudy, training requirements, technology updates, off-year reviews, requirements for resident records, Vulnerable Adult training resources, and information about the roles of the Ombudsman, Powers of Attorney, guardians, and conservators. Adult Foster Care Provider Meeting January 14, 2010 - This information was presented at the Adult Foster Care provider meeting held at Wright County Human Services on January 14, 2010. The information includes medical supply resource, statistics, NET Study, background study monitoring, residents' records, documents to maintain, VA Act training, and provider manuals. Adult Foster Care Provider Meeting September 30, 2009 - This information was presented at the Adult Foster Care provider meeting held at Wright County Human Services on September 30, 2009. The information includes statistics, H1N1 updates, and legislative updates on background studies, VA training, data privacy, capacity, and supervision technology. 211 Information and Referral - "211" is the national abbreviated dialing code for access to health and human services information and referral. 211 is a free, confidential service with universal social value, accessible to the entire population and national in scope. 211 is for everyone - from individuals, families, and professionals to community agencies, government, and people facing barriers due to language, poverty or personal difficulty. Calling 211 will help anyone get information and access to vital community services. The 211 call will be answered 24/7 by an Information and Referral Specialist who assesses the caller's needs and refers the person to the appropriate community, social, health and government services. Alzheimer's Association - The Alzheimer's Association is the largest national voluntary health organization supporting Alzheimer research and care. Foster Provider Liability Coverage through Minnesota Joint Underwriting Association - 1-800-552-0013. All foster care providers in the State of Minnesota licensed by the Department of Human Services, Department of Corrections, approved by a tribal government or a court, and foster clients are automatically covered by the policy. Adult foster care providers must also live in the home with the clients and be the primary care giver. Office of Inspector General (OIG) Exclusion/Medicare & Medicaid Fraud - A search must be completed monthly by all providers registered as a Minnesota Health Care Provider. Search for all individuals affiliated with the licensed Adult Foster Care facility. Office of the Ombudsman for Mental Health and Mental Retardation Schedule II Controlled Substances - Schedule II controlled substances must be stored in a locked area. Tax Information - Publication 17 contains tax information regarding certain foster care payments. The Arc - The Arc is a national organization of and for people with mental retardation and related developmental disabilities and their families. Services Available to Seniors Booklet Schedules/Training DatesNo Schedules or Training Dates available at this time. |
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