Our website no longer supports Internet Explorer. For the best browsing experience, we recommend using Chrome, Safari, Edge or Firefox.
MSHO/MSC+ care coordination
Each HealthPartners Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+) member has an assigned Care Coordination. This page contains forms, guides, templates and clinical resources for MSHO/MSC+ Care Coordinators.
Screening & Care Plan Tools
- DHS 3428 - LTCC - Long Term Care Consultation Srv. Assmt. Form
- DHS 3428Q - Person's Evaluation of Foster Care, Customized Living, or Adult Day Services
- Person's Evaluation of FC, CL AD Work Aid
- DHS 3427 - LTC Screening Document
- DHS 3428H - Minnesota Health Risk Assessment Form
- DHS 3427H - Health Risk Assessment Screening Document
- Minnesota Health Risk Assessment Work Aid
- DHS-3427T - LTC Screening Document -Telephonic
- DHS 3426 - OBRA Level 1 Screening Form [DHS-3426]
- DHS Elderly Waiver Residential Services Workbook and Tools
- DHS 3936 - My Move Plan Summary
- DHS – 3428D – Supplemental Waiver Personal Care Assistance Assessment and Service Plan
- DHS – 4690 – Communication to Physician of Personal Care Assistance Services
- New Enrollee with PCA Workflow-8/2020
- Initial Request for PCA Services-8/2020
- PCA Request for Additional Hours-8/2020
- PCA Annual Reassessment Workflow-8/2020
- HP Collaborative Care Plan-4/2022
- HP Collaborative Care Plan Instructions
- HP Care Transition Post Discharge Assessment Form
- HP Pre-Admission Screen Process
- HP Unable to Reach Outreach Form-12/2019
- MSC+ Care Coordinator Change-4/2022
- MSC+ Care Coordinator Introduction-4/2022
- MSC+ Care Plan to Member-4/2022
- MSC+ Care Plan to Member Other-4/2022
- MSC+ Care Plan to MD or Care Team
- MSC+ Unable to Reach-5/2022
- MSC+ Member Services Care Plan Change-4/2022
- MSHO/MSC+ Provider Care Plan Cover Letter
- MSHO/MSC+ Provider Care Plan Summary Letter
- MSHO Care Coordinator Change-4/2022
- MSHO Care Coordinator Introduction-4/2022
- MSHO Care Plan to Member-4/2022
- MSHO Care Plan to Member Other-4/2022
- MSHO Care Plan to MD or Care Team
- MSHO Member Services Care Plan Change-4/2022>
- MSHO NH Authorized Representative-4/2022
- MSHO Unable to Reach-5/2022
- Reminder: Please remember to enclose the appropriate attachments found in the Miscellaneous section. Enclosures for members will include the Statement of Non-Discrimination & Language Block and may include the appropriate Appeal Rights.
- Bolger Order Form-1/2022
- LSS HP readmit prevent referral form-1/2022
- DHS 5181 - Long Term Care (LTC) Communication Form [DHS-5181]
- DHS 5841 - Recommendation for State Plan Home Care Services[DHS-5841]
- DHS 6037 - Home and Community-Based Services (HCBS) Transfer & Communication Form [DHS-6037]
- DHS MMIS Data Entry Form
- DHS MMIS Data Entry Confidentiality Agreement
- HP Authorization to Disclose PHI-4/2022
- HP Benefit Exception Inquiry Form
- HP Benefit Exception Instructions
- HP Denial Termination/Reduction (DTR) Form-12/2019
- HP Denial Termination/Reduction Instructions
- HP Service Authorization Form-12/2019
- Transitional Health Risk Assessment Form-8/2020
- Clinical Care Planning Guide - Asthma
- Clinical Care Planning Guide - CAD
- Clinical Care Planning Guide - Chronic Pain
- Clinical Care Planning Guide - Diabetes
- Clinical Care Planning Guide - Eating Disorders
- Clinical Care Planning Guide -HTN
- Clinical Care Planning Guide - Mental Health
- Health Information Library
- Fast Track Interventions Skin Breakdown
- Fast Track Interventions UTI
- FBRxCobraandedBoxInsert-1/2022
- FBRxCobraandedOutreachLetter-1/2022
- Final Tivity Silver Sneakers-1/2022
- Key Contacts Guide
- Language & Interpreter Services
- 2022 MSHO Supplemental Benefits-1/2022
- 2022 MSHO Supplemental Benefits – How to Order-1/2022
- MinnesotaHelp.Info
- Safe Disposal of Medications-1/2022
- Safe Disposal of Medications Locations Flyer-1/2022
- Safe Disposal of Prescription Medication Brochure-1/2022
- Silver Sneakers workaround to getting member 16 Digit ID-1/2022
- Supplemental Benefits - iPad Criteria - HP
- ILS Authorization Guidelines-12/2019
- PCA Network Listing
- Quick guide for Juniper referrers
- Juniper program descriptions
- Juniper tri-fold brochure
- 2022 MSHO Model of Care Training-1/2022
- HealthPartners-Bluestone Care Coordination Update-1/2022
- SilverSneakers Overiew PPT-1/2022
- Model of Care Training 2020
- Model of Care Training 2019
- MSHO Training Manual
- Presentation Provider Signature Requirement Training
- Webinar Presentation - HP Delegation training
- HSS Program Updates and MSHO Training-8/2020
- Psychiatric Admission Guide
- Do's and Don't of Discussion Mental Health
- Delusions of Illness
- ACT Teams
- NAMI Mental Health Crisis Planning
- Mental Health Crisis Alliance
- NAMI Behavioral Health Medication List
- DHS Behavioral Health Homes Website
- RideCare & Spec. Transportation Exception Request Policy
- RideCare & Spec. Transportation Exception Request Form
- HealthPartners Fax Ride Request Form
- Appeal Rights - MSHO
- Appeal Rights - MSC+
- Statement of Non-Discrimination and Language Block-4/2022
- DHS Care Plan Audit Protocols - EW-4/2022
- DHS Care Plan Audit Protocols - Non-EW-4/2022
- Contact Request Form-12/2019
- HP Care Coordination for MSHO Policy-9/2020
- HP Code of Conduct
- HP Delegation Oversight Policy-9/2020
- HP First Tier Downstream Related Entity (FDR) Attestation Template
- HP First Tier Downstream Related Entity (FDR) Policy
- HP Fraud Waste Abuse (FWA) Policy
- Utilization and Review and Financial Incentive-9/2021