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Application for Integrated License: Home and Community-Based ... 2026
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- Click ‘Get Form’ to open the Application for Integrated License: Home and Community-Based Services in the editor.
- Begin by selecting whether you are submitting a Renewal Application or an Initial Application. Fill in the home care license expiration date if applicable.
- Complete the Applicant Information section, providing your 'Doing Business As' name, HFID number (if applicable), physical address, and contact details.
- Designate an authorized agent who will receive all notices. Ensure to provide their contact information, including email.
- In the Basic Support Services Offered section, check all services you will provide as outlined in section 245D.03.
- Review the Fees section carefully. Calculate and enter your revenue from services under this designation if you are a renewal applicant.
- Attach any required documentation for initial applicants, such as organization charts and program policies, before finalizing your application.
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Jun 19, 2017 The program permits a State to furnish an array of home and community-based services that assist Medicaid beneficiaries to live in the communityRead more
Applicants submitting a 245D license application will pay a $4,200 application fee. Annual renewal fees. All DHS licenses expire on Dec 31, of each calendarRead more
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