Are you a Michigan resident looking for help with application forms, like the Homehelp form? If so, no need to worry. The State of Michigan has made the process simple and offers assistance when filling out these forms. This blog post will provide easy-to-follow instructions on how to fill out the Homehelp form and any other required paperwork accurately and completely, as well as links to helpful resources. With these tips in hand, you'll be able to simplify your homehelp application experience while avoiding common mistakes. Let's get started!
| Question | Answer |
|---|---|
| Form Name | Michigan Gov Homehelp Form |
| Form Length | 9 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 2 min 15 sec |
| Other names | DHS, MDCH, MSA-4678, ASM |
|
|
ASB |
ASM 135 |
1 of 9 |
HOME HELP PROVIDERS |
INTRODUCTION
The items in this section apply to both individual and agency provid- ers.
PROVIDER
SELECTION
The client has the right to choose the home help provider(s). As the employer of the provider, the client has the right to hire and fire pro- viders to meet individual personal care service needs. Home help services is a benefit to the client and earnings for the provider.
The determination of provider criteria is the responsibility of the adult services specialist.
Home help services cannot be paid to:
A spouse caring for a spouse or a parent caring for an unmarried child under 18 (responsible relative).
Note: Couples who are separated must provide verification
that they are no longer residing in the same home
(unavailable). Verification may include their driver’s license, rent receipt or utility bill reflecting their separate mailing address. A spouse who is legally separated from a spouse cannot be paid to provide home help.
A minor (17 and under).
Fiscal Intermediary (FI).
Note: Fiscal intermediary services is defined by CMH as services that assist the client in meeting their goals of
community participation and integration, independence or productivity, while controlling the client’s individual budget and
choosing staff who will provide the services and supports identified in the individual plan of service. The fiscal intermediary facilitates in the employment of service providers and is not the provider of direct hands on care services.
Home help providers who also provide
Example: Home help services cannot be provided from 8:00 a.m. until 10:00 a.m., if the provider is also providing
ADULT SERVICES MANUAL |
STATE OF MICHIGAN |
DEPARTMENT OF HUMAN SERVICES
|
|
ASB |
ASM 135 |
2 of 9 |
HOME HELP PROVIDERS |
PROVIDER
CRITERIA
Determine the provider's ability to meet the following minimum cri- teria in a
Age
The provider must be 18 years and older.
Ability
To follow instructions and home help program procedures.
To perform the services required.
To handle emergencies.
Physical Health
The provider’s health must be adequate to perform the needed ser- vices.
Knowledge
The provider must know when to seek assistance from appropriate sources in the event of an emergency.
Personal
Qualities
The provider must be dependable and able to meet job demands.
Training
The provider must be willing to participate in available training pro- grams if necessary.
Home help payment may be terminated if the provider fails to meet any of the provider criteria.
PROVIDER
INTERVIEW
An initial
Explain the following points to the client and the provider during the initial interview:
ADULT SERVICES MANUAL |
STATE OF MICHIGAN |
DEPARTMENT OF HUMAN SERVICES
ASB
ASM 135 |
3 of 9 |
HOME HELP PROVIDERS |
The provider is employed by the client not the State of
Michigan.
As the employer, the client has the right to hire and fire the provider.
A provider who receives public assistance must report all income received as a home help provider to their family independence specialist or eligibility specialist.
The client and provider are responsible for notifying the adult services specialist within 10 business days of any change in providers or hours of care.
The provider and/or client is responsible for notifying the adult services specialist within 10 business days if the client is hospitalized.
Note: Home help services cannot be paid the day a client is admitted into the hospital but can be paid the day of discharge.
The provider must keep a log of the services provided on the
on a quarterly basis. The log must be signed by both the provider and client or the client’s representative.
All earned income must be reported to the IRS; see
www.irs.gov.
No federal, state or city income taxes are withheld from the warrant.
Parents who are caring for an adult child do not have FICA withheld.
Note: Parents who wish to have FICA withheld must be assigned in ASCAP as other relative in the Provider Assignment screen.
All individual providers will receive a
Department of Community Health.
Provider must display a valid picture identification card and social security card.
ADULT SERVICES MANUAL |
STATE OF MICHIGAN |
DEPARTMENT OF HUMAN SERVICES
ASB
ASM 135 |
4 of 9 |
HOME HELP PROVIDERS |
The client and provider must sign the
Note: Providers determined to be a business/agency are exempt from signing the
All providers must sign a
Provider Agreement, before payments are authorized.
Note: Providers are required to complete and sign the agreement only once. If there is a signature date on Bridges/ASCAP provider screen, another
PROVIDER
ENROLLMENT
All home help providers must be enrolled in Bridges by a designee at the local county DHS office prior to authorizing payment. Once a provider is enrolled, Bridges will assign the provider a seven digit identification number. The adult services specialist must allow 24 hours from the time of enrollment for Bridges to interface with
ASCAP.
Instructions for enrolling a provider on Bridges are found on the Office of Training and Staff Development home page. Instruc- tions on assigning a provider in ASCAP are in the ASCAP User Guide located on the adult services home page.
PERSONAL CARE SERVICES PROVIDER LOG
Each individual provider must keep a log of home help services delivered. The DHS- 721 is used for this purpose.
Tasks on the provider logs are automatically marked with an X when printed from ASCAP based on the client’s home help
functional assessment.
The provider must indicate what services were provided and on which days of the month.
ADULT SERVICES MANUAL |
STATE OF MICHIGAN |
DEPARTMENT OF HUMAN SERVICES
ASB
ASM 135 |
5 of 9 |
HOME HELP PROVIDERS |
The client and the provider must sign the log when it is completed to verify that the services approved for payment were delivered.
The log must be submitted to the local office quarterly. Provider logs must be received within 10 business days after the last service date on the log. Failure to do so will result in suspension of payment.
The adult services specialist must initial and date the log upon receipt, demonstrating review of the log.
Retain the log in the client’s case record.
A separate log is required for each provider.
Incomplete logs must be returned to the client/provider for completion.
Agency/business providers have the option of submitting monthly invoices in lieu of the
The service (s) provided, and
The date(s) of service.
See ASM 136, Agency Providers.
HOME HELP STATEMENT OF EMPLOYMENT
The purpose of the
An employment statement must be signed by each provider who renders service to a client.
The statement of employment does the following:
Confirms an understanding of the personal care services provided, how often services are provided, and wages to be paid.
ADULT SERVICES MANUAL |
STATE OF MICHIGAN |
DEPARTMENT OF HUMAN SERVICES
ASB
ASM 135 |
6 of 9 |
HOME HELP PROVIDERS |
Requires positive identification of the provider by means of a picture ID and social security card.
Documents an understanding by both parties that the client, not the State of Michigan, is the employer of the provider.
Stipulates that the client must report any changes in the work schedule to the adult services specialist.
Instructs the provider to repay the State of Michigan for services they did not provide.
Informs the provider that a
Informs a provider receiving public assistance that this employment must be reported to the Department of Human Services
Requires the client and provider must sign the
Distribution of Employment Statement
The adult services specialist will make two copies of the completed and signed form and distribute as follows:
Give one copy to the client.
Give one copy to the provider.
Place the original form in the client’s case record.
MEDICAL ASSISTANCE HOME HELP PROVIDER AGREEMENT
Federal regulations require that all providers of Medicaid covered services complete and sign a provider agreement. This agreement states providers will abide by Medicaid policies in providing services to program clients and in receiving payment from the program. In order to meet this requirement, the Michigan Department of Community Health (MDCH) developed the MSA- 4678, Medical Assistance Home Help Provider Agreement.
ADULT SERVICES MANUAL |
STATE OF MICHIGAN |
DEPARTMENT OF HUMAN SERVICES
ASB
ASM 135 |
7 of 9 |
HOME HELP PROVIDERS |
All home help services providers must have a completed and signed
Procedure
The adult services specialist will furnish a copy of the
Before forwarding the
Assign Provider Tab.
Send the
Provider Enrollment Lewis Cass Building 3rd Floor
320 S. Walnut
Lansing, Michigan 48913
MDCH Provider Enrollment scans the provider agreements and files them under the provider identification numbers.
Locating MSA-
4678 Signature
Date in ASCAP
To locate the
Select Client.
Select the HIS $ icon.
Click on the Provider/TimeTask/Service Plan button. Highlight the provider.
Locate the 4678 Date field. This is a read only field, reflecting what is in Bridges.
ADULT SERVICES MANUAL |
STATE OF MICHIGAN |
DEPARTMENT OF HUMAN SERVICES
ASB
ASM 135 |
8 of 9 |
HOME HELP PROVIDERS |
If there is a date in the signature date field, a
Note: The signature date can also be found in ASCAP under the Client’s for Provider tab. Access this screen by clicking on the utilities menu and selecting Client’s for Provider. Search by the
provider name or identification number and click on the provider name. The provider information is displayed on the detail screen, including the
LOCAL OFFICE
INDIVIDUAL HOME
HELP PROVIDER
HOURLY RATE
Each local DHS office has an established individual home help pro- vider rate. Specialists must not authorize above or below the estab- lished rate.
Cases with hourly rates above the established county rate must be substantiated by an approval letter
PROVIDER
INCOME
VERIFICATION
Requests received by the local office for verification of provider income or employment should be forwarded to MDCH at:
Michigan Department of Community Health
Long Term Care Services Policy Section
Capital Commons Building, 6th Floor
P.O. Box 30479
Lansing, Michigan 48909
OR
FAX to
ADULT SERVICES MANUAL |
STATE OF MICHIGAN |
DEPARTMENT OF HUMAN SERVICES
|
|
ASB |
ASM 135 |
9 of 9 |
HOME HELP PROVIDERS |
JOINT POLICY
DEVELOPMENT
The Adult Services Manual (ASM) policy has been developed jointly by the Michigan Department of Community Health (MDCH) and the Department of Human Services (DHS)
ADULT SERVICES MANUAL |
STATE OF MICHIGAN |
DEPARTMENT OF HUMAN SERVICES