Connect/MSC+ transfer and CFSS administrative process updates
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Administrative policy governing UCare processes for member transfers, CFSS plan documentation (DHS-6893W and DHS-6893P), THRA removal, and related intake/communication forms affecting Care Coordinators, CFSS providers, and MSC+ workflows.
UCare will implement use of DHS-6893W effective 6/1/26 and require it for DHS-6893P CFSS SDP approvals on or after 6/1/26.
Removal of the UCare Transitional Health Risk Assessment (THRA) paper form requirement.
Monthly Activity Log and form 5841 are no longer required in certain contexts (e.g., SNV and HHA); Monthly Activity Log retained for MSC+ Institutional only.
The DHS-6893W does not replace the PCA/CFSS Communication Form to UCare; both have distinct purposes.
CFSS and Transfer Administrative Criteria
CFSS and transfer administrative criteria
Requirements for CFSS plan approval, transfer processing, and communication forms.
CFSS Documentation and Coding Notes
| No codes listed |
Submission, Documentation, and Processing Requirements
Complete, sign, upload DHS-6893W and distribute approved forms
Care Coordinator must complete and sign the DHS-6893W and upload the completed form to MnCHOICES. After approval, the Care Coordinator sends the approved DHS-6893P and the DHS-6893W to the member, the CFSS provider agency, and/or the FMS provider; the CC also notifies Community Services outside of MnCHOICES when approved.
- DHS CFSS Calculator must be used when completing the DHS-6893W.
- DHS-6893W informs the member of CFSS SDP start/end dates and final units/dollar amounts.
- Do not upload the PCA/CFSS Communication Form to MnCHOICES; the DHS-6893W meets the MnCHOICES attachment requirement.
Submit PCA/CFSS Communication Form via fax or email; processing time
Submit the PCA/CFSS Communication Form (completed, signed, and dated) and any relevant documentation to UCare via the listed fax number or email address; allow up to 14 calendar days for processing of the request.
- Fax: 612-884-2094
- Email: pca_cfss@ucare.org
- Incomplete, illegible, or inaccurate forms will be returned to sender and delay processing.
Forms and Process Definitions
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