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RESTORE AND COMMUNITY BASED SERVICES (HUBS) ELIGIBILITY/INELIGIBILITY/CHANGE FORM (Completion Instructions on Pages 47) DEPARTMENT OF HUMAN SERVICES (DHS) OFFICE INFORMATIONCounty assistance office

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How to fill out home and community-based services

01

Contact your local Area Agency on Aging or Aging and Disability Resource Center to see if you qualify for home and community-based services.

02

Complete an assessment to determine your needs and create a care plan.

03

Choose a provider for the services you require.

04

Fill out any necessary forms and submit them to the appropriate agency.

05

Schedule an interview with a case manager to discuss your care plan and preferences.

06

Review and sign the care plan to start receiving services.

Who needs home and community-based services?

01

Seniors and older adults who require assistance with daily activities such as bathing, dressing, and meal preparation.

02

Individuals with disabilities who need support to live independently in their own homes and communities.

03

People with chronic health conditions who can benefit from medical care and therapy services provided at home.

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What is home and community-based services?

Home and community-based services are programs designed to help individuals with disabilities or elderly individuals remain in their homes and communities rather than in institutions.

Who is required to file home and community-based services?

Providers of home and community-based services are required to file these services.

How to fill out home and community-based services?

To fill out home and community-based services, providers must document the services provided, the individuals receiving the services, and any other required information.

What is the purpose of home and community-based services?

The purpose of home and community-based services is to support individuals with disabilities or elderly individuals in maintaining their independence and quality of life.

What information must be reported on home and community-based services?

Providers must report on the types of services provided, the individuals receiving the services, the frequency and duration of services, and any other required information.

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