Get Mn Dhs-6322a-eng 2012-2026

The MN DHS-6322A-ENG form is designed for users seeking authorization for continued Dialectical Behavior Therapy (DBT) services. This guide provides clear, step-by-step instructions for filling out the form online, ensuring that users can complete their requests efficiently and accurately.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by filling out the recipient information section. Enter the recipient's last name, first name, middle initial (MI), MHCP recipient ID number, date of the current diagnostic assessment, and date of the current functional assessment in the designated fields.
3. If DBT is being provided alongside exclusionary services, complete the rationale section. Clearly describe the medical necessity for providing concurrent services, referencing options like partial hospitalization, outpatient psychotherapy, or day treatment.
4. Indicate the expected duration of DBT treatment by filling in the start and end dates. Include discharge criteria if discharge is anticipated within this authorization period and describe the expected changes in functioning as a result of DBT involvement.
5. Address the four criteria for continued DBT authorization. For each criterion, describe the recipient's participation and engagement in the treatment program, progress made, evidence of continued need for skill acquisition, and planning for transition and discharge.
6. In the provider statement section, type or print the provider's name, title, and signature. Ensure that the provider completes all required fields, including the date.
7. Gather and prepare the supporting documentation that must accompany the DBT authorization request. This includes the current diagnostic assessment, most recent functional assessment, updated treatment plan, and LOCUS Recording Form if available.
8. Finally, after reviewing all information for accuracy and completeness, save the changes. You can then download, print, or share the completed form as necessary.

Start filling out the MN DHS-6322A-ENG online today to ensure timely authorization for continued DBT services.