The Michigan Home Help medical needs form (DHS-54A): what it is and who signs it

The short answerThe DHS-54A, called the Medical Needs form, is a form a Medicaid-approved medical professional signs to certify that your parent needs personal care services because of a medical or disability condition. The State's policy requires one when a Home Help case opens. Your parent has to obtain it, but cannot fill it out. A doctor or other listed professional completes it.

If you are arranging care for a parent, this form can be the first thing you are asked to chase. It helps to know what it is for before you call anyone.

What the form is

The State of Michigan's Adult Services Manual (section ASM 115) calls it the Medical Needs form. It certifies a need for personal care services that comes from a medical condition, a physical disability or a cognitive disability. It is not the Home Help application. It is one required part of a case.

The manual says the medical professional does not prescribe or authorize personal care services. After the form is in, an Adult Services worker does a comprehensive assessment to decide which services are needed. To see how the whole process fits together, read who qualifies for Home Help and how to apply.

Who can sign it

The manual says the form must be completed by a medical professional who is an approved Medicaid provider, enrolled in CHAMPS, and holds one of these licenses:

• Physician (M.D. or D.O.)
• Physician assistant
• Nurse practitioner
• Occupational therapist
• Physical therapist
• Clinical nurse specialist

The professional signs and dates the form, enters their NPI number, and says whether they are a Medicaid enrolled provider. The State's client handbook adds that a Veterans Administration doctor may use VA Medical Form 10-10M instead. The manual also lists a second accepted form, the MDHHS-6200.

Who gets it, and how to find it

The manual says the client is responsible for obtaining the form, and that the client cannot complete it. The State's client handbook says you can get the form by calling your local MDHHS office. The sources we read do not say who sends the signed form back to the State, so ask your parent's Adult Services worker how they want to receive it.

Finding the right phone number

We did not find one statewide Home Help number in the State's materials. The State's Home Help handbook says to call or visit the adult services unit at your local MDHHS office. Our guide to how to contact Michigan Home Help walks through finding that office. The State has a page to find your county office at michigan.gov/mdhhs/inside-mdhhs/county-offices.

When it is needed, and when a new one is

The manual says the form is required when a case first opens. A new one may also be needed when:

• The worker sees a significant health decline that needs clarifying.
• Self-care has improved and services would be reduced, but the client says their needs have not changed.
• The time frame stated on the current form has run out.

The manual says a new form is not needed if a case closes and reopens within 90 days with no change in condition. The same goes for a denied case with a new referral within 90 days of the certification date, unless the condition has changed.

Why the signature date matters

The date of the professional's signature is the medical certification date. The manual tells the worker not to authorize Home Help services before that date. The State's client handbook says Home Help services cannot be paid before the medical professional signs the form. So an early signature date is worth asking about. Whether any hours are approved is the State's decision.

Common questions

Is the DHS-54A the same as the Home Help application?

No. The State's policy says the Medical Needs form is not the application. It is one required piece of the case.

Can I fill out the form myself or have a family member do it?

No. The State's policy says the client must obtain the form, but the client cannot complete it. A listed medical professional completes it.

Is there another form that can be used instead?

Yes. The State's manual lists the MDHHS-6200 as the other accepted Medical Needs form. A client's Veterans Administration doctor may use VA Medical Form 10-10M, according to the State's client handbook.

Can Home Help be paid for care given before the doctor signs?

The State's policy tells the worker not to authorize Home Help services before the date of the medical professional's signature. Ask the Adult Services worker how this applies to your parent.

Does the doctor decide which services my parent gets?

No. The State's manual says the medical professional does not prescribe or authorize personal care services. The Adult Services worker's assessment decides the services needed.

This is general information, not legal, tax or benefits advice. Whether someone can be paid depends on the State's decision for that person. Rules change, so confirm with MDHHS. Already Caring is a private company and is not part of MDHHS or the State of Michigan.