HCBS Provider Forms


If you prefer not to print and scan paper documents the HCBS Change Request and common attachment forms are available with DocuSign. To receive our menu of DocuSign forms send an email to MMAC.DocuSign-NOREPLY@dss.mo.gov with “HCBS” in the subject line.


ADC Assurances

AIDS Waiver Addendum

Attestation of Medical Records Loss or Destruction

Business Organizational Structure

CDS Annual Service Report

CDS Assurances

CDS Quarterly Financial & Services Report

CDS Service Area Commitment

CDS Vendor Profile

Change Request – HCBS Providers

EFT – Paper Form

EVV Attestation Form

Financial Management Services (FMS) Addendum



IHS Assurances

IHS Provider Profile

IHS Service Area Commitment

Medically Fragile Adult Waiver (MFAW) Addendum

PC (APC) Addendum

Respite Timesheet – PDF

Respite Timesheet- Excel

Structured Family Caregiving Waiver