7/18/16
Dear Care Coordination Partners,
As DHS moves forward with requirements related to Person Centered Planning, Blue Plus will update Care
Coordinators on the use of the newest forms and requirements. Please see information below regarding a required
DHS form 3936-ENG called “My Move Plan Summary”. The Person-Centered, Informed Choice and Transition
Protocol (PDF) requires Care Coordinators to work together with the person who is moving to create this summary.
Please begin using this form immediately. The Care Coordination Guidelines will be updated to reflect this
requirement.
Please contact your Partner Relations Consultant with any questions.
Thank you,
Government Programs Partner Relations Team,
[email protected]
Policy Integration/HCBS
Past Bulletins
July 15, 2016
TO: Case managers, support planners and other interested
stakeholders
FROM: DHS Aging and Adult Services and Disability
Services divisions
EFFECTIVE: Immediately
PURPOSE: To announce the release of the My Move Plan Summary
(DHS-3936) in eDocs
CONTACT: [email protected]
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Lead agencies should start using the My Move Plan
Summary (DHS-3936)
To help with the process of moving, DHS created the My Move Plan Summary, DHS-3936ENG (PDF) to support people with disabilities, including people with mental illness and
people who use long-term supports and services. The summary is a written agreement
that:

Helps to clarify roles expectations before, during and after the move

Helps make the move successful as it clearly communicates all of the key elements
of the plan.
Requirements
The Person-Centered, Informed Choice and Transition Protocol (PDF) requires lead
agencies, specifically case managers and support planners, to work together with the
person who is moving to create this summary.
Lead agency roles and responsibilities
When using the My Move Plan Summary, the lead agency (e.g., support planner, case
manager, etc.) should:

Initiate the document’s creation

Build and share the summary with the person

Inform the person about the process, including any changes to the plan

Refer to the document throughout the move

Update the document when it needs modification or changes

Sign and keep a copy of the completed document in the person’s file.
For more specific information about lead agency responsibilities, see Page 16 of the protocol
(PDF).
More information
Blue Cross® and Blue Shield® of Minnesota is a nonprofit independent licensee of the Blue Cross and Blue Shield Association
Care Coordination Communiqué
Government Programs from Blue Plus
DHS is in the process of developing online person-centered practices content to support
lead agency staff. It will be available soon, and we will alert you when it is ready.
In the meantime, to view transition requirements, view Bulletin #16-56-02: Lead Agency
Requirements for Person-Centered Principles and Practices – Part 2 (PDF).
Blue Cross® and Blue Shield® of Minnesota is a nonprofit independent licensee of the Blue Cross and Blue Shield Association