This version of the form is not currently in use and is provided for reference only. Download this version of Form DHS-6189Y-ENG for the current year.

Form DHS-6189Y-ENG Waiver Transportation Provider Assurance Statement - Minnesota Health Care Programs (Mhcp) - Minnesota

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What Is Form DHS-6189Y-ENG?

This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the DHS-6189Y-ENG form?
A: The DHS-6189Y-ENG form is the Waiver Transportation Provider Assurance Statement for Minnesota Health Care Programs (MHCP) in Minnesota.

Q: What is Minnesota Health Care Programs (MHCP)?
A: Minnesota Health Care Programs (MHCP) is a program that provides health care coverage to eligible individuals in Minnesota.

Q: Who is required to complete the DHS-6189Y-ENG form?
A: Transportation providers participating in the Waiver Transportation program under Minnesota Health Care Programs (MHCP) are required to complete the DHS-6189Y-ENG form.

Q: What is the purpose of the DHS-6189Y-ENG form?
A: The purpose of the DHS-6189Y-ENG form is to ensure that transportation providers comply with the requirements and standards set forth by Minnesota Health Care Programs (MHCP).

Q: Are there any fees associated with the DHS-6189Y-ENG form?
A: There are no fees associated with the DHS-6189Y-ENG form. It is a required document for transportation providers participating in the Waiver Transportation program.

Q: How often do transportation providers need to complete the DHS-6189Y-ENG form?
A: Transportation providers need to complete the DHS-6189Y-ENG form annually or whenever there are changes to their information or services.

Q: What happens if a transportation provider does not complete the DHS-6189Y-ENG form?
A: Failure to complete the DHS-6189Y-ENG form may result in the suspension or termination of the transportation provider's participation in the Waiver Transportation program.

Q: Is the DHS-6189Y-ENG form specific to Minnesota?
A: Yes, the DHS-6189Y-ENG form is specific to transportation providers participating in the Waiver Transportation program under Minnesota Health Care Programs (MHCP) in Minnesota.

Form Details:

Released on August 1, 2021;
The latest edition provided by the Minnesota Department of Human Services;
Easy to use and ready to print;
Quick to customize;
Compatible with most PDF-viewing applications;
Fill out the form in our online filing application.

Download a fillable version of Form DHS-6189Y-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.