Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: UPDATE TO THE HOME AND COMMUNITY BASED SERVICES REFERRAL FORM
FORM REVISION #
The Home and Community Based Services Referral form (IM-54A) has been updated.
Revisions include the following:
- Contact information for the Family Support Division (FSD) Home and Community Based Services (HCB) Unit has been updated.
- Instructions for sending HCB referrals to the Department of Health and Senior Services. Contact information has been updated.
FSD staff must continue using existing processes to refer requests for assistance with HCB services to the HCB Processing Center.
Referral processes are discussed in:
- Email Memo IM-49 Change in FSD Process for Home and Community Based Waiver Services, dated August 8, 2017
- Memo IM-22 Home and Community Based Services (HCB) Referral Update, dated March 23, 2021
Begin using the updated IM-54A effective immediately.
- Review this memorandum with appropriate staff.
- Destroy all previous versions of the Home and Community Based Services Referral (IM-54A) form.