Applications and Forms

Home and Community Based Services

HCBS Referral Form (HCBS-1)

Money Follows the Person

Request for Supplemental Transition Funds

Provider Billing Forms

SSBG/GR Advanced Respite Invoice
SSBG/GR In-Home Services Invoice

Direct Deposit Information

Vendor ACH/EFT Application - (This form is for SSBG/GR payments only)

The Application for Provider Direct Deposit form must be used for MO HealthNet payments. The form is available at the MO HealthNet Division’s web site.  A form must be submitted for each MO HealthNet provider number.