Form 1056 Overview

DSPD uses the Form 1056 to establish the purchase of service(s) and set authorized spending limits.  The Form 1056 is also referred to as the Purchase of Services, the Purchase Service Authorization, the Authorization to Bill Services, and/or DHS/DSPD Service Authorization Form.

The Form 1056 is the official / formal document used to establish (between DSPD and the service provider) the "authorized" type, amount, and duration of the service(s) the provider is expected to deliver to the person.  The provider is required to authorize at least one employee to view and electronically approve or reject each 1056.  

Electronic approval of the 1056 means the provider has accepted the type, amount, and duration of the service(s) documented on the form and they agree to deliver those services within that scope until the service / plan ends.  

Electronic rejection of the 1056 means the provider disagrees with the type, amount, and/or duration of the service(s) documented on the form and they require the support coordinator to resolve the cause of the disagreement.

The 1056 data is driven by and oriented around the version / activation of the Person Centered Support Plan (PCSP).

If a "material" change is made to a service the provider delivers on the PCSP Budget, the provider is required to electronically approve or reject the 1056 produced by the change.  A "material" is one where the service code's, start/end dates, rate or units are changed.  If the Monthly Max is the only item changed on the budget in that version of the plan, then no 1056 is generated.

If the provider wants to stop delivering services to the Person, they must give written notification of their intention to do so at least 30 days in advance of the date the change is expected to happen to:

     a. The person and/or their legal representative/guardian (if any).

     b. DHS/DSPD.