473 NAC 2-005.04
Form DSS-4A designates the vendor responsible for providing the service authorized in the plan and gives special instructions and service limitations. Each provider from whom service is purchased must receive Form DSS-4A for prior authorization of service. Data entry of Form DSS-4A is optional; if it is desired the local unit shall notify Central Office.
If an individual in-home service provider is authorized, the client shall sign Form IRS-2678, "Employer Appointment of Agent" (see 473 NAC 3-003.01).
2-005.04A Authorization Standards