TX HHS Form 1720. Appointment of a Designated Representative

The TX HHS Form 1720, Appointment of a Designated Representative, is a crucial document that helps solve the problem of designating a representative to manage consumer-directed services (CDS) for individuals receiving care. This form is typically used in situations where an individual requires assistance with managing their CDS benefits and needs someone to act on their behalf.

This form requires specific information from the employer, including the relationship between the employer and the person receiving services, as well as details about the designated representative (DR). The DR must be a willing adult 18 years or older who has agreed by signature to serve in this capacity. Additionally, if the DR is a non-relative, the employer must obtain information needed to request a criminal conviction check with the Department of Public Safety.

The form also includes conditions and responsibilities for the designated representative, including the requirement that they grant permission for the financial management services agency (FMSA) to obtain a criminal conviction check. Furthermore, if the DR has been convicted of an offense under Chapter 32 of the Penal Code or an offense barring employment as listed in the Texas Health and Safety Code, Section 250.006(a) and (b), they are ineligible to participate in the CDS option.

• The form is used for designating a representative to manage consumer-directed services (CDS) for individuals receiving care.
• It requires specific information from the employer, including the relationship between the employer and the person receiving services.
• The designated representative must be a willing adult 18 years or older who has agreed by signature to serve in this capacity.
• If the DR is a non-relative, the employer must obtain information needed to request a criminal conviction check with the Department of Public Safety.