TX HHS Form 1728. Liability Acknowledgement

The TX HHS Form 1728, Liability Acknowledgement, is a crucial document that helps resolve the issue of employer liability in Consumer Directed Services (CDS) options. This form is used when an individual or their legally authorized representative (LAR) hires service providers as employees to receive services.

This form outlines the responsibilities and liabilities of both the employer and employee. The employer is solely responsible for any negligent acts or omissions by themselves, their employees, or contractors. The form also highlights that employees are not employed or retained by the Texas Health and Human Services Commission (HHS), state or federal governmental agencies, or the Financial Management Services Agency (FMSA). As an applicant for employment through the CDS option, individuals acknowledge reading and understanding this information.

The form requires both the employer and applicant to sign and date their acknowledgement. Additionally, employers must complete Section I if they are a subscriber of Texas Workers' Compensation or Section II if they have made alternative arrangements for employee work-related injuries or illnesses. This document helps ensure that all parties understand their roles and responsibilities in the CDS option.

• This form is used when hiring service providers as employees to receive services through Consumer Directed Services (CDS) options.
• The employer is solely responsible for any negligent acts or omissions by themselves, their employees, or contractors.
• Employees are not employed or retained by the Texas Health and Human Services Commission (HHS), state or federal governmental agencies, or the Financial Management Services Agency (FMSA).