TX HHS Form 1749. Employer and Entity Service Agreement

The Employer and Entity Service Agreement (Form 1749) is a crucial document issued by the Texas Health and Human Services (HHS) for individuals receiving Consumer Directed Services (CDS). This agreement outlines the terms and conditions between the individual (hereafter referred to as "the Individual") and their service provider, also known as the Contractor.

The purpose of this form is to facilitate the delivery of authorized services by the Contractor on behalf of the Individual through the CDS option. The Contractor must meet specific eligibility requirements, including criminal history and registry checks, licensure or certification where applicable, to deliver the assigned service(s). The agreement also outlines payment terms, requiring the Contractor to submit a completed HHSC Form 1739, Service Provider Agreement, prior to receiving payment from the Individual's Financial Management Services Agency (FMSA).

This Employer and Entity Service Agreement is essential for ensuring that services are delivered in accordance with program rules and regulations. The agreement must be completed anew if there is a change in the Individual's status, such as a change in guardianship assignment or expiration of eligibility requirements. By completing this form, individuals and their service providers can ensure seamless service delivery and payment processing through the HHS-funded CDS option.