TX HHS Form 1749. Employer and Entity Service Agreement

The TX HHS Form 1749, Employer and Entity Service Agreement, is a crucial document that helps solve the problem of ensuring authorized services are provided to individuals with disabilities or special needs. This form is used in situations where an individual requires support services through the Consumer Directed Services (CDS) option, funded and administered by the Texas Health and Human Services Commission (HHSC). The form is typically filled out by the service provider, also known as the "Contractor," who agrees to deliver specific authorized services to the individual.

The key features of this form include required information such as the individual's name and program details, as well as conditions for payment. The Contractor must meet eligibility requirements, including criminal history checks and licensure or certification where applicable. Additionally, the Contractor must submit a completed HHSC Form 1739, Service Provider Agreement, prior to receiving payment from the Individual's Financial Management Services Agency (FMSA). The form also outlines specific procedures for documentation of services delivered and approval by the individual.

This agreement is essential for ensuring that authorized services are provided to individuals with disabilities or special needs. Key points to note include:

• The Contractor must provide authorized services at the approved rate of pay;
• Each service provider must meet eligibility requirements, including criminal history checks and licensure or certification where applicable;
• Prior to receiving payment, the Contractor must submit a completed HHSC Form 1739, Service Provider Agreement;
• The individual must approve documentation of services delivered before the Contractor can be paid.