TX HHS Form 2065-B. Notification of Waiver Services

The TX HHS Form 2065-B, Notification of Waiver Services, is a crucial document that helps individuals who have been determined eligible for a specific waiver program. This form serves as a notification to the individual and relevant providers about the services they are entitled to receive under the program.

This form requires key information such as the name of the waiver program, the individual's eligibility date, and the effective dates for their services. It also outlines the individual's responsibilities, including paying for room and board or copayments, and specifies the providers authorized to deliver services. The form highlights the importance of following the Individual Service Plan/Individual Plan of Care (ISP/IPC) and notes that providers are not authorized to provide services after the termination date or "To" date.

The TX HHS Form 2065-B is typically filled out by HHSC Case Managers, who use it to notify individuals about their waiver services. Key points to note include:

• The form is used for individuals determined eligible for a specific waiver program.
• It outlines the individual's services and responsibilities under the program.
• Authorized providers are specified, along with any conditions or follow-up actions required.