TX HHS Form 2065-B. Notification of Waiver Services

The Texas Health and Human Services (HHS) issues the Notification of Waiver Services form, TX HHS Form 2065-B, to notify individuals of their eligibility for specific waiver programs. This document outlines the services identified on the individual's service plan, including effective dates and any changes to the plan.

The form provides essential information about the individual's responsibilities, such as paying for room and board or copayments, along with the authorized providers delivering these services. It also includes a note regarding provider authorization, emphasizing that services are only valid until the termination date or the "To" date on the service plan.

This notification is an important tool for individuals receiving waiver services to understand their rights and responsibilities. As stated on page 2 of the form, it includes a statement of these rights, ensuring transparency and clarity throughout the process. By completing this form, the HHSC Case Manager Office provides essential information to facilitate effective service delivery and management.