TX HHS Form 2327. Individual or Member and Provider Agreement

The TX HHS Form 2327, Individual or Member and Provider Agreement, is a crucial document that helps facilitate a mutually beneficial arrangement between an individual/member and their provider in the Adult Foster Care (AFC) program. This form outlines the essential terms and responsibilities of both parties, ensuring a smooth and respectful living environment for aged and disabled adults.

This agreement requires key information, including the individual's/member's name, social security number, and Medicaid number. The provider must comply with minimum standards for AFC, provide services according to authorization, and allow HHSC/MCO representatives to monitor or inspect their home at reasonable hours. The individual/member has a right to privacy, and both parties agree to abide by Title VI of the Civil Rights Act of 1964.

The form also outlines monetary responsibilities, including payment of room and board, purchase of personal items, and other expenses. This agreement is essential for individuals/members who require supportive care in a private residence and for providers seeking to offer this type of service. The TX HHS Form 2327, Individual or Member and Provider Agreement, should be used when an individual/member requires AFC services and a provider is willing to offer these services.