TX HHS Form 2808. Youth Empowerment Services Waiver - Waiver Provider Selection

The TX HHS Form 2808, Youth Empowerment Services Waiver - Waiver Provider Selection, is a crucial document that helps solve the problem of selecting a provider for YES Waiver services. This form is typically completed by Comprehensive Service Providers (CSPs) or Wraparound Provider Organizations (WPOs) and submitted to the selected YES Waiver provider.

This form requires specific information from the CSP/WPO, including the type of selection, participant name and date of birth, Medicaid number, primary and secondary diagnoses, and medical diagnosis. The participant must also indicate their understanding of the waiver program and their right to choose a provider and transfer to another if needed. Additionally, the CSP/WPO representative must verify that the participant meets clinical and Medicaid eligibility requirements.

The form highlights key features such as participant choice and the responsibility of the CSP/WPO to ensure that the selected provider is confirmed by the Texas Health and Human Services Commission (HHSC). By using this form, participants can exercise their right to choose a provider that best meets their needs. Key points to note include:

• The participant has the right to choose their Waiver provider from a list of providers in their service area.
• The CSP/WPO must receive confirmation from HHSC that the participant meets clinical and Medicaid eligibility requirements.
• The participant has the right to transfer to another Waiver provider if they so choose.