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

TX HHS Form 2808. Youth Empowerment Services Waiver - Waiver Provider Selection is a crucial document that helps Comprehensive Service Providers (CSPs) or Wraparound Provider Organizations (WPOs) select a YES Waiver provider for youth empowerment services. This form must be completed by the CSP/WPO and submitted to the selected provider.

The key features of this form include required information such as participant name, date of birth, Medicaid number, primary diagnosis, and medical diagnosis. The form also requires the selection of a YES Waiver provider, including the name of the provider staff contact and area code and telephone number. Additionally, the form verifies that the participant has received a list of YES Waiver providers in their service area and understands their right to choose their provider.

This form is typically used when a CSP/WPO needs to select a YES Waiver provider for a youth empowerment services program. The form ensures that the selected provider meets the necessary eligibility requirements, including clinical and Medicaid eligibility. By completing this form, the CSP/WPO can confirm their selection of a provider and ensure that the participant receives the necessary services.