TX HHS Form 3022. Provider Selection

The Texas Health and Human Services (HHS) Form 3022, Provider Selection, is a crucial document for individuals seeking Adult Mental Health (HCBS-AMH) services. This form helps solve the problem of selecting a provider agency (PA) or recovery management (RM) entity that best suits an individual's needs. Typically, this form is completed by HCBS-AMH participants and/or their legally authorized representatives (LARs).

The Provider Selection Form requires key information, including the participant's name, CARE ID number, clinical management for behavioral health services (CMBHS) ID, address, date of birth, and LAR's name if applicable. The form also outlines the participant's responsibilities, such as understanding their freedom to choose a provider and following procedures outlined in the Participant Handbook if they wish to change their RM entity or PA.

This form is essential for ensuring that HCBS-AMH participants receive the necessary services from a provider agency of their choice. Key points to note include:

• The participant has the freedom to choose their RM entity and HCBS-AMH PA service provider.
• Once enrolled, participants may transfer to another RM entity or HCBS-AMH PA if they so choose.
• If a participant wishes to change their RM entity or HCBS-AMH PA, they must follow the procedures outlined in the Participant Handbook.