TX HHS Form 3024. Respite Relative Provider

The TX HHS Form 3024, Respite Relative Provider, is a crucial document for individuals seeking respite services from a relative. This form helps solve the problem of documenting the provision of respite services by a relative, as required by the Adult Mental Health (HCBS-AMH) Program.

This form requires essential information such as the individual's name, CARE ID Number, and Clinical Management for Behavioral Health Services (CMBHS) ID. The relative provider must also provide their own name, date of birth, and county of service. Additionally, the form needs to be signed by the individual or Legally Authorized Representative (LAR), indicating the date(s), time, duration, and total units of respite services provided.

The TX HHS Form 3024 is typically used when a relative provides respite services to an HCBS-AMH participant. The form must be completed in accordance with an active Individual Recovery Plan (IRP) and submitted for reimbursement. It's essential to note that the relative provider can only submit a claim for one unit of service per calendar day, as specified by the form.