TX HHS Form 3854-A. Emergency Response Services Procedures

The TX HHS Form 3854-A, Emergency Response Services Procedures, is a crucial document for ensuring compliance with federal and state regulations regarding excluded individuals or entities. This form helps organizations identify and report any excluded employees or contractors, thereby preventing payment for services furnished by these individuals.

This form requires the contractor to have a written process for screening employees and contractors prior to hiring or contracting, as well as on a monthly basis. The process must include searches of both federal and state LEIE websites, prohibiting payment for any items or services furnished by an excluded individual or entity. Additionally, the contractor must self-report any exclusion information discovered to HHSC-OIG.

The form also mandates that the contractor conduct or contract with an entity to conduct monthly searches of the federal and state LEIE databases for all employees. This ensures that any excluded individuals are promptly identified and reported. The form provides specific instructions on what evidence is required to demonstrate compliance, including dates of searches, employee information, and self-reporting details.