TX HHS Form 3854-A. Emergency Response Services Procedures

The TX HHS Form 3854-A, Emergency Response Services Procedures, is a crucial document that helps ensure compliance with federal and state regulations regarding excluded individuals or entities. This form is typically used by contractors or legal entities working in the healthcare industry to demonstrate their commitment to screening employees and contractors for exclusion from participation in Medicare, Medicaid, and other federal health care programs.

The form requires the contractor to have a written process for screening employees and contractors, which includes searching the federal HHS Office of Inspector General (HHS-OIG) LEIE website and the Texas HHSC Office of the Inspector General (HHSC-OIG) LEIE website. The procedure must prohibit payment for any items or services furnished, ordered, or prescribed by an excluded individual or entity and require immediate self-reporting to HHSC-OIG if exclusion information is discovered.

The form also mandates monthly searches of the federal and state LEIE databases for all employees and contractors subject to screening requirements. The contractor must provide evidence of these searches, including dates, employee information, search results, and self-reporting details. By using this form, healthcare organizations can ensure they are meeting regulatory requirements and maintaining a compliant environment.

• The form is used by contractors or legal entities working in the healthcare industry to demonstrate compliance with federal and state regulations.
• The procedure requires searching the HHS-OIG LEIE website and HHSC-OIG LEIE website prior to hiring or contracting, as well as on a monthly basis.
• Self-reporting is required if exclusion information is discovered during the screening process.