TX HHS Form 4211. Respite Funding Agreement

The TX HHS Form 4211, Respite Funding Agreement, is a crucial document for families seeking respite services for their children enrolled in the Early Childhood Intervention (ECI) program. This form helps solve the problem of securing funding for respite care, which provides temporary relief to caregivers and ensures the well-being of children with special needs.

This agreement outlines the terms and conditions of receiving respite funds, including the hourly co-pay based on family size and income, as well as the level of care required. Key features include the complexity of care scale (basic, moderate, or intensive), which determines the hourly rate, and the requirement to use respite providers who are 18 years old or older.

The form also highlights important conditions, such as the need for families to take full responsibility for payment to respite providers, complete expense vouchers per the required procedure, and hold the local ECI agency and Texas Health and Human Services Commission (HHSC) harmless from any injury or accident during the provision of respite services. By understanding these requirements, families can effectively utilize this form to secure the necessary funding for their child's respite care.