TX HHS Form 4211. Respite Funding Agreement

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

The agreement outlines key features, including the hourly co-pay scale based on family size and income, as well as different levels of care (basic, moderate, and intensive) with corresponding rates. The form also emphasizes the responsibilities of the parties involved, such as agreeing to receive respite funds exclusively for purchasing services, taking full responsibility for payment to providers, and selecting and supervising providers. Additionally, it highlights specific procedures, like submitting expense vouchers on a monthly basis and including all required information.

This agreement is typically used by families with children enrolled in the ECI program who require respite care services. Key points to note include the requirement for family members to be 18 or older as respite providers, the prohibition on carrying unused hours into another month, and the need to submit vouchers on a timely basis to ensure reimbursement. By understanding these requirements and procedures, families can effectively utilize this form to secure funding for their child's respite care needs.

• The agreement outlines different levels of care (basic, moderate, and intensive) with corresponding hourly rates.
• Families must agree to receive respite funds exclusively for purchasing services.
• Providers must be 18 or older and not live in the same household as the child enrolled in the ECI program.
• Unused hours cannot be carried into another month, and vouchers must be submitted on a monthly basis.