TX HHS Form 5010. Enrollment Systems Attestation

The TX HHS Form 5010, Enrollment Systems Attestation, is a crucial document that helps ensure the successful implementation of enrollment systems for Medicaid and CHIP Services Program. This form is typically submitted by Managed Care Organizations (MCOs) or Designated Medicaid Organizations (DMOs) to demonstrate their readiness to operate in accordance with state and federal regulations.

The attestation form requires MCOs/DMOs to certify that they have tested and successfully processed files outlined in the CHIP JIP, 834 Companion Guide, and 834 CHIP Companion Guide provided by the state's vendor, MAXIMUS. Additionally, they must attest to having all internal processes and procedures in place for operational start date preparation. The form also includes certifications regarding completeness, accuracy, truthfulness, and compliance with federal and state laws, regulations, policies, and contracts.

The key features of this form include the required information on MCO/DMO organization details, program type, and attestation statements. The form also outlines responsibilities for retaining and preserving original documents, submitting them as requested by Texas Health and Human Services Commission (HHSC), or permitting access to them as required by law and contract. By completing this form, MCOs/DMOs demonstrate their commitment to compliance and readiness for enrollment operations.

• This form is used by Managed Care Organizations (MCOs) or Designated Medicaid Organizations (DMOs) to attest to the successful implementation of enrollment systems.
• The form requires certification regarding testing, processing, and preparation for operational start date.
• It includes certifications regarding completeness, accuracy, truthfulness, and compliance with federal and state laws, regulations, policies, and contracts.