TX HHS Form 5875. HCS Waiver Program Self-Assessment Certification

The TX HHS Form 5875, "HCS Waiver Program Self-Assessment Certification", is a crucial document for organizations participating in the Home and Community-based Services (HCS) Waiver Program. This form serves as a certification of self-assessment, ensuring that providers are familiar with the program's principles and will implement them accordingly.

The form requires organizations to review and indicate their understanding of various HCS certification principles, including individual rights, staff member and service provider requirements, program provider requirements, service delivery, programmatic requirements, restraints, and protective devices. By signing this form, authorized representatives certify that they are familiar with each principle outlined in Texas Administrative Code 26, Part 1, section 565,565.5-565.37.

This form should be used by organizations participating in the HCS Waiver Program to demonstrate their understanding of the program's principles and commitment to implementing them. The TX HHS Form 5875 is essential for ensuring compliance with Texas Administrative Code requirements and maintaining program certification.